Featured alumni of the University of Colorado School of Pharmacy: Sandra Leal, PharmD, CDE (repost)

I had the great pleasure last week to visit the launchpad of my academic career: the Department of Pharmaceutical Sciences at the University of Colorado School of Pharmacy.  Recently relocated from the historic 9th & Colorado campus in Denver, the School currently occupies academic and research buildings at the impressive new University of Colorado Denver’s Anschutz Medical Campus six miles east in the city of Aurora.

Next year, the UCD School of Pharmacy will be celebrating the centennial of its establishment on the University of Colorado at Boulder main campus. In a discussion with Dana Brandorff, Director of Communications and Alumni Affairs, about potential centennial publicity activities, I suggested that the School feature some of its more noteworthy alumni.

As an example, I wish to offer this repost of an interview with one of my own former students, Sandra Leal, as written on October 10, 2009, for the Diversity in Science blog carnival in honor of Hispanic Heritage Month.

Note: The following post appeared originally at the former ScienceBlogs home of Terra Sigillata on 10 October 2009.


This month, DrugMonkey is hosting the Diversity in Science Blog Carnival, started by DN Lee of Urban Science Adventures! to celebrate the scientific contributions of individuals from underrepresented groups. To celebrate US Hispanic Heritage Month, DM asked for us “to write and submit your posts in honor of scientists whose ancestors came from Spain, Mexico, the Caribbean and Central or South America.”

One of the greatest rewards of being an academic scientist is watching remarkable people pass through your laboratory and classroom who then go on to do amazing things. Upon reading Drug’s call, my mind turned immediately to a perfect subject for this carnival. Continue reading

El Rio Community Health Center honored with 2009 APhA Pinnacle Award

El Rio.jpgAs I have said on occasion, the health care insurance reform debate seems to have underestimated the role of the clinically-trained pharmacist in improving care and cutting health care costs. Hands-on community-based drug management models have been operating around the US with far less fanfare than cut-rate prescriptions at Wal-Mart or CVS Caremark.
So I was delighted to learn via Phoenix pharmacist commenter, Michael Guzzo, that El Rio Community Health Center in Tucson, Arizona, was recognized this past summer with a 2009 Pinnacle Award from the American Pharmacists Association (APhA) Foundation.

These awards were inspired by and created in response to the increasing importance of the proper use of medications in today’s health care environment. Morbidity and mortality associated with improper medication use is a major public health problem, resulting in significant disability and up to 100,000 deaths each year. An estimated 177 billion dollars is spent annually on preventable hospitalizations, lengthened stays, and/or prolonged treatment as a result of prescribing contraindicated therapy, drug-drug interactions, adverse drug reactions, duplication of drug therapy, and/or errors in drug administration.
“The 2009 Pinnacle Award recipients represent those who are shaping the future of health care delivery,” said William M. Ellis, APhA Foundation Executive Director and CEO. “Their work shows that system changes and new thinking are not only possible but can enhance medication use and improve patient outcomes. The one constant between all of the award winners is that they never fail to put the patient as the focal point in the care process and I commend them for their commitment to quality.”

Guzzo pointed out to me that a four-minute YouTube video is available from APhA detailing the activities of El Rio. Diabetes disproportionately affects Hispanic patients, and especially type II diabetes in Native Americans of the Pima tribe, in the Land of the Sun. Through a series of culturally-sensitive and reading level-appropriate materials and face-to-face medication counseling, El Rio’s team of three clinical pharmacists and others are making great strides in improving the quality of life, and decreasing the costs of diabetes complications, for thousands of good folks in the Sonoran region.
Of great pride to me is that the team is led by Pharmboy laboratory graduate, Sandra Leal, PharmD, CDE. We featured an interview with her back in October for the Diversity in Science Carnival during Hispanic Heritage Month. Sandra is featured prominently in the second half of this video.

