OCP going OTC (?)

I think it’s been a while since my last pharmacy-related post about something topical (and, no, not “topical” as in applied to the skin, but “topical” in the usual sense of the word). Can’t be entirely sure that I’ve ever written one, actually… Well, it doesn’t matter; I’m going to write one today. In this technological age, I’m probably a bit late pitching in my two cents’ now, but I’m busy, ok?

Over the week-end, I watched part of this talk show-type thing, and they were discussing a proposal received by the TGA to make the oral contraceptive pill (OCP) available in Australia without a prescription. For those of you unfamiliar with the Australian health system, the TGA (Therapeutic Goods Administration) is the organisation that determines what medicines are allowed in Australia and how they can be accessed (e.g. from a pharmacy with/without a prescription). It’s basically our equivalent of America’s FDA. Also, you can currently only access the OCP with a script, which, depending on how many repeats you are given, may allow you to have up to a year’s supply before seeing your doctor again.

There doesn’t seem to be an awful lot of information available publicly about the details of the proposal, except that pharmacists will need to get patients to complete a “minor questionnaire” and also measure their blood pressure before supplying the OCP. This is because there are some potential risks for certain people.

From what I gather, there’s a lot of opposition from doctors to this move. That’s kind of a given, though, since any move to give pharmacists more responsibility or an expanded role in healthcare is usually not taken well by doctors. And, ok, fair enough – doctors go through a lot of training to be able to do what they do. I would never suggest that my pharmacist training is enough to enable me to take on the roles of a GP. However, with the right training, I do believe that managing the supply of the OCP is something that pharmacists can greatly assist GPs with. Wouldn’t it be good to clear waiting rooms of people who are just there to get another OCP script, and allow GPs to focus on patients who need their attention?

Yes, I know there are benefits of having OCP patients visit their GPs on a regular basis, and some women who take the OCP need GP attention too. That’s precisely why I’m not advocating a “down-scheduling”, but rather something along the lines of increasing the expiry of OCP scripts. If, for example, a script written for an OCP was valid for three years, instead of the current one year, it would still be up to the patient’s prescriber to decide whether they want to give them two repeats or eight repeats (or however many repeats they judge to be appropriate for that particular patient).

If the TGA wants to proceed with down-scheduling, I reckon there will need to be more than just a “minor questionnaire” in place to prevent inappropriate supply, and to also ensure timely referrals. Yes, some guidelines or mandatory training would be great, but it shouldn’t stop there. Perhaps there should be some sort of an agreement between the patient and their pharmacy – an official document that helps ensure that the patient has received the appropriate counselling, and whereby the patient agrees to return to their doctor for regular reviews (time frame set by the GP? Maybe the GP should get in on this? There is the danger of making this more trouble than it’s worth… This is why I reckon the increased expiry and repeats thing could work better.)

Additionally, pharmacies will definitely need to provide private consultation rooms for this. Ideally this would be a separate room, and not just a table and a couple of chairs with a bunch of screens around them. Of course, I guess there is also the consideration of whether pharmacies will find it worthwhile to send a pharmacist out of the dispensary for 5-10 minutes for what could be just one sale (or just a referral and no sale). Pharmacies might end up asking for government reimbursements for these services.

I feel like the more I write about this, the more issues and problems I think of in relation to this proposal. I have hopes that this could be a positive step for the profession, but it needs to be done right. I remember a friend once told me about how, when she goes overseas, she can just walk into a pharmacy and buy any random OCP she wants – no questions, no forms, no history checks. The very thought of it still stuns me. Just have to remember that although we have rules and regulations in place for a reason, there may be equally valid reasons for these to be changed.

Advertisement

the baking of the cake

So… I’ve been asked to post the recipe for the Frangelico cake that featured in the last post. I think I didn’t include it in that post originally because I’d just taken a recipe that I found off Google. But I suppose I kind of tweaked it enough to be able to kind of post it as kind of an original recipe. (I only just realised, as I was proofreading this, that I wrote “kind of” so many times in that one sentence… Totally wasn’t intentional.)

The original recipe was sourced from All Recipes Australia, courtesy of someone called “kate” who apparently also lives in Queensland. Thanks “kate” (you’ll probably never read this, but thanks all the same).

