Ignoring Doctor’s Orders – A Common Practice!

18106721Have you ever gone to a doctor for a medical problem, had that physician prescribe a medication, but then ignored the doctor’s instructions and didn’t get that prescription filled?

If your answer is “yes” to that question, then your action is a common one. Studies show that nearly one-third of the medications prescribed to individuals remain unfilled.

In a recent Canadian study, researchers examined the prescription data of nearly 16,000 patients in a primary care network of over 130 doctors. Of the 37,000+ prescriptions written, almost one-third remained unfilled nine months later. The nine-month period was used to give patients time to fill those prescriptions in case some medications were prescribed on a “take as needed” basis.

As one might expect, the drugs most often not filled included the more expensive brandMH910221052 name drugs, but the non-compliance issue also included less expensive medications that are used to treat chronic conditions such as headache, heart disease and depression.

And the non-compliance issue was not limited to low-income patients. In fact, all of the patients in the Canadian study had some form of universal prescription insurance coverage, and this made the significance of medication non-compliance all the more surprising.

The prescriptions most often filled and taken as ordered included those for acute bronchitis and urinary tract infections, conditions that usually involve significant discomfort if not resolved quickly. For individuals with medical issues that exhibit with less obvious symptoms and no pain (such as high blood pressure, mild diabetes, and high cholesterol), the non-compliance rates were higher.

The study was designed to investigate adherence to medication prescribing only and did not specifically address patient attitudes or beliefs about medication prescribing, and it did not consider the consequences of medication non-compliance.

As a comparison to this study of Canadian patients with universal health care, prescription fill rates in the United States are slightly higher (between 72% and 78% depending on the study reviewed). But, although fill rates are surprisingly better in the US, non-compliance to specific medication dosing is also greater.

Dr. Troyen Brennen, executive vice president and chief medical officer of CVS Caremark stated, “If we can get people to take their medications, they’ll have fewer heart attacks, they won’t develop complications associated with diabetes and they won’t be going to the emergency department with asthma.”

MH900406754Studies of US patients indicate that of the 32 million Americans that use three or more medications daily, 75% are non-adherent in one way or another. They simply do not take their medication properly for optimum effect.

This degree of non-compliant behavior (that includes not initially filling a prescribed medication as well as not taking a prescribed medication properly) has been estimated to create an economic impact of an additional $100 billon in yearly US health care costs and causes an estimated 125,000 needless deaths each year.

The various reasons for medication non-compliance are numerous. They include fear of medications, side effects experienced while on a therapy, and patient ignorance to the importance of a prescribed medication.

Nearly half of patients elect to discontinue an effective medication by either stopping the therapy early or taking their medications incorrectly. Many patients simply forget to take their medications, particularly with the elderly.

Compliance rates also varied with the type of physician who prescribed the therapy regimen. Prescriptions were filled more often when prescribed by primary care physicians, especially pediatricians. Interestingly, if the physician was a specialist, younger, female or part of a group of more than 10 physicians in a practice, then the patient’s prescription fill rate decreased.

It would seem that patient education regarding their illnesses, specifically the onesMH900401001 without noticeable symptoms, would encourage better medication compliance. When patients understand the seriousness of the so-called silent killers (high blood pressure, mild diabetes, high cholesterol) and the importance of proper dosing to eliminate side effects but maintain therapeutic results, then medication compliance most likely will improve.

When the health care model includes better communication between patients and their physicians and pharmacists, as well as better follow-up care from the prescribing physicians, then medication compliance issues will decrease and patient outcomes will increase.

Thoughts? Comments? I’d like to hear them!

Posted in About James J. Murray, About Medications/Pharmacy, Blogging, Cost of Ignoring Doctor Orders, Deaths Related to Therapy Non-Compliance, Drug Error Prevention, Drug Errors in The Elderly, Drug Misadventures, Economic Impact of Therapy Non-Compliance, Generic Drug Safety, Generic Drug Use, Generic Drugs, Generic Drugs in the US, Medication Therapy Non-Compliance by Physician Types, Misuse of Drugs, Non-Compliance in Medication Therapies, Non-Compliance to Physician Orders, Non-Compliance to Prescription Therapies, Non-Compliance with Medication Therapies, Patient Therapy Compliance Issues, Patient Therapy Outcomes, Pharmacy/Pharmaceuticals, Prescription Drug Safety, Prescription Fill Practices in the US and Canada, Prescription Fill Rates, Prescription Fill Rates in the US and Canada, Prescription Prescribing Practices, Prescription Trends, Reasons for Medication Therapy Non-Compliance, The Pharmacy Profession, The Practice of Pharmacy, Types of Medication Non-Compliance | Tagged , , , , , , , , , , , , , , , , , , , , | 2 Comments

E-Liquids = The New Murder Weapon!