Congratulations to all the good folks at El Rio who are making a world of difference in the lives of diabetes patients in Arizona and serving as an example for community pharmacy practice models nationwide

Naturopathy drug prescribing proposal in Ontario: Rx for a liability nightmare

Canadian flag.jpgTwo weeks ago, Canadian Skeptics United published on their Skeptic North site a piece by an Ontario pharmacist criticizing a proposal by the province to grant limited prescribing rights to naturopaths. The essay, which was reprinted in the National Post on Tuesday, outlines the intellectual and practical conundrum presented by allowing those with education that diverges from science-based practices to prescribe drugs.
The naturopath lobby has come out in force and appears to be relatively unopposed in the 54 comments that follow, primarily because the NP closes comments 24 hours after online posting. Therefore, those with a more rational and considered viewpoint based in facts have been locked out from commenting. This is quite disappointing to me personally and professionally because of the wildly emotional appeals, strawman arguments, and smears and attacks on the author himself without, of course, addressing his well-founded criticism of the prescribing proposal before the provincial government. At the Skeptic North post, the piece even drew a naturopath who equated the criticism of his/her field with the Nazis and Mussolini. However, ad hominem attacks, especially Godwin’s Law, are quite common when one’s stance is flawed.
Naturopathy, sometimes called naturopathic medicine, is an unusual and inconsistently regulated alternative medical practice that co-opts some evidence-based medicine, often in nutrition and natural product medicines, but also subscribes to “vitalism” (vis medicatrix naturae) and makes use of homeopathic remedies that defy the rules of physics and dose-response pharmacology.
Naturopathy is, however, a warm and fuzzy term, especially when equated with “natural medicine” and the fact that people with naturopathy degrees advertise themselves with the honorific of “Dr.” The increasing popularity of naturopathy is also supported by cultural influences. I’ve written before that many, uh, natural product enthusiasts have become interested in naturopathy following the relocation of musician Dave Matthews from Charlottesville, VA, to Seattle, WA, where his wife, Ashley Harper, earned a naturopathy degree at Bastyr University.
In addition to the description of the practice in the NP op-ed, an excellent review and critical analysis of naturopathy by Kimball C Atwood IV, MD, can be found at Medscape General Medicine. The abstract is as follows:

“Naturopathic medicine” is a recent manifestation of the field of naturopathy, a 19th-century health movement espousing “the healing power of nature.” “Naturopathic physicians” now claim to be primary care physicians proficient in the practice of both “conventional” and “natural” medicine. Their training, however, amounts to a small fraction of that of medical doctors who practice primary care. An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices. Despite this, naturopaths have achieved legal and political recognition, including licensure in 13 states and appointments to the US Medicare Coverage Advisory Committee. This dichotomy can be explained in part by erroneous representations of naturopathy offered by academic medical centers and popular medical Web sites.

Like many alternative practices, naturopathy claims to harness the body’s own healing power as if differentiating that fact-based medicine does not also employ the body’s capacity to heal. The very same drugs that naturopaths wish to prescribe are those which can only work because they interact with targets in the body for which our endogenous compounds already act.
It seems to me that naturopathy adopts either science-based medicine or pseudoscience depending on the venue in which it serves the organization.

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Sandra Leal, PharmD, CDE: A Hispanic Heritage Month Interview on What Pharmacy Can (and Should) Be

