Man pleads guilty to relabeling drugs with bogus FDA codes

This is some crazy stuff right here. The length that people will go to pull off a scam in the name of making money continues to amaze me. “Arif Diwan, 60, owner of Lifescreen LLC, a Cranston, R.I., based company that labeled, advertised, and sold drugs and pharmaceutical products under the brand name “LifeLogic,” pleaded guilty in federal court in Providence today to conspiring with others to purchase drugs manufactured in India and other countries, repackaging and relabeling them making it appear that they were manufactured in the United States and Europe, and had been approved by the United States Food and Drug Administration (FDA), and then reselling them… According to court documents, between 2012 and 2015, Diwan received and filled numerous orders for high-cost pharmaceutical products, including a number of products used in the treatment of cancer. Diwan admitted that he rebranded and relabeled drugs manufactured in India, including adding bogus FDA codes and markings to make it appear that the drugs had been manufactured in the United States or Europe and were approved for sale by the FDA. The drugs were shipped by Diwan to customers in numerous countries. Diwan did not sell misbranded and mislabeled drugs in the United States.”

Two important things to note: first, this happened between 2012 and 2015, and second, nothing appears to have been sold in the United States.

When people wonder why we need something like the new Track-and-Trace legislation, all one has to do is point them to the article above. Hopefully, the ability to see a drug’s pedigree from the manufacturer to the patient will prevent this type of thing from happening, or at least make it significantly harder to do.

NFC packaging for medications

NFC is good for more than figuring out how much liquor you have.

NFC World: “The two companies [Thinfilm and Jones Packaging] are collaborating to integrate Thinfilm’s NFC OpenSense technology into paperboard pharma packaging and establish key manufacturing processes for production on Jones’ high speed lines.” In addition “the work…will also include the integration of ferrite shield labels with the NFC OpenSense tags. This will enable NFC to function on metalized packaging such as blisters …”

Pretty cool stuff. By using NFC in the packaging, the simple tap of an NFC-enabled phone will allow you to authenticate the product, as well as track individual items. Would be neat to tie this into IV labels somehow.

My #ASHPMidyear15 technology loadout

I’ve made a few changes to my technology travel bag from last year.

My loadout for ASHP Midyear 2014 consisted of a Lenovo Yoga 2 Pro ultrabook, a Microsoft Surface Pro 3, and a Samsung Galaxy S5 smartphone.

I’ve since sold my Surface Pro 3 (SP3) and replaced my Galaxy S5. The SP3 was a great machine, but at the time I felt that I needed a better mobile keyboard experience. In hindsight, it was the wrong move. I used the SP3 to take handwritten notes, mark up PDFs, etc, and I desperately miss the active digitizer and pen support. I hope to remedy that problem with a Surface Pro 4 at some point in the near future.

My Galaxy S5 was a great phone. It went everywhere I went for more than a year, at times acting as my only “computer”. I used it for obvious things like calls, text messages, emails, etc – as well as to play games, listen to music, take photos, check my social media feeds, and so on. I’ve recently replaced it with a Samsung Note 5.

This year’s ASHP Midyear loadout will include:

  • Yoga 2 Pro– Same as last year. The Y2P will act as my primary workhorse. I will be using it to compose blog posts and manage photos and videos that I capture while walking around the exhibit hall. The only difference from last year is an upgrade from Windows 8.1 to Windows 10.
  • Toshiba Encore 2 Write – Remember above when I said that I missed having a Windows tablet with active digitizer and pen support? Well, the Encore 2 Write is my solution for the time being. The Write will likely go with me everywhere I go while I’m at Midyear. It’s small and light enough that I can carry it around, it offers great pen support for note taking, and has just enough horsepower to be productive. It does not replace the SP3, but it’ll do for now.
  • Note 5 – I’ve been wanting to try a Note for a while. Finally pulled the trigger, and I don’t regret it for a second. The Note 5 is big, beautiful, well made, fast, the screen is crystal clear and bright, the camera is second to none, the pen experience is phenomenal, and the battery life is good. What can I say, the Note 5 is the best smartphone I’ve ever owned. Period. I’ll be using it to manage my calendar, make calls, send texts, read and respond to emails, etc. I will also be using it to take photos and videos when possible. Not to mention that I’ll be using it to take handwritten notes. It’s possible that I will leave the Write in my room and try to go it alone with the Note 5. I see no reason why I shouldn’t try.

