How pharmacy is reshaping society

How pharmacy is reshaping society


– Hello, we’re gonna go
ahead and get started. Thank you so much for being here today. We have the pleasure of
hosting Dean Letendre from the College of Pharmacy. Dean Letendre has been dean and professor of the University of
Iowa College of Pharmacy since September 2007. Before coming to Iowa,
he served for six years as dean and professor at the University of Rhode Island and Executive Secretary
of the Rhode Island State Crime Laboratory Commission. Previously, he spent almost 20 years on the executive staff of the American Society of Health System Pharmacists, serving for much of that time as the Director of the Accreditation
Services Division. His responsibilities included all matters concerning post graduate
pharmacy residency and technician training programs. He has authored many publications and has spoken publicly extensively, devoting a substantial
portion of his professional career to growth and development of post graduate pharmacy residencies and in advising pharmacy students and residents nationwide. Today he has invited two of his Doctor of Pharmacy students, Kylie Baiting and Alisha Roddinghaus, and he will further introduce
them in just a moment. So please join me in
welcoming Dean Letendre today. (clapping) – Thank you, Carrie, thank you. Well good afternoon everyone, and I hope the sound is good
enough in the background there? Good, wonderful. Well, I’m delighted to
be here to represent our outstanding college of pharmacy. For the uninitiated, you should know that our program, while we are currently housed in less than fabulous facilities, soon that’s going to
change, as all of you know. Our program is among the
finest in the United States. And by definition then, if it’s one of the finest
in the United States, it’s one of the finest in the world. And we’ll talk more about that. I got together with both
Kylie and with Alisha, Kylie Baiting, Kylie,
you want to stand up for just a moment? Kylie is one of our P3 students. Kylie is from New
Hampton and she completed her Bachelor of Science
degree and Luther College before coming here to pursue
her Doctor of Pharmacy degree. And then her other accomplice
here is Alisha Roddinghaus, and Alisha’s from Charles City, Alisha did her undergraduate
work here at Iowa, before then continuing on in
our Doctor of Pharmacy program. Both are P3 students. So, when you think about medical school and dental school, think
the same thing about pharmacy school, completing
a bachelors first then going on to four
professional years of study. Thank you. Well, there’s so many things
that we could talk about in terms of the global impact of drugs. And what we did today was we
decided that we would just, the three of us got together and we decided that we would try to concentrate in the
time that we have together on just four broad areas. First, we want to talk about pandemics. And how did pandemics lead
to the discovery of drugs. Then, as a part of that then, we want to focus
specifically on antibiotics and immunizations because
they’re largely the groups of drugs that have been used
to treat those pandemics. From there, we’re going
to move to the dangers of misusing medications
with a specific focus on antibiotic resistance
and the opioid epidemic. And then finally, we
could pick a whole host of current health care issues that impact society here in the United
States and globally, but we have chosen to just focus on three; Rising health care costs,
medication adherence, and obesity. To get us started, I’d like
to talk for a few moments about the Black Plague. And actually, for the
first couple of moments, I’m not gonna speak at all, because we have a little
handy-dandy YouTube. – [Shiya] Rats, fleas and humans. 14th century Europe. A bloody and deadly combination. The grim reality of having the plague in the 14th century was if you sneezed on your daughter, you just killed her. The bacteria that causes plague, yersinia pestis, lives in rats. Certain rats have developed an immunity to yersinia pestis. But not fleas that feed on their blood. A toxin produced by yersinia pestis, blocks the abdomen of the flea so that it can’t actually swallow
the blood that it sucks out of the rat. So it leaps from a rat,
lands on a human being. It bites the human and vomits some of the rat’s blood infected with yersinia pestis
back into the human victim. And the first victim of the plague is now walking around 14th century Europe. If you were unlucky
enough to get the plague, you would either get pneumonic version or the septicemic version. In the pneumonic version, the organism settles in your lungs and over four, five,
perhaps seven day period, your lungs essentially just liquefy. And you’ll cough them up and die. In the septicemic version of plague, the bacteria inhibits your
body’s ability to clot. Essentially you are bleeding to death from everywhere at the same time. So if you were caring for a loved one in your home who had the plague, who was coughing all over you, the grim reality of it was that you knew that by the end of the week, everybody else in the
house would either be dead or dying. No one has to die of the plague today. The organism that causes plague, is actually easily
treatable with very common and very inexpensive antibiotics. So, if you’re dying of the plague today, you are really unlucky. But if your dying of the plague in 1349, you’re just doing what all
your neighbors are doing. – So, let’s just focus just for a moment on what caused the Black Plague. Well, from the medieval
thinking stand point, some, the logical thinking at the time, was this has to be some
type of divine intervention. We have sinned and
therefore God has come down and He is raging mad and so therefore, for all the sins that we have, He’s going to place the
plague on human kind. Well as we know that that’s not true. Current knowledge was
reported in the small tape that you have. You have your yersinia pestis, which is the organism
that was discovered by a French biologist,
Alexander Yersin at the end of the 19th century. How did the Black Plague end? Well, the most logical conclusion, even though they don’t know exactly, certainly cleanliness came in, health care issues, public health issues, matters of sanitation,
how you disposed of, of your waste of both bodily waste and food waste and so on and so forth. That began to improve as we know, as society began to grow
and learn from these things. But other dimensions, hygiene,
bathing, boiling water and certainly burning of dead bodies, but more than likely,
similar to the comment that was made about the
rat forming an immunity against the disease, in all likelihood, over
time, more and more human beings developed that immunity. Let’s now move to the more recent time, the Influenza Pandemic. And I’m sure that there
are folks in the audience here who had loved ones
who died from that. In fact, my, I know that
my own wife’s grandfather passed away in the 19th era as a result of the Influenza Pandemic. The global death toll
estimated at that time of about 50 million deaths worldwide. 625,000 of those deaths
were in the United States. Killed more people than
World War II alone. One quarter of the U.S. and one fifth of the world’s population was infected. The average life span during that epidemic decreased by 10 years and the death toll was so high that funerals at that time were limited to 15 minutes. This would have been some of the common advertisements and so forth that one would have seen back in the early, early 19s, showing wear your mask as a way of preventing that. Trying to prevent the
complications from Influenza, pneumonia, people would be
told if you had these things, just simply go to bed,