DiSBadge_150.jpgThis month, DrugMonkey is hosting the Diversity in Science Blog Carnival, started by DN Lee of Urban Science Adventures! to celebrate the scientific contributions of individuals from underrepresented groups. To celebrate US Hispanic Heritage Month, DM asked for us “to write and submit your posts in honor of scientists whose ancestors came from Spain, Mexico, the Caribbean and Central or South America.”
One of the greatest rewards of being an academic scientist is watching remarkable people pass through your laboratory and classroom who then go on to do amazing things. Upon reading Drug’s call, my mind turned immediately to a perfect subject for this carnival.
Sandra U of A.jpgSandra Leal was a rising pre-pharmacy sophomore from the University of Arizona in Tucson who came to the University of Colorado School of Pharmacy for a summer cancer research internship sponsored by the American Cancer Society. She took on a difficult project involving transient transfection of human leukemia cells to ascertain the role of the oncoprotein transcription factor c-Myb in activating production of DNA topoisomerase IIα, an enzyme whose action in DNA decatenation and chromosomal segregation is absolutely required for cellular proliferation. Among her many laboratory talents, Sandra became a champion at CsCl double-banding of supercoiled plasmid DNA because even Qiagen-prepped plasmids were too impure for leukemia cell transfection. Her intellectual and technical contributions then and later led ultimately to co-authorship on a publication in the Journal of Biological Chemistry.
Despite her initial intentions to go the University of Arizona College of Pharmacy, Colorado was successful in recruiting Sandra to their BS and Doctor of Pharmacy programs due to the generosity of L Samuel Skaggs and his family’s ALSAM Foundation. A philanthropist whose family is deeply entrenched in the history of pharmacy in the western US, Skaggs endowed over a dozen full-tuition scholarships at Colorado for students from underrepresented groups in inner cities or rural towns to become pharmacy professionals and, ultimately, return as role models for young people like them.
Sandra graduated as valedictorian of her class of over 100 doctor of pharmacy students.
Sandra Leal, AZDS.jpgWith her basic science foundation and training in pharmacy practice, she returned to Arizona for residency training with a focus in diabetes education and clinical service. Among her many accomplishments since, Sandra became the first pharmacist in the state of Arizona to earn limited prescribing rights and she is immediate past-president of the Association of Clinicians for the Underserved.
For this Diversity in Science Blog Carnival entry, Sandra agreed to answer a few questions for Terra Sigillata readers. Sandra is not only a role model for Hispanic students in science and pharmacy but her story tells us what can and should be done in the field of pharmacy practice.

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Franck’s pharmacy tech claims unjust termination in polo horse deaths; sues under Florida Whistle-Blower’s Act

Today’s post comes to your courtesy of yet another of my revered Canadian colleagues: pharmacist Scott Gavura, author of the excellent Science-Based Pharmacy blog.
Puukolo Maui-Born Polo horse.jpg
Back in April, 21 Venezuelan polo horses from the Lechuza team died at the U.S. Open Polo Championship in Palm Beach County, Florida after being injected with a compounded supplement similar to Biodyl®intended to prevent equine rhabdomyolysis syndrome (EMS) – known otherwise as “tieing-up” or azoturia.
Franck’s Pharmacy in Ocala, Florida – the heart of Florida’s equine community – was the compounding pharmacy where the supplement recipe was prepared. The cause of the horse deaths was attributed to selenium overdose.
The Orlando Sentinel and Drug Topics report that a 13-year pharmacy technician, Sheila Harris, has filed suit against the company for terminating her following her cooperation with a US Food and Drug Administration investigator. The Sentinel story reports that Harris mixed the fatal supplements and supplied the investigator with “the mixing directions she was given by the lab pharmacy manager.”

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Biodyl, Franck’s Pharmacy, and Florida Polo Horse Deaths: Guaranteed It’s the Decimal Point

Last weekend, 21 Venezuelan polo horses collapsed and died at the US Open championship match at the International Polo Club Palm Beach in Wellington, Florida (AP, CNN). The deaths have now been associated with injection of a veterinary mineral supplement produced by a compounding pharmacy in Ocala, Florida. Located in central Florida about 45 min south of the University of Florida, Ocala is well-known for its density of equestrian farms and training centers.
Precisely how this supplement killed the animals is not yet known but I can guarantee that it was a calculation error involving an errant decimal point, the bane of any professor in the STEM disciplines.
The compounding pharmacy that provided the supplement was apparently trying to reproduce the formula of a swine and equine supplement sold worldwide under the brand name, Biodyl. Biodyl is produced by Merial, an animal health product company run as a joint venture of Merck and Sanofi-Aventis. Merial conducts business in about 150 countries and lists annual sales at $2.6 billion; while they have operations in Duluth, Georgia, the Biodyl product is not sold in the US and their pressroom site does not have any information on this case as of this afternoon.
However, and to be clear, the product in question was not made by Merial. Rather, it was a custom formulation apparently commissioned by a veterinarian from Franck’s Pharmacy, a compounding pharmacy that has been in the business for over 25 years. Compounding pharmacies do what comes to mind when one thinks of an old-fashioned pharmacist in a Norman Rockwell painting.
Today, compounding pharmacies continue to play an important role in human and veterinary medicine in providing specialty products made to specific doses not available commercially, free of preservatives or potential allergens, or otherwise meet individual patient needs. The International Academy of Compounding Pharmacists has an excellent primer on the role of this practice of pharmacy.

