Compounding Pharmacies: Last Week Tonight with John Oliver (HBO)

let's talk about pharmacies you know those places that let you arm a robot or as some people insist on calling that getting your blood pressure taken when you picture a pharmacy in your mind you probably imagine a place that your doctor calls in a prescription and someone counts out pills that were manufactured somewhere else but that is actually a relatively new phenomenon a lot of pharmacies used to make medication on sites as this old film shows a doctor's prescription may seem mysterious to the average layman but it's all very simple to the pharmacist it is his responsibility to make sure that each prescription is filled exactly as the doctor has ordered an error in the compounding of a prescription could be injurious or even fatal to the patient yes any error could be fatal which is why we only hire nearsighted men to eyeball ratios out of a series of identical bottles and if that doesn't work do feel free to die happy nineteen forties to water all and well that is obviously no longer how it works in your local CVS there are places that do still make their drugs from scratch on site they are called compounding pharmacies and they exist for a very good reason compounding pharmacies make medicine for people whose needs cannot be met by an fda-approved product let's say you're allergic to a specific ingredient in a pill your doctor can write a prescription tailored to your specific needs and a compounding pharmacy will mix it that's right compounding pharmacies basically make bespoke medication I'd say designer drugs if that phrase hadn't already been taken by egregiously Dutch dealers selling pills to suburban kids dishes to good trust me it's it's going to send you to out this fish it's for your dance parties seventy five hundred compounding pharmacies all over this country and they can fill highly specific prescriptions for all sorts of reasons maybe you're having trouble swallowing pills they can make the same drug in liquid form maybe you need a drug in a lower concentration and what's commercially available they can do that for you so they do very important work and it is not just humans that benefit there are no manufactured medications maybe for birds so you need to go to your compounding pharmacist so they can make the right volume because it could be large medium or small each one might like a different flavor or require a different volume she likes pina colada flavor that's it really a tropical bird whose favorite flavor is Pina Colada look I'm just gonna say it that parrot is basic your basic your a basic bird so at this point so far so good but as you probably guess from the very fact that we're talking about this three in the first place there are some huge problems here because compounding pharmacies are subject to much less oversight than large drug manufacturers if you get a drug that was mass-produced in a factory both the drug and the factory are under a lot of scrutiny but if you get one from a compounding pharmacy it is very different as a former head of the FDA will tell you compounded drugs are not FDA approved as commissioner of the FDA then you can't tell us sitting here now that every drug being used in the United States is safe and effective no I really cannot holy that's kind of starting to hear isn't it and look at one level it does make sense that if compounding pharmacies are making bespoke medication the FDA doesn't treat them like they're a giant manufacturer you know you wouldn't subject Mikey's Lemonade Stand to the same regulations coca-cola has to obey for mass producing Minute Maid because that would be overkill and besides even if Mikey did pee a little bit in his lemonade which let's face it he definitely did the damage is inherently limited but as you will see oversight is so lacks that compounding pharmacies have become the Wild West of the drug industry resulting in fraud and in the worst cases many many people dying and you may not even know that you're taking a compounded drug because they can be used in clinics or hospitals without your or your doctor's knowledge so tonight let's take a look at this industry let's start with the fraud a few years back TRICARE the military's health insurance program noticed a big increase in being built for veterans specially compounded scar and pain creams but there was a problem as the man who oversaw the program admitted are these creams a viable alternative for treating the pain of wounded warriors they don't appear to be we don't have any evidence that supports that and he was right about that those creams were total one study found that they didn't work any better than treatments that contained no medicine at all and it's shocking that that was allowed and it is why I'm so excited to announce my amazing new pain cream Johnny gel it's it's great for relieving tenderness in your back neck and joint and yes it is just mayonnaise ask your doctor if Johnny gel is right for you now what happened was a number of compounding pharmacies realized that there was a loophole where they could build TRICARE for the cost of each individual ingredient in their creams so they simply added as many expensive ingredients as they could and by the time the military realized what was happening the costs have gotten ridiculous it's just been an astronomical explosion of the charges in a relatively short period of time we're on track this year to spend over two billion dollars unless we get our hands around this two billion two billion dollars when we talk about overspending in the military I don't think anyone would have guessed a not insignificant chunk of that has gone to lotion and unfortunately even when there isn't fraud it is not rare for compounded medication to be ineffective when the FDA tests drugs from commercial manufacturers the failure rate is typically below two percent but when they run tests on compounded drugs around 33 percent of the drugs failed that's one in three put that in perspective contact the drugs have about the same failure rate as the Jonas Brothers we all know we all know which one I'm talking about and it is not you Kevin you are doing great come on guys he's been through enough you're doing really great Kevin you're actually my favorite but a drug simply not working is by no means the worst case scenario here because while again you would not expect the FDA to be testing every small batch drug made you would at least hope that someone was making sure the places they were made were clean the conditions can be appalling as multiple investigations have found over the years with some particularly revolting examples in one Miami pharmacy a compounded drug for lung disease was found in the same refrigerator as the employees lunch at another pharmacy compounded drugs were stored in the employees bathroom it sickened me and really did bothered me a lot yeah it should have second you because you should not store an open box of loose pills next to a toilet I've never been to pharmacy school but I'm pretty sure lesson one is don't put the pills where you poop so how could that happen well in the absence of FDA oversight state pharmacy boards are supposed to send inspectors to make sure conditions are sanitary but in many states there is an extreme shortage of them as of 2016 Hawaii had only one inspector Kansas had two and Illinois had just three despite the fact it has nearly 2700 pharmacies meaning each inspector would have been tasked with 900 locations to keep an eye on and the only way that it's possible if the inspectors are just texting each pharmacy you're good and this lack of oversight can be especially dangerous if a lab is producing sterile drugs that are injected into the body a few years back one compounding pharmacy made national headlines after it was found to be the source of a massive meningitis outbreak the Food and Drug Administration is telling doctors don't use any products from the New England compounding Center you know when they went in there they actually found fungus in a vial that you could see with naked eye they saw some guck for want of a better word in it they put it under a microscope and it was a fungus that is disgusting the only worse thing to find in a vial of medicine than visible guck would be a visible duck because putting aside the issue of Hygiene how did you miss this how did you not hear the quacking your oversights a mess and while it would have been comfortably bad enough if that pharmacy any CC was just making drugs for individual patients it was actually producing medication in bulk the thing remember it was absolutely not supposed to do compounding pharmacies are supposed to do small batches based on individual prescriptions for any cc skirted those rules to make more money shipping