Cig_a_like--_2013-10-21_03-47For all the wonders of the technological age of today, there are times when life-enhancing advances can turn sinister. One such example is the evolution of e-cigarettes.

Electronic cigarettes were first patented in 1963. The mechanism simulates smoking a real cigarette by using a heating element to vaporize a liquid solution contained within the device. Most solutions consist of a mixture of nicotine and flavorings, while others contain flavors without nicotine.

Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. As the technology progressed, reusable units became available. TheseLava_size_02 improved mechanisms could be refilled with solutions that contained varying combinations of nicotine, flavorings and solvents. They were more cost effective, achieved greater public acceptance and offered a variety of flavor choices.

The down side to all the improvements, however, is that now we have a dangerous, and even deadly, powerful stimulant on the market—liquid concentrated nicotine (e-liquid). It’s made in factories and even in the back rooms of shops, and it’s sold legally in stores and online. The solutions are available for sale by the vial, the liter, by the gallon and even by the barrel.

The normal nicotine levels in sealed, disposable e-cigarettes used to be 1.8% to 2.4%. But the new liquids used in these reusable devices are available in 7.2%, and even up to 10% concentrated solutions. Interestingly, it’s the higher concentrations that are available in the largest quantities on the Internet—with sizes ranging from one liter to a gallon for consumer use and up to a 55-gallon drum for manufacturing purposes, all with little regulatory oversight.

Some of the packaging for consumer use incorporates childproof bottles and warning labels, but many of the products coming from overseas—particularly from China—do not include such safety standards, and the FDA does not yet regulate the manufacture and distribution of nicotine-containing e-liquids.

Nicotine, in this most potent liquid form, not only supplies the fast-growing electronic cigarette industry but it also is evolving into a new recreational drug category.

The popular nicotine concentrates produce a stimulating high, yet are powerful neurotoxins. A teaspoonful of even highly diluted e-liquid can kill a small child. One of the reasons these e-liquids are so deadly is that they are absorbed more quickly through the GI tract than other substances.

Additionally, the nicotine solutions are readily absorbed through the pores of the skin. Recently, a Kentucky woman was admitted to the hospital with severe cardiac issues after her e-cigarette broke in her bed. The e-liquid spilled and absorbed quickly through her skin, causing a life-threatening cardiac event.

MH900437315One of the problems with the concept of e-liquids is that adults do not seem to understand the risks involved in exposure to these concentrated solutions and carelessly leave the containers unprotected around the house. Between 2012 and 2013, there has been a 300% jump in the number of calls to poison control centers related to liquid nicotine overdoses, and the number is on pace to double this year. There has even been a documented suicide death by an adult who injected liquid nicotine.

Lee Cantrell, a professor of pharmacy at the University of California and the director of the San Diego division of the California Poison Control System, stated, “It’s not a matter of if a child will be seriously poisoned or killed. It’s a matter of when. This is one of the most potent, naturally-occurring toxins we have and its sold all over the place.”

Liquid, concentrated nicotine (e-liquid) provides an interesting opportunityMH900241229 for murder mystery writers to utilize a powerful neurotoxin that is poorly regulated, readily available and one that can easily be injected or incorporated into food, drink or on clothing to produce a rather dramatic, yet stealthy, murder scene.

Thoughts? Comments? I’d love to hear them!

Posted in About James J. Murray, About Medications/Pharmacy, About Writing, All About Murder, All About Writing, Blogging, Concentrated Liquid Nicotine, Cryptococcus Infection Outbreak, Drug Abuse, Drug Poisoning, Drugs For Murder Plots, Drugs Used to Murder, E-Liquids, Electronic Cigarettes, Ideas for Murder Scenes, Instruments of Death, Interesting Murder Weapons, Killing a Villain in a Novel, Murder by E-Liquid Overdose, Murder By Nicotine Overdose, Murder Weapons, Murder With Drugs, Nicotine and Murder, Nicotine Used For Murder, Party Drugs, Plotting Murder Scenes, Poisons Used to Murder, Prescription For Murder Blog, The Art of Writing, Tools of Murder, Ways To Kill, Writing Death Scenes, Writing Murder Scenes Using Concentrated Nicotine Liquid | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 9 Comments

Scorpion Venom – A Lethal Opportunity!

Scorpions are predatory arthropods—exoskeleton or shell-like creatures. They originateddeathstalker_240 in England in the High Middle Ages (around 1200 AD).

