Editorial: Valentine's Day! Who/What Are We Celebrating?

Formerly called Saint Valentine's Day, now shortened to Valentine's Day, it is a day to celebrate love and affection and express it by presenting flowers, candies, and/or greeting cards (valentines).

The day is named after one, two, or three early Christian martyrs named Valentine. Valentine of Rome was martyred about 269 AD; Valentine of Terni was martyred about 197 AD; and a third Valentine was martyred in Africa. It is interesting that there was no romance or love and affection related to these individuals.

For several centuries, the token of affection originally was a handwritten note with or without designs. Later, the presenter would decorate their notes with paper or cloth lace. These individual "works of art" were replaced by mass-produced greeting cards in the 19th century. In the last half of the 20th century, cards were supplemented or replaced by gifts, including roses and chocolates, as well as jewelry. Today, some valentines are sent digitally over the Internet. It's interesting that we have gone from "time involvement" (the first cards), to "convenience" (the mass produced cards), to "economical/time savings" (candies, etc.) to "free" (the Internet).

There is a lot of discussion and disagreement on why February 14 was selected as the date for the celebration. Possibly the selection was related to a poem by Geoffrey Chaucer (Parlement of Foules) in 1382:

For this was on seynt Volantyns day
Whan euery bryd comyth there to chese his make
(For this was sent on Valentine's Day
When every bird cometh there to choose his mate)

I remember in grade school when my parents would buy my brother and me a package of 30 valentines each for classmates in school. It would take hours (at least it seemed like it) to decide which one was best for each person and to write their names on the back with a #2 lead pencil. It was always fun bringing my sack home from school after we shared them to look at the valentines I received from my friends.

For whatever the reason, February 14 (this Sunday) is Valentine's Day. This is an opportunity to express your feelings for those special people in your life.


Loyd V. Allen, Jr., PhD, RPh
Editor-in-Chief

Dosing Devices and Accuracy
A study has just been reported that assesses parents' liquid medication administration errors by dosing instrument type and the degree to which parents' health literacy influences dosing accuracy. Enrolled in the study were 302 parents of children presenting for care.

Parents were observed for dosing accuracy (5-mL dose) using a set of standardized instruments (2 dosing cups [one with printed calibration markings, the other with etched markings], dropper, dosing spoon, and 2 oral syringes [one with and the other without a bottle adapter]).

The percentages of parents dosing accurately (within 20% of the recommended dose) were: (1) 30.5% using the cup with printed markings, and (2) 50.2% using the cup with etched markings. More than 85% dosed accurately with the remaining instruments. Large dosing errors (>40% deviation) were made by 25.8% of parents using the cup with printed markings and 23.3% of parents using the cup with etched markings. Oral syringes appeared to be the better device to use. Limited health literacy was associated with making a dosing error.

In summary, dosing errors by parents were highly prevalent with cups compared with droppers, spoons, or syringes.

Editor's Note: This provides a great opportunity during counseling to confirm the parent's ability to use the proper dosing device.

Moreno MA. Medication safety for children. Arch Pediatr Adolesc Med 2010; 164(2): 181-186.

http://archpedi.ama-assn.org/cgi/content/abstract/164/2/18

Pfizer's $2 Billion Fine Reveals Potential Issues with Health Care Reform
The federal government (FBI) announced that pharmaceutical giant Pfizer will pay $2.3 billion in civil and criminal fines for promoting "off label" uses of three of its big selling drugs by doctors treating patients in the Defense Department and Postal Service health plans. Even the FBI admits in its release that the "fraud" charges result not from injury or illness suffered by any of these patients, but rather from government payment of health insurance claims for "off label" prescriptions to federal employees. Let's look at the following issues:

• It is legal for doctors to prescribe and patients to take legal drugs for purposes not included in the FDA-approved labeling for the product in question.
• However, federal employee health benefits do not cover "off label" uses of the drugs.
• The federal health plans consider a claim for off-label prescriptions as a fraudulent claim.
• The FBI did not approach federal employees for recovery of the billions paid out for uncovered prescriptions; it went after the drug maker instead. (Why file a hundred thousand lawsuits when just one will do the same job?)
• It is routine for many patients to take prescriptions for off label conditions, including certain so-called "orphan drugs" which are labeled for only one obscure use, but which have proven vital in treating other conditions. (Note: It is estimated that about half of all prescriptions are for "off-label" use.)
• Blue Cross/Blue Shield and other private health plans will pay patient claims for such prescriptions, but the government employee health plans will not.

While it is publicly stated that a potential healthcare plan won't interfere with your treatment if you like the doctor you have, how can this be true if the government intends to stop the payment for "off label" drug prescriptions, even in cases where both the patient and the doctor believe the off label use is in fact helping the patient improve his or her condition?

Editor's Note: This is potentially a new form of cost control that must be monitored. As many third-party payors do not pay for compounded medications, since the FDA has claimed they are "new drugs"(incorrectly in this Editor's opinion), any new healthcare plan may deny coverage for them. Does this mean that intravenous admixtures, pediatric preparations, etc. are not to be covered? If the government will not pay for off-label use or any unapproved drug (that should include all the pre-1938 drugs), they will not be paying for much and the healthcare program will be drastically limited in benefits.

http://www.examiner.com/x-19285-Chicago-Economic-Policy-Examiner~y2009m9d2-Pfizers-2-billion-fine-says-more-about-Obamas-health-care-reform-than-it-does-about-drug-makers

Stockley's Drug Interactions 2010
Pocket Companion
Baxter K, ed
London, UK: Pharmaceutical Press; 2010
504 pages; $39.99; Paperback

This pocket-sized book contains nearly 1550 interaction monographs pertaining to specific drugs or drug groups which are alphabetically arranged. It also contains a comprehensive index for ease of use. Clinical significance of an interaction is indicated by severity rating symbols. This book is also translated into Spanish, Italian, and Japanese, as it also has wide international appeal and use.

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