don’t interact with others. Stay away from other
people so that you won’t infect others. Impact of immunizations. Development of vaccinations is not that, as new as you might think. In fact, in the 1800s, Edward Jenner, Jenner’s milkmaid told him,
“I shall never see smallpox, I shall never have smallpox
for I’ve had cowpox.” What happened was that Jenner, this was quite accidental at the time. Jenner was scratching
materials from cowpox sores on the arm of 18 year old,
8 year old, pardon me, James Phipps. Phipps felt poorly for several days, but remarkably made a full recovery. A short time later then, Jenner then scratched fresh human smallpox into Phipps sore. Phipps did not contract smallpox. This work then, provided
the foundation for future current vaccinations. So from the 1800s forward, we actually had some
scientific work being done that demonstrated that
the knowledge of how one would transmit and
prevent the transmission of disease was actually taking hold. The impact of vaccinations
in such areas as Polio, of course, brings to mind
a much more modern era. In 1938, National Foundation
for Infantile Paralysis, the March of Dimes was founded. Polio research was funded by FDR. And in 52, not unlike
the Moonshot activities that we have going on today
where the federal government is trying to fund research to help us cure various dimensions of
cancer, at this time, you could look at this, in it’s time, as a Moonshot effort when
Jonas Salk then created the first effective Polio vaccine. And of course, that was
a life saving event, because today, 99% of
the Polio in the world has been eradicated as
a result of the vaccine that has been created. The cost of treatment, sixty cents. Sixty cents for protecting
on child from Polio. Yet, not surprisingly,
because of low socio-economic and other kinds of political
activities going on in three countries,
there are three countries that have not stopped Polio. And so Polio in the world
is ostensibly concentrated in three countries, Nigeria,
Afghanistan, and Pakistan, and we know, all know,
what’s happening in those three countries. Let’s just look at the
impact of what vaccinations, the introduction of vaccinations has done to society globally. And just look back to the 1900s and you can see all of
those very large circles. And you can see that from 1900 to 2010, the impact that vaccines
have had on these diseases. In many cases, as we’ve
indicated, they’ve virtually eradicated these things and in some other instances
they’ve certainly minimized their impact to a great extent. And of course the attendant
consequence is not only in terms of people’s livelihood and the things that they do, but the economic impact has
just been extraordinary. Let’s talk about that economic
impact just for a moment if we could. The cost of not getting vaccinated. Vaccine preventable diseases in adults cost the U.S. almost $9 billion in 2015. Vaccine preventable diseases in adults cost the U.S. $9 billion in 2015. 80% of that cost or 7.1
billion can be blamed on unvaccinated adults. You can see on the right
hand side the total cost of vaccine preventable diseases starting with the flu itself. So one question I would ask, because of the things they ask us to do in a presentation like this, is come away with actionable items. So one actionable item
would be to ask everyone in the audience, and I’m not asking you to raise your hand, but have you all been
vaccinated for the flu? And if you haven’t, then that
would be an actionable item. Something very easily done and by the way, these two young ladies
that we have here today are very well trained in being
able to provide vaccinations. As an example of that, our pharmacy students alone
have provided just in the 16-17 season, 73 organized
flu shot clinics. Over 6300 immunizations have
been given by our students alone in the greater Iowa City area. Let’s talk about antibiotics
for just a moment. And to start off, I’m
gonna show you another – [Narrator] World War I,
more than 10 million dead. Many from infection of their wounds. After the war, research
intensified to find safe methods of repelling
the bacterial invaders. Among those on the case,
was Scottish physician, Alexander Fleming. While studying staphylococcus bacteria, Fleming noticed something unusual growing in the culture dish, a mold. Penicillium notatum. He saw that the bacteria
surrounding the mold had died off which lead
him to speculate the mold was producing a substance that
was lethal to the bacteria. He named the substance penicillin. For the next several years,
Fleming tried extracting penicillin and applying
it to treat infections. But he was unsuccessful
and eventually gave up. Fleming’s work, however,
proved invaluable. In 1935, scientists Howard
Florey and Ernst Chain at Oxford University
came across a record of Fleming’s curious, but
incomplete work with penicillin and decided to investigate. This time, they successfully extracted and purified penicillin. And in 1940, they tested it. They injected 8 mice with lethal doses of the bacteria streptococci, then they injected four of
the mice with penicillin. Within hours, they beheld the results. The four mice not treated
with penicillin were dead, but three of the four that had been given penicillin were alive. From Fleming to Florey and
Chain the world’s first antibiotic was born. – It was a miracle drug. It cured so many diseases that had caused so much pain and suffering. Strep throat, rheumatic
fever, scarlet fever, syphilis and gonorrhea. It was things that we wouldn’t
even think about today should kill you. – You can imagine back then, and it’s very difficult
in today’s society, to fully appreciate how things that we take as common place that can be treated, were life threatening at that point in time. And to stop and try to reflect back, and when you think about that, that was the 1930s, 1940s,
so we’re talking less than a century ago, some
of the most common ailments that human society acquires
were life threatening. And that was especially
true and vulnerable with young children and older adults. So you can imagine, today
we take that for granted, but we take it for granted
because we’ve had these life saving treatments. And those life saving
treatments, for the most part, at least as it relates
to communicable diseases and so forth, find their home
in vaccines and antibiotics. Again some advertisement
that one would have seen. I have to find humor in the
one in the lower left corner. It says Penicillin cures
Gonorrhea in four hours. It’s almost like everyone wanted to go out and get Gonorrhea or something, ya know? ‘Cause what the heck, it’s
gonna be cured in four hours. But you can imagine in war time though, on a more serious note, how during war time the use of penicillin saving GI’s limbs and other kinds of things that one was able to treat, right there, in the battle field that previously was untreatable, and as a consequence in
World War I for example, many, many lives were lost
simply because of infection. The good, the bad and
the ugly of antibiotics. The thoughtless person
playing with penicillin treatment is morally
responsible for the death of the man who succumbs
to infection with the penicillin resistant organism. Alexander Fleming. The fact of the matter is
Fleming was a sloppy scientist. And it was because of
the sloppiness that’s how penicillin was discovered. He actually left a petri
dish out over the weekend. And when he came back, spores had fallen onto that petri dish, as he was showing you in that slide, and if you can think about bread mold, that’s what it would’ve looked like. But interestingly enough, the material around where
that bread mold existed was dying so he knew there