Although scorpion venom has a fearsome reputation, there are only about 25 varieties (out of the over 1,700 species) that have venom capable of killing a human being.

Using the venom of one of these deadly varieties as a murder weapon could create an interesting story twist and help craft a rather exotic murder mystery plot.

But to do so, we should focus only on the deadly varieties of scorpions and, in particular, on one of the deadliest species. The Deathstalker scorpion is just such a killer. It’s also known as the Israeli Yellow Scorpion and its tail is full of powerful, lethal venom.

A sting from a Deathstalker is extremely painful and will cause localized muscle paralysis. As the venom spreads throughout the body, the paralytic effects become systemic and a person will eventually die.

MH900438738The venom contains a small protein called chlorotoxin, a chemical that blocks chloride ions from entering muscle cells. Without chloride ions present, the body’s muscles can’t relax. They remain rigid and are unable to function.

The symptoms of progressive systemic paralysis begin with fine motor skill impairment—such as the inability to move a hand properly or to walk without a limp.

Eventually, the muscles of the diaphragm are affected and breathing becomes difficult. The person will drool when the esophageal muscles tighten, preventing proper swallowing. Speech will be difficult as the tongue muscle ceases to function.

Death usually results from suffocation since the muscles that control MH900332900breathing become totally paralyzed, although at times the heart muscle ceases to function first and cardiac arrest is the cause of death.

As is sometimes the case with natural poisons, the venom of the Deathstalker has been shown to have medical benefits also. The special proteins in the Deathstalker scorpion’s venom are used as imaging agents.

When dilute versions of the venom are injected, they seek out brain tumor cells and other cancerous tumors. When stimulated by a laser in the near-infrared part of the spectrum, the venom proteins emit a glow that, although invisible to the eye, can be captured by a camera.

MH900289343Special laboratories (there are only two in the world) “milk” the Deathstalker and other venomous creatures to extract their venom for drug research and medical purposes.

When developing murder mystery plots using exotic murder weapons—such as scorpion venom—one of the considerations is a reliable source of your lethal agent.

In this case, one of those special laboratories or a specialty hospital using the venom extract for imaging would make excellent, believable sources for your murder weapon.

Thoughts? Comments? I’d love to hear them!

Posted in About Writing, Acute Poisons, All About Murder, All About Writing, Blog Writers, Blogging, Bloodless Death Scene Writing, Bloodless Death Scenes, Deadly Scorpion Venom, Deathstalker Scorpion Venom, Deathstalker Scorprion, Designer Drug Deaths, Drugs For Murder Plots, Drugs Used For Murder, Instruments of Death, Interesting Murder Weapons, Israeli Yellow Scorpion, Israeli Yellow Scorpion Venom, Lethal Scorpion Venom, Murder Weapons, Murder With Drugs, New Drug Discoveries, New Drug Research, Plotting Murder Scenes, Poisonous Scorpion Venom, Poisons Used to Murder, Scorpion Stings, Scorpion Venom, Story Development, The Deadliest Scorprion, The Science of Murder, Tools for Murder, Tools of Murder, Types of Deadly Scorpions, Writing Death Scenes | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , | 2 Comments

Do Fictional Characters Evolve or Is It the Writer?

MH900448464When developing a fictional character, there are several methods that writers can use. The first thing that usually happens, however, is that writers picture a person in their minds and that first impression of a character often sticks with them throughout the story.

But this first impression is a one-dimensional view. It’s the equivalent of a cardboard cutout of a cartoon character. Layers of personality and history must be added to a character, even before starting to write the story, in order to properly develop how the character acts and moves within the written scenes.

In general, there are five aspects of a character, besides appearance, that a writer must think about before introducing a major character into a storyline.

The first is to consider personal details of the character. These include the finer aspects of the character’s appearance. The writer might imagine an older man as a protagonist, but decisions like how old, how much grey hair or any hair, glasses or no glasses, weather worn skin with wrinkles or not, or other specific physical features further define the character for the reader.

Next in consideration is the character’s background. The character’s history regarding family, childhood memories and experiences, sibling order, past schooling and special skills learned help determine how that character will react within specific scenes.

MH900438653Other things to consider are the specific characteristics of your character. These are the things that drive your character to do the things you want to write about. They include good and bad habits, temperament and attitude, as well as fears and interesting secrets that make a character unique.

The next step is to decide if your character has specific likes and dislikes. We all have things we like and dislike, but a strong positive or negative view gives a character depth and helps the reader identify with the character. Consider topics such as music, sports, political affiliations and social beliefs to further define your character’s likes and dislikes.