In addition to the three machines above, I’ll also be carrying various cables, adapters, and external chargers for my smartphone.

And there you have it, my ASHP Midyear 2015 technology loadout.




Choosing the right computer for the job

“Jack of all trades – master of none”

I recently read a great article by Paul Thurrott [PC vs. Tablet: Use the Right Tool for the Job]. The article concisely articulates how I feel about the non-Windows tablet space these days. I was a little surprised to discover that the article was posted in December of 2013.

Paul brings up some interesting points about the use of tablets versus PC’s.(1) I’ve been pursuing the perfect machine for many years. Like Paul, I tried using a Palm Pilot with a folding keyboard. And later a slew of tablets – iOS, Android, BlackBerry, webOS – in a jaded attempt to find a single, perfect device. To date I haven’t found a device that meets all my requirements for both home and travel. The Surface Pro 3 (SP3) was nearly perfect, but not quite. I believe Microsoft has finally figured “it” out.

I’ve had reason to think about the singular-device theory again due to the large number of articles covering the new Apple iPad Pro. I’ve seen many articles comparing it to the SP3. I don’t read those articles because they’re nothing more than clickbait. I really don’t think anyone believes that a mobile OS can compete side-by-side with a desktop OS. I’ve seen many try, and they’ve all failed. The iPad Pro is quite literally the Samsung Galaxy Note Pro 12.2 from January 2014, which is simply another attempt at creating a “real computer” out of a mobile OS. The SP3 is so much more.

I went down the iPad path a few years ago. I realized after several months that my three-year old tablet PC was much more capable. Unfortunately, I did the same thing with Samsung Galaxy tablets as well. Remember what Albert Einstein had to say about insanity, “doing something over and over again and expecting a different result“. It seems that that is applicable for those trying to use a mobile OS for “real work”. Anything I can do on a non-Windows tablet I can do on my phone. Why do I need a tablet running a mobile OS with mobile processors and mobile limitations? I don’t.

Thurrott states it perfectly: “Now, it’s certainly true that some people — many, in fact — can get what for them is “real” work done on a tablet or even a smartphone, phablet, or mini-tablet. That is, these devices provide access to email, calendar, contacts, the web, social media networks, various Microsoft and third-party services, and even remote desktop capabilities for the truly dedicated. They are simple and easily manageable…Of course, in our world—what we might call IT, or that of knowledge workers, but what I prefer to think of as the world of the “doers”—PCs aren’t going anywhere. And I think that many reading this, like me, have had that moment when we’ve sat with our hands hovered uncertainly over some other device—tablet, phone, whatever—and have simply gotten up, fished the laptop out of whatever bag it’s stored in, and gotten back to work. That is, we’d perhaps like to be able to get it all done on such a simple device. But our jobs are a bit more demanding.”

It’s strange, but after many years in search of a single mobile device to meet all my needs, I find myself slowly migrating back toward larger, more capable machine when I have work to do. I’ve even considered going back to a desktop machine for a host of reasons.(2) And like Paul, I believe that “I’m on the vanguard of something that will eventually occur to others…I’m not going to compromise my work or personal experiences for the other. I’m going to use the right tool for the job”.

Do I still want an ultrabook? Absolutely, but it won’t be my workhorse machine. Do I still want a non-Windows tablet? Sure, I like to tinker, but I won’t use it for anything more than surfing the net and playing games.