I suppose another reason I couldn’t be bothered posting the recipe before was that a lot of my measurements weren’t very exact… so there’ll be a lot of approximations in the recipe below…

1. Preheat oven to 160C. Grease cake tin with some butter, and dust with a bit of flour (I actually used almond meal instead of flour here because, well, I just have a ridiculous surplus of almond meal…)
2. Measure out ~100g dark chocolate and ~100g butter, and melt these together in a small bowl in the microwave (in ~10 second bursts)
3. Whisk 3 eggs (medium-sized) in a large bowl, and then mix in (just under) 1/3 cup of caster sugar, 1/3 cup of plain flour, 1 cup almond meal, and 1/3 cup of Frangelico (but, yes, I did put in a little bit of extra Frangelico, and then a bit of extra almond meal)
4. Stir in 2-ish tablespoons of chia seeds, and then transfer cake mix to baking tin
5. Bake for ~30 minutes or until skewer comes out clean

I also made a simple cream cheese frosting to spread on top of the cake. This basically just involved beating together 250g of cream cheese, 1/3 cup of icing sugar, some hazelnut syrup and, yes, more Frangelico (I’m not an alcoholic, I swear – it was just a splash).

The cake turned out kind of fudge-y, which is perfectly fine. I added the chia seeds on a whim in an attempt to make the cake remotely healthy-ish (almonds are good too, right? Vitamin E and whatnot). At the very least, I didn’t expect it to affect the actual taste very much. Fortuitously, this addition seems to have added a nice bit of texture to the cake. Maybe next time I’ll try it with chopped hazelnuts or something, or make it with a different liqueur and add fruit. Maybe Chambord…?

Well, I hadn’t given too much thought to the end product when I was making it; I just hoped it would be an edible and reasonably tastey cake. Mission accomplished, I suppose, if I do say so myself. Also, my sister liked it, which was the whole point of the exercise, anyway.

I baked a cake

I don’t bake very often, which is something I actually find a bit odd because when I think about all the smells that I like, most of them involve baked goods (bread, roasts, anything with pastry, etc). Despite it being a hot summery day today, I decided to bake a cake. It’s kind of an early birthday cake for my sister.

The thing that I always hear about baking is that it’s really important to get the measurements right. When I hear things like that, it makes me think that, as long as you have a clear recipe, it doesn’t matter if you don’t have much experience with baking …so long as you follow the recipe. Simple, right? Having done a fair bit of compounding in my years in pharmacy, I’m pretty confident I can follow a recipe.

You can probably already see where this is heading: the recipe was not followed very strictly. Well, the end result was still fine. I had basically just searched online for an easy-ish recipe that I’d already have all the ingredients for (no way I’m walking down to the grocery store in this blazing heat just to buy a pack of hazelnuts or something!) To paraphrase the recipe, all I had to do was measure out the ingredients, melt the butter and chocolate together, and then mix everything together and bake.

For this cake, I needed 150g of butter. I didn’t think this would equate to a lot of butter (NB: estimating things like weight, distance, volume, etc is not my forte) but as I started to measure it out, it started to look like a lot, so I skimped on the butter a bit… Next was the dark chocolate. Yeah, no problem, I thought, there’s always plenty of chocolate in this house. But, yeah… might have been a little bit short on that too (most of the chocolate we have has nuts and fruit and whatnot…). Not to worry – the chocolate I did use was pretty good quality stuff, so I reckon that more than makes up for the slight shortcoming.

Long story short (not that it took very long at all), I basically compensated for less butter and chocolate (although I assume I sort of saved some by just melting it in a small bowl in the microwave instead of using a saucepan like the recipe said) with more Frangelico (which I used to help rinse the chocolate out of the bowl I’d melted it in), and then compensated for the extra Frangelico with more almond meal (which I wanted to use more of anyway because it was kind of expiring). Anyway, point is, it’s fine. Well, my sister hasn’t tried it yet, which I suppose will be the real test, but mum and I tried some that stuck to the cake tin, and it got her approval.

Strange thing that I’ve noticed is that although I don’t drink very often, and don’t drink much when I do, there’s something about cooking with alcohol that really seems appealing to me, particularly for desserts or anything sweet. I am not sure why.