was some type of activity going on that was causing
the cells around it to die. But that would have never happened, had Fleming been a more
polished scientist. He would have put the cover on. He would have put it away. And as a consequence penicillin would not have been discovered. Antibiotic resistance,
we’ll come back to this in a little bit. But antibiotic resistance is a huge factor in today’s society. The high number of bacteria, few of them are resistant to antibiotics. Antibiotics kill the
bacteria causing the illness as well as good bacteria
protecting the body from infection. The resistant bacteria now
have preferred conditions to grow and take over. And of course, bacteria
then can transfer their drug resistance to other
bacteria causing more problems. Now, what are some of
the reasons why we have causes of antibiotic resistance. Well, one’s certainly,
regulatory barriers. Antibiotics are available over the counter and not regulated in some countries. They’re taken like candy. They think that well, shoot, if this works then we can just take ’em willy-nilly. The availability of few new antibiotics, the lack of funding, and economic appeal from the pharmaceutical
industry has lead to a decrease in the development of new
antibiotics, believe it or not. Antibiotic over use is enormous. How many times each of you in this room, whether it’s your child or your grandchild or another loved one, someone
has the symptoms of the flu. They go to the pediatrician. There’s an expectation on
the parent of the loved one to walk out with a prescription for what? An antibiotic. Well, in more than 80% of the cases, we have others here who
are far more expert in pediatric therapeutics than I am, members of our college and so forth, that can tell you that perhaps
as much as 80% of the time an antibiotic isn’t warranted. Because it’s a viral infection,
not a bacterial infection. But yet they come, they
go home, they get better, yes, they would get better
anyway, even without the antibiotic. But because of that they’re treated, and because of over treatment resistance occurs. So, inappropriate prescribing. And then other major issue, particularly in an environment like Iowa and other agricultural
states is the influx of high doses of antibiotics
into the food chain. So, antibiotic resistance
in the United States, 2 million people every
year acquire antibiotic resistant infections. And that number is increasing. 23,000 people every year die from antibiotic resistant infections. Antibiotic resistance is a global threat. And I just picked one, we
could have picked many, but we picked one. The bacteria that causes
the sexually transmitted disease gonorrhea, which I joked about a little bit earlier, is no longer susceptible to
previous cephalosporin levels. Cephalosporins came
about in the late 1970s. Yet another miracle antibiotic. I was studying that when
I was in graduate school. The first generation cephalosporins. They were an antibiotic that
was going to be the cure-all. It was the next step beyond penicillin. Well, in April of this year,
the remaining antibiotic that is used to treat
Gonorrhea, azithromycin, we call it a gorilla drug
because that is a very powerful antibiotic agent,
was ineffective at treating 34 cases of gonorrhea
in the United States, United Kingdom rather, sparking fears that gonorrhea
could soon become untreatable. I’ll let you read that. One of the major causes, will come back to that, are folks get their
prescription for antibiotics when they are appropriately prescribed, they start feeling better
after three or four days, and they stop taking the antibiotic. What happens? You stop taking that antibiotic, that bacteria then has an
opportunity to then regrow, reinfect the individual as
opposed to staying the course which is typically seven to ten days. Stay the course with the antibiotic. So another actionable item. If you are appropriately
placed upon an antibiotic, take that antibiotic right
through until it’s completed. HIV and AIDS Let’s even get more modern. So now we’ve gone from the plague, we’ve gone through the flu epidemic, we’ve gone through Polio, and now I’d like to just take a moment and talk about HIV and AIDS. And once again, Just some comments about
the global consequences of HIV and AIDS, globally, 33.4 million are living
with HIV/AIDS currently. 25 million have died since 1981, but of course, that number
has plummeted as a result of treatments that we’ve
been able to generate. 97% of the people with
HIV live in developing and moderate income nations, which is surprising to some folks, but quite frankly for
those of us who work in the health care arena, once again, if you start thinking about
the plague and others, it’s not uncommon for some of these things to take root in developing nations. 28.6 million people in poor
and moderate income countries and only one third of these
people are getting the treatment that they need. HIV medication advancements. You can see over the course of the last several years that a person
without HIV, 79 years. A person with HIV diagnosed at age 20 taking current HIV medicines 71 years. At one point in time that
would have been unthinkable. You can, I’m sure, virtually
everyone in this room remembers a point in time
when HIV was a death sentence. A person with HIV diagnosed at age 20 and not taking current HIV
meds, life span of 32 years. Now, of course, we think
about the impoverished in countries like sub-Sahara
Africa and so forth, but then what brings
it to light often times is celebrities when they get it. Whether it’s Rock Hudson or Arthur Ashe or Magic Johnson. Unfortunately, tennis
great Arthur Ashe died because treatments weren’t
available at the point in time when he contracted the disease, whereas Magic Johnson
continues to live a very normal and healthy
lifestyle because treatments were, in fact, available
when he was first diagnosed. HIV in the United States,
44 medicines and vaccines are currently in development. Three in cell and gene therapy, 25 antivirals and 16 vaccines. Cost of HIV treatment in the U.S. The average cost of treating one American over the course of their
lifetime, almost $400,000. The U.S. is expected to
spend almost $30 billion annually on HIV/AIDS programs, but what is the cost of life? Quite frankly, that’s
a small amount of money and I would anticipate
that during the course of my lifetime, HIV will be eradicated. Now, at this point, I
would like to transition our presentation over to Kylie. Kylie, please? – Thank you Dean Letendre. Okay, so, so far we’ve
kind of talked about these big pandemics that
have hit every corner of the world. For the next few minutes, Alisha and I are gonna talk
about the opioid epidemic which hits a little closer to home. This is both geographically
as it’s mostly seen in America and probably
personally for some people in this room today. So pain is a problem throughout the world. More than 65% of people around the world report that they experience
pain at least once a week. Of those people who experience pain, 71% of people require treatment. So their pain is so bad they
need some type of intervention. So pain treatments vary
from country to country and even person to person. But in America we have
responded to this problem with opioids. So what exactly are opioids? Opioids are any substances
that act on opioid receptors in the body to
reduce the affect of pain. So most of the time we think of these as prescription pain
relievers, so hydrocodone, morphine, oxycodone, percocet,
vicodin, things like that. But this is also the illegal drug heroine. Heroine is considered an opioid because it too acts on opioid
receptors in the body. So just taking a look at
why this problem is so big in the U.S. So as a whole, the