I’m really looking forward to the next round of Surface Pro devices because as I said above, Microsoft gets it.

1) Generic use of terms “tablet” and “PC”.
2) Bang for your buck. A Core i7 desktop with 8GB or RAM and 1TB hard drive can be had for around $500.

Will healthcare disruption come easy and fast?

Healthcare is so massively broken, that its disruption will come easy and happen fast

The quote comes from part of a weekly newsletter that I receive from Peter Diamandis. Peter was the keynote speaker at the ASHP Summer Meeting in Minnesota a few years ago. Truly inspirational. To date it is perhaps the only keynote address that I haven’t regretted sitting through.

Here’s a bit more from the newsletter:

Healthcare is so massively broken, that its disruption will come easy and happen fast. Hundreds of startups are working to make you the ‘CEO of your own health’ — to augment (or replace) doctors and hospitals.

I expect new AI-enabled healthcare options to be free or near-free, and so much better, that people will forgo traditional medical care in favor of these superior options. This will cause today’s healthcare system to crater.

Think libraries in an age of Google… Think traditional wired landlines in an age of mobile telephony… Think taxis in an age of Uber… Think long-distance in an age of Skype… the list goes on.”

I defer to Peter’s wisdom and incredible insight into the future, but I don’t think disruption in healthcare will come easy or happen fast. No industry needs disruption more than healthcare. However, healthcare appears resistant to the normal rules of the cosmos. The healthcare industry thinks that EHRs and bar code scanning technology is cutting edge. Their idea of mobile is using a smartphone as a drug reference.

There are many things being developed to improve healthcare, but the innovation is coming from outside sources. People are literally leaving healthcare to innovate things for healthcare. It’s a bit wonky, but true. The real test will come when innovators try to integrate their solutions back into healthcare. Good luck, ladies and gentlemen.

Healthcare is years behind other industries when it comes to innovation and cutting edge advances. As an example, I’ve been waiting for the use of pharmacogenomics for nearly 20 years. The concept has been around for a long time, but its integration into mainstream medicine remains elusive.

Peter has much more to say on the issue and I highly encourage you to read the rest. I also encourage you to subscribe to his newsletters. I find their content quite interesting.

I’m done with #Lenovo machines

I’ve had a lot of laptops over the years. I started with a Compaq tablet PC back in the day. Great machine. Ground breaking design and functionality. Tried Toshiba a couple of times. Nice machines, but they always had terrible batter life. Had one really nice high-end business class HP. I liked that machine. I’ve had three Dell’s, all crap. And I’ve had three Lenovo machines: a T410s laptop, an x201t tablet PC, and my most recent purchase, a Yoga 2 Pro.


Continue reading I’m done with #Lenovo machines

Do patients in the U.S. really own their healthcare data?

Yesterday I was reading through my Twitter stream when I came across a brief exchange between Eric Topol (@EricTopol)  and Farzad Mostashari (@Farzad_MD). Both are big names in the digital healthcare space.

Continue reading Do patients in the U.S. really own their healthcare data?

My ASHP Midyear 2014 technology loadout

I’m always tinkering with my travel bag to find just the right mix of computer technology and carrying convenience.

Most recently I’ve been carrying a Yoga 2 Pro, an Asus VivoTab 8, and a Samsung Galaxy S5. The Yoga 2 Pro serves as my primary machine for pretty much everything. The VivoTab 8 is an 8-inch Windows 8 tablet with Wacom digitizer, i.e. pen support. I use it to take notes, mark up PDFs, etc. I find that it’s just “okay”. The 8-inch screen is too small at times, and lately the digitizer has been finicky; a known issue with this tablet. The S5 goes everywhere I do. I use it for the obvious things – calls, text messages, emails, etc – as well as to play games, listen to music, take photos, check my social media feeds, and so on.