their medical education to 23 different states eventually killing more than a hundred people and it's a little weird that you don't remember that story right well though to be fair it was 2012 and we were all distracted trying to find Kony at the time where's Cody did we get him did we get Cody does anyone remember it seems so important at the time I bet we got him we wouldn't have just given up would we look while regulations required them to have an individual prescription for each patient they managed to get around that by simply faking patient names and not even seeming to try that hard investigators also allege that employees falsified prescriptions with fake names like big baby Jesus Roy Rogers Wonder Woman and Budweiser but why it's like they were trying to get caught and it didn't even stop there they also fill prescriptions with names and this is this is real like Jimmy Kimmel David Schwimmer Michael Bolton Jack Bauer Sarah Marshall RuPaul and Method Man and that is such a gloriously random group of people most people would see no connection between them unless you are me and you have some very specific very bold theories about who killed JFK I've clearly cracked it none of you leave the country I think there may have been a second Schwimmer but this this scheme though was incredibly lucrative in fact the president of any Cece Barry Cadden made over 60 million dollars in the three years leading up to the outbreak and he seemed to know what he was doing was wrong because he was once asked at a filmed employee training session about keeping records of patient names and prescriptions and his answer was comically suspicious there's no wonder one patient names for the Barbara blocks that's something for another time yeah what sign that's we can talk about that those that's actually one of the more difficult things we do let's just talk about the products now okay well we're being recorded okay if you are being recorded saying you don't want to say something while being recorded you've probably already said too much all right so this is where we keep the guns or the ski masks and the big bags of money with dollar signs on them where does that money come from well I probably shouldn't talk about that while we've been recorded the defining hallmark of any CC was just how clearly everyone knew that they were breaking the law at one point the company's national sales director even sent out an email with the unassuming subject line huge importance which reads in part all names must resemble real names no obviously fake names and I know I don't have to say this but also never put anything in writing which is the criminal thing to put in writing now thankfully Cadden eventually went to prison and Congress passed a law toughening up enforcement of regulations among compounding pharmacies which is great in theory the problem is they wrote in some massive loopholes for instance the law required any pharmacy that wanted to mass-produce drugs you know the way that any CC did to register as something called an outsourcing facility and submit to much stricter inspections but it made doing so completely voluntary and and if you need if you need everyone to obey a rule it just can't be voluntary it's like stop signs say stop and not shrug emoji and so perhaps unsurprisingly only seventy-seven facilities are currently registered that's just 1% of compounding pharmacies and because the FDA had no system to catch violators many pharmacies just carried on exactly as they were with something pretty bold about it how bold just watch this the FDA's inspection of downing labs in July found sterility failures in 19 lots of drug products ashley downing is the co-owner of downing labs they asked you to recall your sterile products that's correct and you decided what no just no that's it she responded to a request for a drug recall the way most of us responded to seeing the trailer for the movie cats no I refuse to acknowledge that this is happening no no no suppose she claimed the FDA had no jurisdiction over her and that she followed all state requirements but the FDA disagreed and while they eventually did manage to force her to comply that didn't happen until almost a full year after that interview and when oversight is this week compounding pharmacies can hurt large numbers of people for a long time just just look at what happened recently in Texas with a company called Guardian pharmacy services this is it here that they apparently mass-produced medicine which was injected into people's eyes and which turned out to contain formaldehyde and acetone two things pretty high up the list of things to keep away from your eyes right above jalapeno peppers and just below the trailer for cats no I said no guardian didn't opt in for FDA oversight so it was regulated at the state level but not it seems very well because nearly 70 people who were injected with their drugs are now partially or completely blind and yet it took six months from the first injections for state regulators to even be notified that there was a problem which is something understandably frustrating for the people who ended up losing their sight by the time Susie Pope went in for cataract surgery at a Dallas eye clinic dozens of patients had gone before her how could 68 people be involved before they pull that off the shelf many of them have the same question we know this real quick hell when lettuce is bad we report it off the shelf every week yeah and of course he's right it's frankly not unreasonable to want a world where you can feel confident that's something that's about to be injected into your eyeball is at least as safe as lettuce because I'll tell you what is a safe as lettuce and that is Johnny gel I have to say Johnny gel may not be as safe as lettuce and yet incredibly not only do be Texas state pharmacy boards not shut down Guardian they haven't shut down a single compounding pharmacy in at least five years now you should know they did put Guardians license on probation but the man behind it simply shut it down and opened up a pharmacy called Medical Park Pharmacy at the exact same location so they door simply changed from this to this and it is hard to notice any meaningful differences there even if you won't recently blinded by some tainted own medication and look again compounded pharmacists play an important role but that is all the more reason why they should be properly regulated so at the very least we need more inspectors at the state level the outsourcing facilities designation should not be voluntary and compounders should have to alert regulators whenever they up and until then bad facilities could probably really benefit from a message from some of the very real names that they've thrown around in their nonsense prescriptions hey I'm David Schwimmer I'm Method Man I am obviously RuPaul I'm Jimmy Kimmel America's favorite late-night host by far Michael Bolton and we'd like to say a few words to compounding pharmacies please don't use our names in your prescriptions we're not just random words to be thrown around so you can evade the law we're real people well some of us are like me Jack Bauer and me Sarah Marshall who do not tell me you forgot Sarah Marshall oh you're the one who broke up with Jason Segel's dick sure did the point is we're mad real mad because our names don't belong on your fraudulent spinal medication mine belongs on a platinum album mine belongs on the list of America's top pretend paleontologists and mine belongs on the Emmy for Outstanding variety talk series at somebody else again so stop using our names to turn your compounding pharmacy into an unregulated drug manufacturer and while we're at it don't even think about trying to sell us any of that $15,000 game cream we don't want to be involved in your lotion scam honey I'm not getting mixed up in your ointment scheme good boy and if you're an outsourcing facility let yourself be regulated like one because if you don't I will tie you up in a dark basement in a black site in southern Turkmenistan and I will inflict a level of pain on you you could not imagine in your darkest most terrifying nightmares Jesus yes but even more importantly we need to make sure that compounded drugs are coming from labs that fully comply with safety guidelines because keep in mind lots of people need compounded drugs and it's not just people my bird needs them too yeah but what Michael Bolton has a parrot of course I do I love parrots to people not realize that how am I supposed to live without you is about a lady parrot I love that part and she reckoned she did leave them for me you Michael Bolton yeah you Michael Bolton you and finally until you're better regulated you should stick to what you were designed to do making pina coladas for birds I miss you what the you