United states makes up 5% of the world’s global population. However, we consume 99% of
the world’s hydrocodone. In fact, in 2010 hydrocodone
was the number one written prescription in the United States. And this was not just the
number one pain prescription, but the number one prescription. So more prescriptions were
written for hydrocodone than any type of blood
pressure medication, cholesterol, diabetes, you name it. So now since 2013, you
are more likely to die from an opioid overdose than
you are from a car accident. Opioid overdoses are the
leading cause of injury death in the United States. So that’s more than
motor vehicle accidents and fire arm injuries. So why is this such a
problem in the United States and nowhere else in the world? Everyone around the
world experiences pain. So there’s many reason but
today I’m going to focus on two of them. The first one is pain
because the fifth vital sign. So actually in the 1980s
and the 1990s, early 1990s, we actually had an under
treatment of pain in America. And a lot of that was seen in minorities. They were feeling, and
many people in America, not just minorities, were feeling like their pain was not being adequately assessed when
they were going to the doctor and then not being adequately treated. So in 1996 the American
Pain Society decided we’re gonna make pain
the fifth vital sign. So that’s why when you
go to the doctor today, they say, on a scale of one to 10, what is your pain today? Even if you’re not seeing
the doctor for pain. The issue with this is that
pain is very subjective. My nine out or ten pain
is gonna be different than Dean Letendre’s which
is gonna be different than Alisha’s. This is not like getting
your blood pressure taken. When they go and take your blood pressure, they know, oh you have
high blood pressure, you need a medication. This is much more subjective. The other issue is
pharmaceutical companies, such as Purdue Pharma came out with new, long-acting opioids. So they wanted to respond to
this under treatment of pain by creating new developments in drugs to kind of treat this. So their kind of, go-to drug for this
solution was oxycontin. So oxycontin was designed
as a long-acting opioid. So what it was gonna do, for
12 hours it was gonna release a little amount of pain
so that people could only take one pill a day. So, every hour for 12
hours it was gonna release just a little amount. So they advertised this
to doctors, patients and medical students as non-addictive. As long as you were taking this medication for legitimate reason, you
could not become addicted. However, this is not true. Even if you are using
these pain medications for a legitimate reason, there is still the potential
to become addicted. Also these products were not made in an abuse deterrent formulation. So what that means is, why
these drugs were designed to release a little bit amount
of medication every hour, they could be crushed. And once they were crushed,
people could then snort them or inject them. So when you would do this,
you would get that full 12 hour dose of medication
in a few seconds. So that resulted in
incredible highs which were very dangerous and were
getting people addicted. So, we’ve seen a rise
in the overall opioids prescription drugs in this country and now we’re seeing a rise in heroine. So like I said, heroine is also an opioid. So four out of five new heroine users started by abusing prescription drugs. And why there’s this link
is because many people feel that heroine is far more cheaper and easier to get. You might go to the
doctor and they might say, No, I’m not going to give
you any more opioids, I don’t feel like this is necessary. And people are turning to heroine. So I think this graphic
is really, really powerful because it just shows how
dangerous these drugs are even though they are prescriptions. A lot of times, especially teens think, oh, these are prescription medications, they’re not more dangerous
than drugs on the street. If you look, if a person
is addicted to cocaine they are 15 times more
likely to become addicted to heroine. If they are addicted
to opioid pain killers, they are 40 times more
likely to become addicted to heroine. So you might be sitting here thinking, this could never happen to me. And I hope that’s true, but the fact is, it’s just not right. Addiction is not a moral failing, and it’s not a problem of the weak minded. Addiction is a medical disease and it can happen to everyone. I would argue that nearly
everyone in this room has been affected by the opioid epidemic whether they know it or not. And to prove this, I just
want to do a little exercise. If everyone could raise
their hand if they’ve ever had their wisdom teeth taken out, or a medical procedure, okay? Keep your hand raised
if you were prescribed a prescription opioid for that procedure. Keep it raised if you had any left over. So nearly everyone’s hand is still raised. So, Alisha will go into this more, but 70% of people who
start abusing opioids do that from getting
it from their neighbor or loved one. So maybe you’re sitting
here thinking this could never happen to me, but it could happen to someone you love. So what does an overdose look like? So overdose can happen
even if you’re taking the medication for legitimate reason. So it’s not just the people
who are using heroine, who are stealing prescription medications and taking too much to get high. It could also happen to your friend or your dad who just
say, had back surgery, can’t sleep at night so he decides to take one more pill, ya know,
has a beer at dinner. And then takes a sleeping
pill because the pain is so bad he can’t
sleep through the night. And he doesn’t wake up the next day. So this is what an
overdose kind of looks like no matter what the cause is. So kinda the pinpoint sign is
these pinpoint pupils here. You can see right here, they get incredibly, incredibly small. The person is likely unconscious, they will be suffering from
respiratory depression, so it’ll be very hard to breathe. If they’re breathing at all, it’ll likely be labored breathing which kind of sounds like
a snoring or a gargling. Their skin will be pale, and their fingertips and lips will be blue if they have pale skin. And maybe purple if their
skin is a little darker. So now that we know what
the opioid epidemic is and what it looks like, I’m gonna turn it over to
Alisha who’s gonna talk about how we can fight this epidemic. – Thank you Kylie. Okay, so what we are getting now is what we call Naloxone. And Naloxone is a drug that
can reverse the effects of an opioid overdose. So it can bring someone out
of that unconsciousness, that slowed breathing, that kind of thing. And currently we have three products that you can get from the pharmacy, that I just stuck in my pocket. But the first one here
is an auto-injector, kinda like the epi-pen where it’s just got the needle in there. I will have it talk to
you in just a moment because it actually talks to you and tells you what to do. But you just take it out of the case and remove the safety
and then it tells you to stick it in the leg,
the outer upper thigh, just like you would an
epi-pen and hold it there for five seconds so that
the medication can go in, but I’ll let you listen
to what this sounds like at least for a little bit. – [Injector] This trainer
contains no needle or drug. (beeping) If you are ready to use,
pull off red safety guard. – So I’m gonna, I’ll leave
this up here if you guys wanna go through this
after the presentation so we don’t take up so much time. You’re free to go through this, but it gives you step by
step as to what you need to do which is really nice. And then there’s two other, I guess I can put that back in the bucket. Two other forms of Naloxone
