DRUG TOPICS
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`IONTVALE, NJ
`23-TIHES/YEAR
`03,000
`FEB 7 2000
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`MAJOR STORIES FOR PHARMACISTS AT [5
`:1 .
`GARE PARTNERS
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`Eckerd teams up with Health Hero to offer Internet-based
`patient care program for home users
`
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`on certain risk factors. It’s a unique
`level of care. Pharmacists can refer
`patients back to theirthsician.” "
`Kitchens said Eckerd’s plan may in-
`clude charging patients to use the pro-
`gram. However, he said, ”itis more
`likely the fee will be included in some
`of the care we’re already providing.
`
`We may not charge them, depending
`on the reimbursement we have in
`
`place with a payer. Based on man:
`aged care participation and patients"
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`acceptance of our plan, we will con-
`
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`tinue to expand our clinical program.”
`In addition to helping high—risk pa-
`
`tients, Kitchens said, the interactive
`
`home care program benefits a patients
`
`caretaker, especially if the patient is
`
`on a complicated drug regimen.
`Besides posing six to 10 ques—
`tions a day, which are customized
`to an individual patient, the de—
`. Vice has the ability to takeglu-
`cometer readings and to down-
`load that information. Patients
`using insulin for the first time
`learn how to use a glucometer
`and can track how they are test-
`ing. Pharmacists can communi-
`cate that information to the pa-
`tient’s doctor, who can make
`dosage changes if necessary.
`”There’s a huge opportunity to
`monitor and follow up drug
`therapy,” said Kitchens.
`Sam Kang, v.p. /corporate develop
`ment, Health Hero Network, said,
`”Pharmacy is one of the most efficient
`ways you can deliver care manage-
`ment. Pharmacists see the patient
`more often than physicians do. Phar—
`macists will be able to look for early
`signs of problems whether they be
`physiological or associated with
`pharmaceutical therapy that would
`indicate they are on a downward tra—
`jectory.” Pharmacists will be able to
`notice early signs of noncompliance
`or misinformation on the part of a pa—
`tient about his or her disease. "Phar-
`
`Imagine this scenario: A device-the
`
`size of an answering machine is
`delivered to a chronically ill pa-
`tient. The device, which the patient
`can easily hook up to a phone line,
`features an LCD screen that displays
`large, bold—faced letters. Easy-to-
`press, recessed buttons allow patients
`to answer questions posed on the
`screen about their condition. A Web-
`based site retrieves the answers. A
`pharmacist accesses and reviews the
`answers and makes recommenda-
`
`tions to improve the patient’s care.
`This scenario is becoming a reality
`for many chronically ill patients, now
`that Eckerd Corp, Largo, Fla., has
`teamed up with the Health Hero
`Negyprk, a Mountain View, Calif.-
`based e-health company, to deliver its
`Eckerd Patient Care management
`services into the home. The program
`leverages Health Hero’s on-line
`services and uses the firm’s Health
`Buddy appliance. The intent is to
`help patients comply with their drug
`regimens, to promote early detection
`of adverse drug reactions, and to
`monitor therapeutic effectiveness.
`George Kitchens, director of clinical
`services in branded pharmaceutical
`purchasing at Eckerd, told Drug Topics
`that the program will roll out Mthin
`the next two months in Eckerd stores
`that have a clinical pharmacist. Tarn-
`pa Bay, Fla, and two other undis—
`closed markets are targeted initially.
`”Pharmacists provide clinical services
`in our retail stores. This is a wonder-
`ful partnership with Health Hero to
`improve monitoring and follow-up of
`high-risk patients,” said Kitchens.
`Emphasizing that the device is not
`intended to diagnose disease or to be
`used as a 911 substitute for emer—
`gency responses, Kitchens said the
`
`28
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`DRUG TOPICS FEBRUARY 7 2000
`
` HEALTH H C
`
`Ne :
`
`n'
`
`Eckerd’s partner-
`shlp wlth Health
`Hero may help
`chronically ill
`patients improve
`their conditions.
`Health Hero’s
`consumer-friendly
`device can be
`used by patlents
`at home to com-
`municate with
`Eckerd pharma-
`cists.
`
`
`
`partnership is educational, with the
`focus on drug-therapy and behavior
`modification in relation to a particu—
`lar condition. He gave the example of
`how the program helps diabetes
`patients. One question patients are
`asked is, Did you check your feet
`today? If they answer No, patients
`will be educated as to why it is im-
`portant to do daily inspections for
`sores, and they will be given instruc-
`tions on how to do these inspections.
`”There are tons of literature that
`
`show problems with drug therapies;
`there’s no monitoring or follow-up,”
`said Kitchens. In addition to face-to-
`face encounters with patients, phar-
`macists now have “a device that helps
`with the educational component,” he
`added. ”Patients get daily feedback
`/ ‘1
`
`macists will be able to identify poten—
`tial problems sooner and have the
`opportunity to intervene,” Kang said.