Finally, the last aspect of your character to be considered, and possibly the mostMH900443241 important, is your character’s current lifestyle or situation. This specific aspect becomes the general setting for your character but will also include specifics like the character’s home environment, the town in which the character resides, the involvement of a marriage or life partner and children, a special job and specific friends that influence the character.

Remember no one in real life is perfect and therefore no fictional character is either. Often, experienced writers will say that the flaws in their protagonists are what propel the story forward and help create the conflict for the story arc.

The question that remains on the table, so to speak, is this: As the story progresses, is it the protagonist or the writer who evolves as the story unfolds?

Certainly, the character evolves purposefully as the story unfolds and conflict is introduced, but does the character change decisively as the writer adds more conflict into the character’s world or is it more of an unconscious evolution?

That’s the specific question—the unconscious evolution of character development. That would insinuate that the writer is actually evolving as he or she becomes more familiar with the protagonist. Just as we become more familiar and more comfortable with a new friend as times goes on, the same is true of a writer and their characters.

MH900444369As the story progresses and continues to unfold, often writers will detour from a preconceived plot or from their original outline. It may be because of an “aha” moment to refine or even redefine the plot, but this detour happens at times only because the writer begins to understand the protagonist better and is more comfortable with the character’s personality.

In a sense, the writer has finally become friends with the protagonist and the writer evolves into letting the character take charge and direct the action, simply because that’s what would be natural for the character if he or she were a real person in real life situations.

And that’s when the act of writing transitions from technique to an art form.

Thoughts? Comments? I’d love to hear them!

Posted in About James J. Murray, About Writing, Accuracy in Writing, All About Writing, Antagonist Development, Blog Writers, Blogging, Character Development Techniques, Characteristics of a Fictional Character, Developing a Writing Career, Developing Better Writing Skills, Developing Writing Skills, Fictional Character Development, Protagonist Development, Steps to Developing Great Fictional Characters, Story Development, The Art of Writing, Tools of Fiction Writing | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , | 5 Comments

Hydrofluoric Acid – The Flesh Eater!

42-15570013Hydrofluoric acid is a colorless liquid that mixes readily in other fluids. It’s highly corrosive and is classified as an acute poison that immediately begins to degrade tissue on contact.

If you’re a fan of the Breaking Bad TV series, you might remember that this was the acid that Jess Pinkman used to dissolve a body in his bathtub, the tub that eventually was eroded by this acid and came crashing through the ceiling.

Ironically, when hydrofluoric acid comes into contact with skin, it initially causes painless burns. Several hours after exposure, however—even after washing the skin—deep, irreversible and painful damage can result and tissue death follows shortly after.

But the damage doesn’t stop at the skin’s surface. After contact, the acid interrupts the body’s calcium metabolism and causes systemic toxicity. As the body’s calcium balance is further disturbed, systemic calcium metabolism is halted. This can lead to cardiac arrest and death. And it doesn’t take much to create this cascading lethal effect. As little as 25 square inches (a 5”x5” area) of affected skin can lead to death.

For example, a drink laden with hydrofluoric acid spilled on someone’s clothing could beMH900425314 considered accidental and easily forgotten. But, over a period of a few hours, the person’s skin would begin to dissolve, calcium metabolism would be interrupted and the person could die from a heart attack.

It’s easy to see how this acid could be an intriguing method of killing off a character in your novel and still not have it link back to the murderer since visible damage may not appear until hours after exposure.

As one might expect, the degree of tissue damage and the resulting lethal effects of this acid depend on the amount, the route, and length of time of exposure.

CB011723For instance, if this acid were added to someone’s eye drops or a nasal spray, the systemic damage would be accelerated due to the greater absorption rate of the acid into ocular tissue and mucous membranes.

If used as a nasal spray, lung tissue damage is assured. Lung tissue swelling and fluid accumulation could cause an irreversible pulmonary edema and the victim would essentially drown in his or her own fluids—thereby allowing a writer to create a rather dramatic murder scene.

And swallowing only a small amount of highly concentrated hydrofluoric acid will cause major organ damage and, more often than not, result in a painful death.

Furthermore, if the person suspects that he or she has been poisoned and vomiting is MH900040199induced, then the tissue damage is enhanced throughout the upper GI tract. This results in even greater absorption of the chemical into mucosal tissue and a more effective shutdown of systemic calcium metabolism. In short, the end result of induced vomiting is a more rapid advancement to cardiac arrest.

One of the reasons this poison would make such a great murder weapon is that hydrofluoric acid is readily available in auto parts stores. It’s one of the main ingredients in aluminum wheel cleaners.