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University of Colorado student died of opium tea overdose

After writing this post, I came across Alex’s obituary and guestbook on Legacy.com. By all accounts, Alex was a great kid – loved and admired by many – an accomplished hockey player and musician with a love for the mountains. This could have been you or I, or worse, one of our own children.
Breaking my heart this morning is news from Boulder that last month’s death of 20-year-old CU student, Alexander McGuiggan, was from consumption of “opium tea.”

Police department spokeswoman Sarah Huntley said investigators believe McGuiggan and others had acquired poppy plants — which are available legally over the Internet — and were boiling pods to make intoxicating tea.
Police believe McGuiggan knew that the tea he was drinking was made of opiates, Huntley said.
“What he may not have been as aware of was the dangers of what he was ingesting,” she said.
The Boulder County Drug Task Force is investigating other people who may have been involved in “the procurement of the tea, and the making of the tea,” Huntley said. Those people could face charges, she said.

A previous report has been that the student and friends were boiling up poppy seeds, but I was suspicious as those lack significant amounts of opiates. Instead, as Ryan Morgan of The Boulder Daily Camera reports accurately, the students appear to have obtained seeds for Papaver somniferum, and grown plants, and extracted the latex from mature pods. Opium is an alcoholic tincture of the pod latex and is comprised of approximately 10% morphine, 0.5% codeine, and other lesser naturally-occurring opioids (the plant synthesizes these opiates of the “benzomorphan” class in a biosythetic pathway beginning with the amino acid, L-tyrosine.).
The sad fact is that we’ve known for over 200 years that this is a bad idea: based upon growing conditions, harvest time, and extraction method, the resulting concoction can provide an extremely variable dose of these compounds. Used medicinally as one of the strongest analgesics (“painkillers”) we know, in higher doses the opiates can impart a warming sense of euphoria but, at even higher doses, suppresses the respiratory control center of the brain stem, resulting in death.

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Up from the comments: Pharmacist objection to legitimate MS Contin prescription

Back in February 2007, we had a lively discussion on a post about pharmacist objection to filling prescriptions for drugs they felt went again their personal moral stance: from morning-after pills to garden-variety oral contraceptives. I held that since pharmacists are licensed by the state to provide a service to the citizenry (and they make about as much money as a full professor at a US research university), they should be required to fill prescriptions. Some commenters argued that ethical practice of one’s profession dictate that one apply moral standards. I disagree. As an agent of the state, one is required to execute the responsibilities of one’s license.
Back then, we discussed where a pharmacist could then draw the line if allowed to be a “conscientious objector.” Could a pharmacist refuse a legitimate narcotics prescription, outside of clear fraud? Could they refuse to fill for an HIV medication or drug to treat a sexually-transmitted disease?
Well, this comment came in from attorney and cancer patient, Sharon Red Deer, former faculty member at the College of Law at the University of South Dakota in Vermillion (MS Contin is an oral, controlled release form of morphine sulfate):

What an interesting discussion. I came across this website researching a law review article I am writing about the hysteria of opioids from the medical community due to my disciplines “war on drugs”. My interest is both professional and personal.
A pharmacist at Walgreens (where I have been customer for several years) refused, on Sunday, to fill a prescription for MS Contin (obviously from my doctor) because he “that I should find some alternative pain relief”. Of course, he doesn’t know that I am terminal or anything else about me. I have had a prescription for MS Contin since I was diagnosed 2 years ago; every month I have it filled there. This was pharmacist I have not seen before. When I asked what I should do, he shrugged. How do these people sleep at night? In my discipline and all PROFESSIONAL disciplines that I am familiar with; your own personal views cannot be allowed to interfere with your obligation to you client (or patient).
In fact, if you are a court appointed attorney, you are obligated to represent that person to the very best of your skill and due diligence unless the person is so repugnant to you as to impede your defense of him / her. No mention of how we may feel about it. Only if the client would be affected. All personal moral and ethical issues are negated. Only the best interest of the client is relevant. It isn’t about the lawyer; it is ALL about the client. I thought that was the standard for all true professionals.