I’m changing things up a little this trip. My loadout for ASHP Midyear will include:

  • Yoga 2 Pro – This is my primary workhorse. It’s a great machine and meets almost all my computing needs. I will be using it to compose blog posts and manage photos and videos that I capture while walking around the exhibit hall.
  • Surface Pro 3 – New this year, the SP3 will likely go with me everywhere I go while I’m at Midyear. It’s small and light enough that I can carry it around, it offers great pen support for note taking, and still has plenty of horsepower for when I need more than a tablet. I thought about leaving the Y2P at home and taking only the SP3, but I’ve never traveled without a “real laptop”. I’ll see how things go during Midyear. If things work out then I’ll leave the Y2P at home next time. Can the SP3 really replace my laptop? I don’t know, let’s find out.
  • Galaxy S5 – As mentioned above, this is my primary mobile device. I’ll be using it to handle my calendar, make calls, send texts, read and respond to emails, etc. I will also be using it to take photos and videos when possible. I thought about taking my Sony Handycam for video, but decided against it for two reasons. First, it’s another piece of hardware to carry around. Second, I don’t know if vendors will allow me to walk around shooting video of everything they demo. For those that allow me to take video, I’ll have my S5.

In addition to the three machines above, I’ll also be carrying various cables, adapters, and external chargers for my smartphone.

And there you have it, my ASHP Midyear 2014 technology loadout.

The illusion of multitasking

Yesterday I went through the drive-thru of a local fast food chain. The young lady manning the register asked for my order, so I started giving it to her. She asked me to pause for a second, and when she resumed she repeated the first part of my order back to me. She had it completely wrong. This happens to me all the time in the drive-thru, which is why I typically avoid them at all cost. Yesterday I made an exception and instantly regretted it.

People working drive-thru windows at fast food joints typically try to multitask, i.e. take an order from one person while trying to put an order together for another, and so on. In my experience this usually results in what happened to me yesterday. Frequently I have to repeat part, if not all, of my order. I find it quite irritating.

Multitasking is a myth, plain and simple. People do not have the mental capacity to concentrate on more than one thing at a time. Don’t take my word for it. There’s plenty of evidence to back up my claim.

Christopher Chabris, PhD is a professor, research psychologist, and coauthor of the best-selling book The Invisible Gorilla. His research focuses on two main areas: how people differ from one another in mental abilities and patterns of behavior, and how cognitive illusions affect our decisions. He has published papers on a diverse array of topics, including human intelligence, beauty and the brain, face recognition, the Mozart effect, group performance, and visual cognition. He was also the keynote speaker at the unSUMMIT that I attended last week. The presentation was fantastic.

According to Dr. Chabris everyone thinks they can multitask, but very few can. His research estimates that a mere 2.5% of people can “do ok as a multitasker”. Unfortunately his research has demonstrated that everyone thinks they can multitask, and those that consider themselves true multitaskers tend to do the worst in experiments that require one’s attention.

Everything that Dr. Chabris spoke about applies to pharmacy, but I found two things particularly interesting:

  • Post completion errors – this is when someone forgets to complete the last step of a process. Examples include leaving an original paper on a copy machine, or in healthcare, when someone leaves the guide wire from a PICC insertion in place. Even when people are told they forgot the final step they often can’t figure out what went wrong. Dr. Chabris refers to this as “satisfaction of search”, i.e. you see what you expect to see. This type of thing happens all the time in pharmacy practice, especially during the distribution process and the IV room.
  • “Illusion of attention” – this is when people think they can pay attention to multiple things at once. He refers to this as an “everyday illusion”, of which multitasking is a prime example. These misconceptions are hard to overcome and systematically wrong. How many times have you witnessed a pharmacist or pharmacy technician trying to do more than one thing at a time – talk on the phone while filling a script, retrieve tablets from a “Baker cell” while on the phone, etc? Happens all the time.

Overall the presentation was solid and the information valuable. I recommend taking a look at Dr. Chabris’ work. The concepts can be applied both directly and indirectly to errors that occur in the pharmacy.