that are available, just put that there for now. This is called a nasal spray and you just kind of rig it together and then you can squirt the medication up into a nostril. And then there’s also,
this one here is just a nasal mist so unlike the
ones you would get for your prescriptions where you
usually have to prime it, shake it up, prime it, this
one is actually already primed so you just squirt
it right in a nostril. And it should be noted
that with all these, that you can use them twice. So, if it doesn’t, if
you don’t see a reversal within the first three minutes, you can give them another dose. So with the nasal sprays you
can use the other nostril if it doesn’t work. But you want to wait
three minutes for that. And then with Naloxone,
the effects of the drug actually only last 30 to 90 minutes and for opiods the effect
is gonna be much longer. So first you’re gonna wanna call 911 before you administer Naloxone, and then give it, and
then you want to make sure you’re waiting around with that person until the emergency services come because potentially they could
go back into their overdose, since the effects of the
Naloxone could wear off. Naloxone will not harm
someone if it’s not, if it’s given without an overdose, so it’s always important
just to give it if you think that there is an overdose. And then, when in doubt, call
911 and administer Naloxone. So we just want you to
remember the phrase I-CARE. The I is for identify an overdose. Like Kylie was saying you
can have pinpoint pupils, respiratory depression
and unconsciousness. The C is or call 911. It only lasts, like I
said, for 30 to 90 minutes so you wanna make sure
you stay with that person after you call them. Make sure they don’t go
back into an overdose. If that happens, you wanna
make sure you administer Naloxone again. It is important to know
that when somebody wakes up from an opioid overdose,
they’re most likely going to be pretty agitated
that you woke ’em up, so you want to just make sure you keep yourself safe with that. Just let them know that
help is on the way. And then A is administer rescue breathing, so you wanna do two rescue breaths followed by one breath every five seconds just to make sure they’re breathing. And then you can go ahead
and administer Naloxone. If that does not work, you wanna resume your rescue breathing. And then E would be for ensure
safety until EMS arrives. We wanted to talk a little
bit about the expanding Naloxone in Iowa. So a couple bills have, or a
bill has recently been passed where Naloxone is available
at pharmacies now. It used to be that it was
only available through paramedics or EMS services
but now law enforcement, fire departments and
service programs are allowed to carry this with them, and they just passed the
standing order for the pharmacy so like a flu shot, you could go to the pharmacy and obtain some Naloxone if the pharmacist finds it deemable that you need it. So either if you find yourself at risk for an opioid overdose or if you know a loved one that you think you will need to use Naloxone for. And we just wanted to
point out for the good Samaritan clause, 48 states
with Naloxone access. Or, sorry, 48 states currently
have Naloxone access, and of those 48 states,
only 35 of them have the good Samaritan clause. And this is a clause
that protects the person who calls 911 in the event
of an opioid overdose so that if that person calling is under the influence of any drugs or has paraphernalia around that they do not get in trouble
for that because they are saving someone else’s life. It’s important to know
that for opioid reversals 82.8% of those were actually
reversed by drug users. So those are the people that
are gonna be at the scene, they’re gonna be most
accessible to the Naloxone and much dropped from that is
9.6% are from family members. And .2% are from public service providers. And then we just want to talk
about a couple other ways that you could hopefully
prevent this epidemic and just medication misuse in general. So 70% of Americans who
misuse prescriptions obtain them from family or friends. We want to make sure
you’re aware of proper medication storage and disposal. So a lot of people tend to
keep their prescriptions in their bathroom which is
not a good place to keep them. Number one, there’s a lot
of humidity in the bathroom. But number two, it’s behind a closed door. So, if someone comes into your house and closes the door in the
bathroom you’re not gonna see them take your medication. It’s too private of an area. Should keep ’em in a more
public place like a kitchen where someone could see
somebody taking something. And then also if you got like a lock box. If you’re concerned about
someone stealing your medications you can get those at a lot of pharmacies and even just like a local hardware store as long as you’ve got a
lock on a box it should help with that. And then as far as disposal goes, most pharmacies will take back any non-controlled medication. You wanna just make sure you take off your information before you give it to them. And then, the Johnson
County and Linn County police departments actually
have drop off boxes where you can bring in
controlled medications at any time, it’s 24 hours. You can just put them in the box and they won’t ask questions. You don’t have to talk to
anybody, so that’s pretty great. And then we just wanted to point out that the economic burden of
addiction is really costly. $1 trillion are spent every year, and that includes drug
treatment, lost productivity and just active addictions. So with that, I’m gonna give
it back to Dean Letendre to talk some more about
the cost of health care. – Thank you Alisha. So we’ll close off and
then we can move right into questions and answers. I’d just like to talk about three current healthcare concerns. As I mentioned at the outset, We could have taken this in
so many different directions. We could have talked about so
many different medications. We didn’t cover cardio vascular agents, we didn’t cover cancer agents, we didn’t cover a whole host of things. We tried to focus in
the limited time we had available to really hone in on those areas that we thought might be impactful. And certainly that
impact is often driven by an untoward consequence
like a flu epidemic or HIV or Polio or whatever the case might be. Then, there’s sort of a
cause celebre if you will, that brings the scientific
community together that says look, we have to
do something about this. And certainly here in
Iowa, we’re no different. We are working feverishly, the various health sciences together, the scientific community in trying to find cures or at least treatments
for many of today’s maladies. Well, let’s just talk about the rising healthcare cost in general. We talk about the United States and what we do to try to eradicate or at least treat disease and eradicate in cases
where we can, disease. But there’s an interesting
phenomenon in our country that is rightfully under great scrutiny and that’s done on a per
capita healthcare spending versus average life expectancy. You can see that the United
States is a huge outlier. Bottom line is we’re not
getting the bang for our buck, if you will, in terms of how
much money we are spending for healthcare in terms of
what it’s doing for overall average life expectancy. And part of that has to
do with the things that we talked about before. Inappropriate use of
opioids, over prescribing and so on and so forth. The U.S. spends more on
healthcare than any other nation in the world. Today, what could we do
with the $15.5 trillion we would have saved if healthcare spending over the last 30 years had been the same as the second highest spending country? Well, we could have