`Sandra Levy l
`www.drugtopics.com
`
`
`
`1
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`Bosch Ex. 2015
`Bosch EX. 2015
`Cardiocom v. Bosch IPR2013-00468
`Cardiocom V. Bosch IPR2013—00468
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`

`

`SQUARING OFF
`
`Plagakis continued
`
`Iacobs continued
`
`
`
`iCal benefits of marijuana, who should? And if
`marijuana is going to be dispensed to patients
`who need it, who should dispense it? I have a sick
`feeling that it will be someone other than pharma-
`cists.
`
`I’m not going to list all the states that have
`legalized it. I know that it started in San Francis-
`co, and doctors actually grew the herb and gave it
`. to their patients. Apparently, it was still illegal to
`sell it. It is a great medicine as an herb, and you all
`know who can benefit from its use. It is now legal
`in Washington, and I do counsel patients on its
`use.
`
`But get this! Marijuana is being used for med-
`ical purposes. Where are these patients getting it?
`They're not getting it from pharmacists, so they
`must be having their sons or nephews buy it from
`seedy characters in the back streets of the cities.
`There is something wrong here. If the herb is
`going to be used for medical purposes, then it
`should be sold by prescription, and the seller
`should be the person who dispenses prescrip-
`tions. Make it DEA Schedule II, have Philip Mor-
`ris manufacture a standardized product with an
`ass-kickin’ trade name like Medoweed, and stop
`pretending that the stuff is not a valuable medi—
`cine just because it has been used as a recreational
`drug illicitly for years. Pharmacists should be the
`only ones selling this herb. Period.
`Years ago, when I sat with David in his living
`room. I was timid. The stuff wasn’t legal any-
`where for any purpose. What would happen to
`my license if I told him the truth and ended up
`with a cop knocking at my door? ”Are you
`stonewalling me, Jim? Will marijuana help me or
`not?”
`
`”It will,” I said. ”It is good medicine for you.”
`David died about a month later. His sister looked
`
`me up. "Thank you," she said, her eyes wet.
`”David spent the last month of his life eating well
`and laughing while he watched cartoons on tele-
`vision.”
`
`THE AUTHOR is a community pharmacist in Bellingham, Wash.
`
`What do you think?
`Should pharmacists dispense marijuana for
`medical use? We want to hear What you have to
`say on this issue. Please e—mail your comments
`to: drug.topics@medec.com. Or send a letter to:
`Drug Topics, Five Paragon Drive, Montvale,
`NJ 07645-1742.
`
`
`
`
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`tory disease and lung, lip, mouth, and tongue cancer.
`There are other significant short-term side effects
`and long-term risks linked to smoking marijuana
`Smoking marijuana may weaken the body’3 antibacte-
`rial defenses in the lungs and introduce bacteria capa-
`ble of causing serious infections in humans. It lowers
`overall blood pressure, which could adversely affect
`the supply of blood to the eye It causes sudden drops .
`in blood pressure; rapid heartbeat, and heart palpita-
`tions. It suppresses luteinizing hormone secretion in
`women, which affects the production of progesterone
`It causes anxiety, panic, paranoia, and psychosis in
`some users because of its mind-altering effects. It pro-
`duces dizziness, trouble with thinking, trouble with
`concentrating, fatigue, and sleepiness. It impairs motor
`skills. With this side effect profile and unproven effica-
`cy, smoked marijuana remains unsafe for any use.
`With one synthetic version of the main psychoac-
`tive cannabinoid in marijuana, delta-9-THC, already
`approved by the Food & Drug Administration in pill
`form (dronabinol, Marinol, Roxane Laboratories)
`and the potential for synthesis of others, why would
`anyone promote smoking a plant as medicinal?
`Safe delivery systems for cannabinoids, which do
`not involve smoking marijuana, can be developed.
`The specific therapeutic compounds to be delivered
`must be identified, isolated, and purified in a man-
`ner consistent with current medical standards. Other
`potentially therapeutic cannabinoid drugs, including
`some without psychoactive properties, are in devel-
`opment and testing. Nicotine inhalers and nasal
`sprays already exist for Rx use, and metered-dose
`inhalers are common for delivery of bronchodilators
`and other drugs. This type of delivery vehicle
`amounts to rapid, needleless injection and may
`evolve as the system of choice.
`The IOM report recognizes the potential for symp-
`tomatic relief from cannabinoid administration but
`
`notes that for nearly all symptoms, better drugs
`already exist. There are no adequate, well-controlled ,
`scientific studies proving marijuana is effective for
`anything. The fact that useful medicines may origi-
`nate in the marijuana plant does not make smoked
`marijuana a medicine. Similarly, the fact that opium
`contains compounds that have become medicines
`does not make raw opium itself a medicine.
`Unsubstantiated claims can mislead patients suffer-
`ing from various diseases into experimenting with
`marijuana. Instead of being helped, they risk serious
`side effects. If they neglect their regular drugs while
`trying marijuana, the damage could be irreversible.
`THE AUTHOR is clinical assistant professor in the division of addiction medicine at
`the University of Florida, Jacksonville.
`
`www.cirugtopicscom
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`DRUG TOPICS FEBRUARY 7
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