Onto something different, but still related: When I went for a run this evening, I was thinking about baking, and thinking about how the word “baked” doesn’t sound quite right, even though it is correct. “I baked a cake.” Why doesn’t it convert into past tense in the same way that “make” does? “I bade a cake.” Don’t think it’ll catch on. Then I thought, what about “wake”… “I boke a cake.” It just sounds wrong. The English language is so weird. I reckon “baked” doesn’t sound right because “maked” and “waked” don’t sound right – but that’s because they aren’t right. Perhaps, however, it’s just because I don’t bake much, so I don’t use the word as much as I might. Well, I guess I know how to fix that.

just phenomenal

I would like to say that it’s not often that I come across a book that’s just totally mind-blowingly amazing, but it seems to be happening more and more often. Maybe it’s because I’m just getting better at picking good books to read, or maybe I’m more receptive to different writing styles and genres and content. Perhaps a bit of both, or something else? Who knows?

What I do know is that ‘Burial Rites’ (by Hannah Kent) is one such mind-blowingly amazing novel. A colleague recommended this book to me back around the time of it’s initial release. I was quite intrigued by it at the time, since it seemed so different and unique. The patriotic part of me likes that it’s written by an Australian author; the worldly part of me loves that it’s set in Iceland, a place whose culture and history I know very little about.

I will admit, however, that part of the reason I put off reading ‘Burial Rites’ for so long was because of all the Icelandic names for characters and places, which I thought might make it a bit difficult to read smoothly. Turns out, I didn’t really have anything to be worried about, since there’s a pronunciation guide at the start, and their words are easy enough to read – at least, it didn’t interfere with the flow of the narrative.

‘Burial Rites’ is actually Hannah Kent’s debut novel, which just adds to my amazement. Her writing is practically flawless, and the way she constructs the characters, the settings, the story – it’s just brilliant. What I really liked about ‘Burial Rites’ is that it alternates between third person and first person (from the point of view of Agnes Magnusdottir, the protagonist), and it’s done in a way that feels like it’s really adding depth and intrigue to the story. It’s sort of like getting inside her mind, like she’s telling you these secrets, and then you’re back to being an observer. Hmm… I’m probably not doing it justice with that description.

Interestingly, the novel is actually based on real people and real events, and even features real places. This actually makes me want to visit Iceland so that I can see all of these places and learn more about the history. Kent’s story of Agnes has sparked my fascination with Iceland, so it’s easy to see how Kent was inspired to share this story in the first place. Something else that I quite appreciate is that Kent isn’t overly descriptive about the landscape and weather. And for a place where it seems to basically be cold and snowing 99% of the time, it would have been easy to get repetitive and/or overly creative with metaphors.

In her author’s note at the end of the novel, Kent mentions that some of the publications she read as part of her research portrayed Agnes as “an inhumane witch”. However, I actually found myself sympathising with Agnes for a lot of the book. Perhaps she was innocent…?

This brings me to another point that I want to write about, but it is kind of a spoiler, so if you don’t want to know anything about the ending before reading it for yourself, please do not continue to read this (until you’ve gone and read ‘Burial Rites’, of course). You have been warned!

As the story nears its inevitable conclusion, Agnes gradually reveals what really happened on the night of the murder, and the reader is told more about her relationship with Natan, one of the victims. The hints start earlier in the novel, but as more of Agnes’s story is revealed, I found myself believing in her innocence, and hoping that her death sentence would be revoked. I almost believed it would be possible for her to have a “happily ever after”, but it was just not meant to be. As I reflected on this after finishing the novel, I realised that “good” endings, or satisfying endings, often are not very happy endings. If Agnes had been acquitted, would I have felt cheated of a “good” ending for the sake of the characters’ happiness? (“Characters” plural, because the Kornsa family she was with and (Assistant) Reverend Toti all cared about her in the end.) So it’s kind of the “best” ending, even if it is a sad one.

I reckon I like ‘Burial Rites’ a lot more than I’d expected to when I first added it to my to-be-read list. I would like to read it again one day, and certainly wouldn’t mind having my own copy (I got this copy from the library). I kind of just want to go around telling everyone to read it.

storm, storm, come this way…

Summer will be upon us soon. Tonight we had a bit of a mini storm, or an introductory storm, if you will. It didn’t rain too much around my place, but you could see lightning constantly flashing in the distance, and we did get a decent (albeit, brief) downpour at one stage.