transformed our $11.6 trillion federal debt into almost
a $4 trillion surplus. We could have sent, you can
read the number, students to four year colleges. We could have covered an area
the size of South Carolina with polar, uh with solar
panels rather, not polar sanels. Solar panels. And we could have bought
everyone in the world four ipads, just to put things in a perspective. I won’t spend a lot of time on this, but suffice it to say, that the organization
of economic countries, developing countries and
communities have worked very hard at trying to
address the issue of healthcare spending and you
can see that once again, the United States is an outlier in every one of the categories. Reducing prescription
drug costs is a top public healthcare concern. And in fact, in this election, this is very recent
data that just came out and the number one
concern expressed by the United States citizenry
is that making sure the high cost of drugs
for chronic conditions are affordable to those who need them. And you can see there are
many other items on there that are related to
healthcare and drug delivery. So let me shift right now to the second healthcare concern that we talked about, and that’s medication adherence. The fact of the matter is
roughly 50% of our society do not take their medications correctly. And that’s irrespective
of socio-economic group. You can be wealthy or
poor, it has no bearing. The fact of the matter
is that half the people in this country do not take
their medications accordingly. Now, look at this, I
think this is actually extraordinary. For every 100 prescriptions written, 50 to 70 are filled. So right off the bat you have folks that get a prescription
and don’t get it filled for a variety of reasons. Some of those are very, very good reasons. You’re trying to decide, a
poor family’s trying to decide between putting food on the table or taking that medication. 48 to 66 are picked up from the pharmacy, of the 50 to 70 that are filled. But you can see already
that they get it filled but they don’t pick it up. And then of that number,
the number that I just said, of the number that are actually picked up, half are taken properly. And then, only 15 to 20%
are refilled as prescribed. Now you can think of
chronic care diseases, such as hypertension, such
as hypercholesterolemia, a whole host of other diseases, and you have only 20%, one in five are actually getting those medications
refilled and taking those. Well, what happens when you don’t take your blood pressure medication? It’s no wonder then that
you have so many folks then that subsequently end up with their blood pressure shooting up, they end up having a stroke, they end up in emergency
room, attending costs, and you can see then
why healthcare spending in our country begins to accelerate. So just, an overview
shot of the medication adherence issue. Nearly three out of four Americans do not always take their
medication as directed. This problem causes one
third of the medicine related hospitalizations in this country. Nearly a 125,000 deaths
every year associated with inappropriate prescription use, and that’s legitimate use. What would be the avoidable costs, let alone the other
costs associated with it? The avoidable cost’s almost $300 billion on our system alone. Last point that I’d like
to talk about is obesity. And particularly in today’s
society where we have these little handy-dandy little devices and you see the children, I know even children
that I get to witness. They have, I think, the best
exercised thumbs in the world. And that’s because they
spend a lot of time on their computers and other
types of electronic devices. Well that’s great for
excitement and using your mind and imagining those sorts of things, but what happens, compare that to our
childhood where your mom booted ya outside and said go play. And you ran around and
you went on the swing set and you did this and you did that, and you exercised and you came in and you were burning up those calories. Well, a lot of the children
today are sedentary. You know, in fact I’ll just
tell you a really quick story. About a year ago, I was at
a counsel of deans meeting right here at the old capital mall. And I walked out, and it was pouring. And I did not have overshoes and I did not have an umbrella. So I timed it such that I
could run across the street, grab the red line bus up
to Reinow to get close to the college of Pharmacy. I got on the bus and we’re
driving down Washington street, and because I’m tall, and
because I was standing at the front of the bus, near the driver, holding on to the strap so
that the students could sit, something struck me. Not one person, on that
entire, the bus was packed. Not one person was speaking. But, everyone was doing this. And for all I know they were probably speaking to their person. I think that is, in part,
reflection of what we have done within our
society and how that impacts our exercising. There’s a consequence,
look at us compared to the rest of the world. 66% of the United States
are classified as obese. Now this could be over weight or obese, versus 37% worldwide. And in children it’s especially striking. Direct cost of obesity, healthcare costs, medical tests, drugs
to treat comorbidities associated with obesity, $152 billion. And then you can see the
indirect costs of obesity include such things as the loss of work, insurance premiums go up and lower wages because of prejudice
against, largely because of prejudice against obese individuals. Weight loss benefits we
know, medical benefits as well as personal benefits,
so I’m not gonna spend a lot of time on that
except that one thing that we should note, the one thing that I
would like to highlight, is the escalating growth
of diabetes in our country. And why do we have that? Because of obesity. So, with that, what I’d
like to do is just close out with this, and then turn it over to questions. I wanted to just share
with you for a moment, because most people’s perception, when I get into a public audience, your perception of pharmacy is your local Walgreen’s or CVS. That might be 98 or 99% of your perception but that’s less than 1% of mine. And the reason is
because the men and women who grace our halls and
these two young ladies are representative of
the outstanding students that we have here. These are extraordinarily
bright, young individuals who are gonna be future
healthcare professionals. They come into our programs, they have a Bachelor of
Science degree already, they spend four more years of study, and unlike what we did, And if you can see, the growth
of drugs in our country, not surprisingly, coincided
with the need to educate people more. You think about the things
we talked about when World War I and Polio and vaccinations, and so on and so forth, it’s no wonder that as
new drugs were discovered we needed to educate people longer. So like in my case, I did a
five year Bachelor of Science degree before I went on
to graduate education. But today, every
pharmacist in this country needs to, in order to
graduate to practice, you need to have a
Doctor of Pharmacy degree and that’s been the case since 2004. And in our case, two
thirds of our students go on for post graduate
education and training beyond their pharmacy
degree because of the complexities associated with diseases and the treatment of those diseases. So, highly scientific, highly trained, these individuals are just extraordinary men and women who
compliment exceedingly well the rest of the healthcare team. And I’d like to close with that. We have an outstanding college of pharmacy here at the University of Iowa. Why? I would like to believe
that the reason why we have an outstanding college of pharmacy is because the compliment