Channel: LastWeekTonight

Views: 5,842,156

Rating: 4.8979993 out of 5

Keywords:

Id: Nuzi7LlSDVo

Length: 19min 14sec (1154 seconds)

Published: Sun Sep 29 2019

Reddit Comments

[u/Goonred]

How'd they manage to get that many JFK killer suspects on the show?

[u/vadergeek]

Hey, that's Dan O'Brien from Cracked as the blood pressure monitor guy. I know he's a writer on the show now, but I don't think I've seen him in one of those photos.

[u/PakiIronman]

Method Man saying "Fuck you" to Michael Bolton is what I needed in my life. That whole segment was amazing.

[u/Sisiwakanamaru]

I think Kristen Bell is a fan of the show, I am glad that she showed up for the segment.

[u/CollumMcJingleballs]

Was hoping to see an appearance from Big Baby Jesus

[u/contraryview]

Why can't all medicines be pina-colada flavored?

[u/HardcoreKaraoke]

I'm surprised there is no real discussion here, just a lot of jokes. He didn't cover retail pharmacies in 2019 being compounding pharmacies but a lot of you use them and there's not really any oversight being used. Source: I'm a retail pharmacy technician.

Now I'm trained and legally certified to be a tech, as our several of my co-workers. But a lot of your compounds are made by untrained techs reading printed out recipes for the first time. Sure the ingredients are reviewed by pharmacists after being measured by techs but some licensed (but essentially retail employees) are making your compounds.

Things are clean at my pharmacy. We don't leave food in our refrigerators, vials/counters are clean and things are carefully reviewed by our pharmacists. Just seeing how things are handled though I know it can't be that perfect all over.

Tldr; the 17 year old selling you candy might be mixing your compound after being certified a few months after they turn 18.

[u/holysweetbabyjesus]

Compound pharmacies are great if you need tuna flavored medicine for your cats.

[u/Majorkerina]

I miss Jack Bauer...