I have not yet had the chance to use this interesting chemical as a death tool in a murder scene, but the possibilities are intriguing and as numerous as the routes of administration for this versatile poison.

Thoughts? Comments? I’d love to hear them!

Posted in About James J. Murray, About Writing, Acids and Tissue Damage, Acids and Tissue Death, Acids Used to Murder People, Acids with Systemic Toxicity, Acute Poisons, All About Murder, All About Writing, Blog Writers, Blogging, Breaking Bad Acids, Breaking Bad Poisons, Contact Poisons, Flesh Eating Acids, Hydrofluoric Acid, Hydrofluoric Acid and Murder, Ideas for Murder Scenes, Instruments of Death, Interesting Murder Weapons, Killing a Villain in a Novel, Murder Weapons, Murdering with Visine, Plotting Murder Scenes, Poisons Used to Murder, The Science of Murder | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , | 8 Comments

Medication Shortages Continue To Plague the US

At one time or another, we may have gone to a doctor to receive help with a medicalMH900448643 condition. More often than not the medical issue has been resolved when the physician writes a prescription for some wonder drug.

You take that order to your local pharmacy, get the medication filled and administer it as prescribed. In due time, the medical issue either goes away or at least becomes manageable.

MB900409125But what would happen if you stopped at your local pharmacy and your pharmacist handed the prescription right back to you and said, “This drug is unavailable. There’s a severe shortage.” We, as patients, rarely give medication supply issues a thought. In our advanced medical system, the pharmaceuticals we require always seem available.

What if they weren’t? Pharmaceutical shortages in the United States are becoming a major medical issue. The number of new and long-term medication shortages has increased by almost 300% between 2007 and 2012, and the shortages are being viewed as a permanent part of the American medical system structure.

The drug categories most affected are those involved in treating severe medicalMH900308894 conditions. The most common shortages were for generic sterile injectable pharmaceuticals, particularly IV fluids and chemotherapy drugs.

Other formulas in dangerous short supply include the heart medication nitroglycerin and cisatracurium, a drug that is used to paralyze muscles during surgery and for patients on ventilators. Without these medications, such life-saving procedures would not be possible.

Erin Fox, the director of the University of Utah’s Drug Information Service and a contributor of data for this analysis, stated, “We are at a public health crisis when we don’t have the medicines to treat acutely ill patients…” In some cases, doctors have had to ration chemotherapy drugs in their clinics or have been forced to use less effective alternatives.

There are several contributing factors that create drug shortages: 1) There are only three manufacturers that produce 71% of this country’s sterile injectable cancer drugs and any production issues (like raw material delays or quality control issues) result in production delays that become more difficult to eventually overcome, 2) many of the factories that make generic sterile injectable medications are aging and this makes the production lines prone to quality control problems that result in either temporary manufacturing shutdowns or closings of entire factories, 3) pharmaceutical companies that manufacture these drugs have not expanded production adequately to account to the increased need of these specific life-saving drugs, and 4) changes in Medicare reimbursements and group purchasing organization’s negotiated rates have driven down prices that pharmaceutical makers receive for their products, making production of these medications less profitable.

MH900321056So, as a nation, what are we doing about this pharmaceutical shortage crisis? In 2012, the US Food and Drug Administration was given additional power to manage the shortages and the US Government Accountability Office was designated to evaluate the FDA’s response to this problem.

With this new law, drug manufacturers were then required to alert the FDA of potential shortages before they become critical so that the industry as a whole could react more effectively to increase production of a medication on the verge of being unavailable.

A recent Congressional hearing on this matter discovered that the number of new shortages actually declined in 2012 for the first time in several years. Additionally, it was shown that the 2013 data indicated similar downward trends in medication shortages.

Ultimately, the solution to this problem is to require that the various entities in the nation’s healthcare system be responsible for maintaining adequate pharmaceutical supplies, and the recent data analysis suggests that this is happening.

Thoughts? Comments? I’d love to hear them!

Posted in About James J. Murray, About Medications/Pharmacy, Blog Writers, Blogging, Cheap Generic Drugs, Chemotherapy Supply Shortage Issues, Drug Shortages in the US, FDA and Drug Supply Shortages, Generic Drug Safety, Generic Drugs, Generic Drugs in the US, IV Medication Supply Issues, Medication Safety Issues, Medication Shortages in the US, Pharmaceutical Shortages in the US, Pharmacy/Pharmaceuticals, Prescription Trends, Reasons for Medication Shortages in the US, Shortages in the US Drug Distribution Chain, The Pharmacy Profession | Tagged , , , , , , , , , , , , , , , , , | 8 Comments