that we have of the other health professions. We have an outstanding school of nursing, medicine, dentistry, public health, and oh by the way, we have a world class health sciences facility
right in our back yard. I’d like to also believe then, that the reason why we
have such good programs in medicine, dentistry,
nursing and public health is because we have a
good program in pharmacy. We’re complimentary to one another. Good patient care is complimentary, good science is complimentary, good education is complimentary. We have an outstanding health
sciences program here at Iowa and it’s just a privilege and an honor for me to stand up today in representing one dimension of that, and that’s the profession of pharmacy. So we thank you for the opportunity today to be with you and talk a
little bit about our world. As I said, we could have
taken this in so many different ways, but these
two young ladies here, I’ve worked very closely with them. We wanted to hit upon
what we thought were some of the highlights. So with that, I’d like to
open it up for questions. And I’m gonna ask my young colleagues here actually to do their
best in addressing most of these questions. So, Kylie and Alisha, please come up here. – And we are right at one PM, so just to be respectful of your time, if anyone does need to
head out at this point, please feel free to do so. – We’re gonna stay for a bit longer, we’re good with that. Go ahead, please. Yes sir. (clapping) – Yes, go ahead. – Do you have any information
on the prescription compliance rates in countries
other than the U.S.? – Yeah, so adherence as
a whole across the globe, is very poor. So in the United States it’s about 50%, but for chronic conditions worldwide, it is also about 50%. So though it’s bad in the United States, we’re not exceptionally
worse in that category compared to other countries. So it’s right about
50% everywhere in terms of chronic conditions. – What can be done about
the over use of antibiotics in agriculture? – Might want to repeat the
question for the people in the back. – The question was what can be done about the overuse of antibiotics, especially in agriculture. I think education is key in that. Informing whoever is giving
the antibiotics to the animals. Letting people know what
that can do to people I think is really important. As far as people goes,
how that is important is just making for avoiding resistance, it’s making sure you take your antibiotics as prescribed, not stopping
them right when you feel better, and taking them all throughout the course. – Another thing that we’re
doing is better education. Starting it right back and the beginning. I don’t think anyone has any poor intentions. For example, the example
that I used earlier, where somebody comes
in for a coughing cold for the little ones. And we know that there’s a high likelihood that it’s viral and not bacterial. Well, I think through education
of healthcare providers, healthcare prescribers,
doing a better job of making sure that when
we prescribe medications that we’re doing so and
we’re doing so much more accurately so that we as, Do no harm. So that we’re not only treating disease, but we’re also not creating
harm by treating disease. So education and training
is very, very important as well. – [Audience Member] Yeah,
I guess I’m talking about the use of antibiotics
as growth promoters. – Yeah, and I think a lot of that, my, growing up my dad was a dairy farmer and now he just does corn, but there are a lot of
regulations in place on what you can feed animals and kinda what you can
put into their systems. But I think a lot of that
would be even more regulations and then also just
making conscious choices as consumers of these products. Kinda knowing what you’re
putting into your bodies, what you’re eating and where your beef is
coming from is huge too. – I agree about the regulations, my dad actually owns a feed mill and he is seeing a lot
more regulations coming in and looking to see what
he’s putting in that feed for animals. Yes. – About the animal antibiotics, Do the farmers obtain
them through veterinarians which would have a control
on the amount of antibiotics or do they just get it over the counter? – I’m not sure on the regulations yet, I know it’s getting stricter
where you do have to start going through the veterinarians, I’m not sure as to where
that’s at right now. Do you know about that? – That I’m not sure of either. But I believe like if, so like growing up, if a dairy cow got sick,
we would obviously get the antibiotic from the veterinarian, but I believe like their
food was not anyway associated with the veterinarian services. – Interestingly enough
in the healthcare system, the way in which animals are
managed is very different than human beings. You have checks and
balances with human beings where many, many decades ago, physicians moved away from, essentially because of
checks and balances, physicians would prescribe and pharmacists would fill
to ensure that you had, Well, that’s not so in the animal side where essentially veterinarians
can both prescribe and administer and fill. And so, in fact that because
a very lucrative part of their practice. And so there’s much more
scrutiny now in terms of looking at veterinary practices and their interface with farmers and how there might be better safeguards in not only education, but also regulation about
how those medications are then utilized in animals. Either smaller animals, but
especially those animals that end up being part of the food chain. – How are pharmacists
reacting to like big pharma marketing plans to push
certain drugs onto patients across the United States? Like how has your education
taught you to prescribe the correct drug versus what
they want you to prescribe? – Yeah, so the question
was how do pharmacists respond to big pharmaceutical
companies pushing these new drugs? So, a lot of it, I think,
is patient education. When patients see commercials
on TV of these new drugs, they think, oh that’s what I need, I need that. So then they go to their doctor and kind of have that
conversation with them. And then the doctor ultimately decides what is prescribed. When they come to the
pharmacy, we can say, you know, do you need
that brand name drug? This generic works just
as well and it’s only $4. So I think a lot of
our response is just to educate our patients on what’s out there and what are the best options. And also taking big
pharmaceutical companies with a grain of salt. Especially with the oxycontin example. They were pushing things
that always weren’t the best for our patients or necessarily true. So making sure we really
look into where their getting this information. Good question. – I think it’s the responsibility
of the pharmacy students and the pharmacist to
be really well informed and able to make decisions on their own if they have a drug
representative come to them and talk to them about a medication. Ultimately, they need to
know, with their background, and their education, as to how
that’s gonna affect somebody. And as far as the oxycontin goes, we actually have a really
great prescription, in Iowa called the Iowa
prescription monitoring program, that providers can log into
and kind of check the use of different patient’s history on their prescription medications. – So part of our, that’s a great question. As a part of our student’s education, not only do they learn
drug literature review so that they look at objective
sources of information to make decisions about medications, but they also learn about a
thing called counter detailing. And so, folks that work for
the pharmaceutical industry, obviously are driven by quotas and how much they sell
and so on and so forth. Very different part of