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Homeopath to be awarded honorary Doctor of Science from first US school of pharmacy

The complicity of revered academic institutions in the promotion of pseudoscience today takes another step forward.
The University of the Sciences in Philadelphia (USP), known formerly as the Philadelphia College of Pharmacy and Science (PCP&S), will bestow an honorary Doctor(ate) of Science on John A Borneman, III, to celebrate their Founders’ Day.
From the university press release:

Borneman has spent his lifetime committed to the development and regulation of homeopathic medicine within the United States. He is the third of four generations of “John Bornemans” to attend the Philadelphia College of Pharmacy. Upon graduation, Borneman joined the firm of John A. Borneman and Sons, Homeopathic Pharmacists, begun by his grandfather in 1907. In 1980, Borneman was a founding director of the newly incorporated Homeopathic Pharmacopoeia Convention of the United States (HPCUS), and in 1983, he was elected the second president of the organization. In the course of his 25 years as president, his leadership evolved HPCUS into a respected international body of scientists and experts consulted by governments world-wide as the leader in homeopathic regulation. His work has led to the wide availability of standardized, high-quality medications to the general public. In Aug. 2008, Borneman assumed the role of HPCUS chairman of the board, where he continues to be a gentle guiding force in a rapidly growing industry. He continues to lecture on homeopathy to both pharmacy and physician assistant students at University of the Sciences, and maintains a practice in community pharmacy and patient care at Treatment Options Pharmacy in King of Prussia, Pa.

Here is a brief primer on homeopathy and you can go to my post here to learn the oft-misunderstood difference between dose-response-based herbal medicines and homeopathic remedies:

Homeopathy is a fraudulent representation of pharmacy and the pharmaceutical sciences that continues to exist in the United States due solely to political, not scientific, reasons. Indeed, homeopathic remedies are defined as drugs in the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 321] Section 201(g)(1) as a result of the 1938 actions of U.S. Senator Royal Copeland (D-NY), a noted homeopath of his time. But scientifically, homeopathic remedies are nothing more than highly-purified water misrepresented as medicine based upon an archaic practice that is diametrically opposed to all pharmacological principles. The mental gymnastics required to teach chemistry, pharmacology, and therapeutics while also embracing homeopathy are beyond the skills of anyone trained in the scientific method.

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Doctor, doctor, give me the news*

I’ve been having this 3:30 am (EST) insomnia for about the last two months, so I often pull the laptop up and survey the blogosphere in the still of the night. A simple look at the Last 24 Hours at ScienceBlogs and elsewhere in the blogosphere tells me that some knuckleheads in the mainstream press have taken issue with Dr Jill Biden, doctor of education, using the honorific, “Dr.”
Keep in mind that the article in question comes from the L.A. Times – the very same paper that graces my e-mail account weekly humping their fishwrapper’s science and environment coverage. I did just look up some of these articles and while some folks are referred to as Senator or General, professionals who earned PhDs carry no honorific.
My dear colleagues below have done a collectively admirable job on addressing the historical use of “doctor” for PhDs, even before physicians used the term “medical doctor.” (However, I do believe that while physicians in Great Britain use “Dr,” it is more honorable to use “Mr” if one is a surgeon.)
But because my pharmaceutical and herbal medicine work causes me to straddle different worlds, here are my two contributions to raise more ire regarding who should or shouldn’t be using the honorific, “Dr”:
N.D. – Doctor of Naturopathy
Pharm.D. – Doctor of Pharmacy

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