I find that most people either really like or really hate storms. I generally don’t mind a good storm as long as I’m not in the process of travelling to or from work, or am trying to go for a run/cycle/something of that nature. I don’t tend to get overly thrilled by storms, though. Well, not as much as I used to when I was a kid. I have a lot of general/vague memories of watching storms from just within the shelter of the overhanging part of the roof in the backyard. To be able to feel the cool wind, the occasional spray of rain, and the thunder as it rumbles to your core – to be so close to all of this, but still safe within the bounds of the house – that felt awesome.

everything in moderation (including moderation)

It seems that Oscar Wilde spent a fair deal of time musing about human desire, and coming up with famous quotes like “I can resist anything except temptation”, and “everything in moderation, including moderation”.

I’ve been thinking over these quotes a bit recently because my horoscope said that my self-discipline and will-power would be tested in the coming months. (I generally only read my horoscopes occasionally, and just out of interest/curiosity, rather than to seek out guidance. I find they tend to give pretty general advice, anyway, like “avoid arguments at home/work” or “you will have a small win this week” – you know, stuff that can be applied to anyone. I don’t really have anything against horoscopes. Just, you know, take them with a grain of salt and some common sense.)

Well, anyway, this particular horoscope believed that I probably “eat, drink and spend too much” …which is probably a fair call. I am generally quite careful and frugal, but I will splash out now and then (mostly on food). Unfortunately, the horoscope had not warned me about one particular temptation…

Yesterday, being Friday, and being that I had longer work days on Monday and Tuesday, I had an early finish. The weather’s been warming up quite a bit, so I thought I’d go to the library and enjoy some aircon before going home. Thought I might pick up a good book, too. So, after treating myself to some lunch at a little eatery I’ve been meaning to try out for a while, off I went.

You can probably see where this is going, so I won’t drag it out too much. Generally when I browse the library shelves, I find maybe one or two novels that excite me enough to pick up and take to the check-out. On this particular afternoon, I found several, and actually had to tell myself to get out of the library before I found any more.

I’d originally gone in search of a copy of ‘Burial Rites’ (by Hannah Kent), which I was pleasantly surprised to find on one of the “recent returns” trolleys within about five minutes of searching. Such a short library visit is quite unheard of for me, so I browsed some more… and found ‘Kafka on the Shore’ (Haruki Murakami) and ‘One Hundred Years of Solitude’ (Gabriel Garcia Marquez). I also found ‘Clariel’ (Garth Nix) but had to (reluctantly) put it back because I knew there was no way that I’d finish more than three books within eight weeks (yeah, I don’t read very fast…)

Well, anyway, I was positively ecstatic with my yield. I was also a bit fearful for my self-control, but I think I’ve potentially discovered an explanation.

As I left the library, I contemplated getting a coffee and maybe a snack or something so that I could sit down and get straight into my new acquisitions (I would have just stayed in the library but, as I mentioned earlier, that place is full of temptation, and I couldn’t risk it). However, I quickly talked myself out of it, and just found a bench in a reasonably quiet section of the shopping centre.

As I headed home later, when the heat wasn’t so intense, contemplating the week-end, I was kind of grateful that I didn’t have plans (previous plans post-poned) because that meant I could spend the majority of my time being a hermit and reading. I did browse some shops before I went home, but I only bought a shirt, and some lollies to restock the “emergency” box at work. (I sometimes joke to new recruits that, while most places have first aid kits, we have a lolly box instead. But, don’t worry, we do have a proper first aid kit as well. It is a pharmacy, after all!)

So, as you can see, I avoided all unnecessary eating, drinking and spending. The area of least self-control (but arguably still ok, since I didn’t pick up more than three books) is perhaps library borrowing. I think that perhaps I’m subconsciously compensating for tightening up other areas by allowing myself to borrow more books. I reckon I’ve borrowed more books from the library in these last few months than I did all of last year (NB: not sure if this is actually true at all).

It is also possible that my frugal subconscious is taking advantage of the inverse relationship between books borrowed and books bought: the more books I borrow from the library, the less I buy from shops. I own a lot of books that I haven’t even read yet, and I think this is because I know that I could read those at anytime …so I go and get more books…

I think on my next visit to the library – to return these three books after finishing them – I won’t borrow any books. I’ll just go treat myself to some ice-cream or something instead.