the world we live in. But yet, it’s part of our world, so we have to contend with that. Well, our students, and pharmacy
students across the land, are taught how to counter detail. So they go into a physicians office and they try to promote their
particular drug product, and then it’s our responsibility
as pharmacists to, when appropriate, to work against that. And say no, you’ve really
been sold a bill of goods, if you will. So that’s with the prescriber side, and then as Kylie was
mentioning and Alisha as well, then on the patient side,
when a patient comes in. And you realize that patient
has a very costly drug when you know that there’s
a cheaper version available. Well, think about the
medication adherence. One of the reasons why people
don’t take the medications, they cost too much. So if you can provide them
with a cheaper version, our students are extremely,
graduates of our program, are extremely well educated
in knowing about those alternatives, calling back
the prescriber and saying listen, you know, I’ve
got a cheaper version here that’ll have the same impact. Very, very good question. – [Alisha] Yes. – I’m concerned about generic drugs. Taking the original drug
and then taking the generic. I can tell the difference between the two and I’m concerned about quality
control for these drugs, especially the ones that
are produced in China and India for example. What do you think about that? – So we actually have regulatory programs that are going to make sure
that the active ingredients in the generics versus
the brand name medications are the same. So, some people may
experience different effects from different manufacturers,
that kind of thing, but the active ingredient
should be the exact same in both products. – [Audience Member] Well, it
should be, but is it really checked? We have so much coming in from
outside the United States. I’m confident in what we have here, but I’m not so confident in what comes in. – Yeah, and that’s really good point. So when I kind of think
of generic equivalents, we use this thing, it’s
called the AB rating. And so all generic
equivalents have to be tested and proven that they are just as effective and just as safe. So like Alisha was saying,
it’s going to have the same active ingredient, but there
might be some additional they’re called excipients,
in the drug that might make it slightly different. Majority of people, I
would say well over 90% can’t tell the difference, but there are some people who do. And if that is the case, I would say, just kinda working,
whatever works best for you. But any drug that you get from a pharmacy in the United States has
been approved through the FDA and has been proven just as
effective as the brand name equivalent if it is generic. – Once again, a very good question. We’re a global organization. Our college of pharmacy works globally. And we do work in economically
developing countries, such as India, we’ll
use India as an example where a lot of drugs are
actually manufactured in India. And the fact of the
matter is while drugs are manufactured in India, they
come to the United States, and meet the qualifications
that Kylie was talking about. There are also drugs manufactured in India that are used in Indian
citizens that don’t meet the same qualifications. And so counterfeit medications globally is a huge international issue. People thinking they’re
taking the right drug for the right reasons, in fact might just be taking
a pill that’s largely, for the sake of conversation, we were talking about
excipients, it could be sucrose. It could be a sugar-like
ingredient without the same level of active ingredient as is intended or as is supposed to be there. So counterfeit medications are huge. When we started looking
at, in the United States, that’s why so much
attention has been given to these online prescribing
pharmacies where you can get your prescriptions
filled by going online and, but where are those drugs coming from? Are they coming from another country and then coming into this country? And then all kinds of untoward events. So, the interface, it
sounds like a sales pitch, and it’s not, just think about it. Would you want your disease
diagnosed over the computer, or do you want an
interface with a physician? Well, similarly you want
a personal relationship with a pharmacist who knows
what’s going on with you and having that relationship
with your pharmacist and overseeing your medications
is really important. Then, when things like that do happen, and it might be, well it’s
easy then to switch you over to another generic
medication and try that out. I had the same experience on a medication. I take Syntheroid and
I had the same thing. I took one generic form of Syntheroid and it impacted me
differently than another. Well, working with, in my case, working with my own pharmacist, finding the right one, until you, as Kylie said,
it’s sort of trial and error until you get to the right one. Any other questions? Pastor Priest. – [Pastor] Who was the one
that, when people go to a lot of different doctors, I work with a lot of elderly people. They have a lot of different doctors, a lot of people making prescriptions, they have a lot of
bottles in their counter and in their cupboards. Who’s the one that navigates
what works with what and that mix of meds that they’re taking? Is it the pharmacists? – Yeah, that’s a very good question. So the question is when
you have patients who see multiple physicians and
have multiple medications who kinda works to make
sure all those dots connect? And it definitely is the pharmacist, but I think it’s kind of a team effort. So the pharmacists are kind of
the chiefs of the medication so what we really pride ourselves on, are when patients come into
the hospital as getting a full medication review. I’m a pharmacy intern at the VA and when I work on the
weekends, that’s what I do. And it’s amazing when you ask a person, okay, tell me how you
take your medications and tell me what you take, how different it is from
the printout that I have that says what they’re actually taking. So I think a lot of it is doing med recs and from pharmacy or pharmacy
students kind of talking with the patients and
see they’re taking it, but then also relaying that
information to everyone who’s involved in that person’s care, such as their physician, providers, no matter how many there are. Because I think during
those transitioning cares, that’s when a lot of patients
can fall through the gaps, when things aren’t communicated. – I’ve often asked elderly individuals who have exactly the
situation you’re describing, I say, have you ever taken the time or if you’re not able to do that, having someone who is a
care provider for you, sit down with your pharmacist
and bring all of those in at the same time? Why? In some cases they’re taking a medication then they’re taking two
or three other medications because of the untoward effect
of the first medication, could be constipation, could
be whatever the case might be. Then, you’re going to different physicians and they’re prescribing
things and one person, the left hand doesn’t know
what the right hand’s doing, so now you’re prescribing
a medication that might counteract with this medication. So having a pharmacist, sort of your care
coordinator, if you will. They’re in a unique position
to be able to look at all those medications on the
table at the same time with a care provider and
answer those questions. – So I think we’re gonna close down the open question portion. Let’s thank them one last
time for coming today. And if anyone has any
additional questions, they will stick around up
here for a few more minutes, if anyone wants to come up. Thank you.

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