Conflicting drug information from "authoritative" sources…
If you do a Google search for "Tylenol #3", the second hit on the page is this link. Looking closely at the page, you'll note that we're talking about "Tylenol #3" specifically. Why then, is the Common Name listed as "acetaminophen – codeine – caffeine"?
There is no caffeine in Tylenol #3. There's just acetaminophen and codeine.
What form(s) does this medication come in?
Tylenol NO. 3 with Codeine®: Each round, hard, white, flat-faced tablet, bevelled-edged, engraved with "3" on one side and "McNEIL" on the other, contains acetaminophen 300 mg and caffeine 15 mg, in combination with codeine phosphate 30 mg. Nonmedicinal ingredients: cellulose, cornstarch, and magnesium stearate. This medication does not contain gluten, lactose, sodium metabisulfite, or tartrazine.
Who should NOT take this medication?
Anyone allergic to acetaminophen, caffeine, or codeine should not take this medication.
In the United States, when a doctor writes "T3" or "Tylenol #3" you're getting 300mg of acetaminophen and 30mg of codeine. No caffeine.
However if you go to the Janssen-Ortho website and hit up their product information PDF for their Tylenol products, it indicates there's caffeine in T2 and T3, but not T4. But the Ortho-McNeil website's prescribing information (PDF), for T3 indicates that it's 300mg APAP and 30mg of codeine. No caffeine.
So WTF is going on here? I called Ortho-McNeil (US makers of T3) and I also called Janssen-Ortho (Canadian counterpart). The US office told me what their website did: no caffeine. I have yet to hear back from the Canadians — they say they'll return your call in one business day. I'm wondering if there's a difference between Canadian T3s and US T3s? Maybe in Canada, they have 15mg of caffeine, whereas in the US, they don't? If this is indeed the case, talk about a nightmare trying to track down accurate consumer information. Yikes.
Update: I just got off the phone with Janssen-Ortho of Canada, and Tylenol #3 in Canada has caffeine in it, which means that it is different than the US formulation of Tylenol #3. If I had trouble figuring this out, how much moreso would your average consumer struggle?
[tags]Medicine, pharmacy, drug information, T3, Tylenol #3[/tags]
How will the 300 Minute Clinics in 2007 impact current medical practice?
According to a Reuter's report, CVS plans to open 300 new Minute Clinics in 2007.
Is this going to change the way doctor's offices fundamentally do business? In the long-term, I think so, because right now they can't compete with retail convenience. In multi-doc office, I expect to see doctor/NP/PA scheduling altering to have a more or less constant presence in the office. This will be particularly true with NPs and PAs who can handle more immediate issues — the things that will be diagnosed at Minute Clinics.
There's been lots of talk in the medical blogging community about how Minute Clinics are "bad" in the sense that a patient's medical history will be spread out over multiple locations. That the treatment prescribed by the NP at the Minute Clinic will be sub-par, or not what one's PCP would have chosen. These are valid complaints, so I expect to see doctors respond in the areas where Minute Clinic density is higher.
You don't need a large medical practice to cover a lot of hours. Lots of hours = lots of availability. Sure it's not as nice as a 7-7 medical practice, but it IS more convenient for the patients/customers. And it has unexpected benefits as well — 3 days weekends once a month and the like are not uncommon for pharmacists.
Realistically, a moderately-sized medical practice (3 docs, say) could easily cover 72 hours of availability per week. 8am-8pm Monday through Friday, and 9am-3pm on Saturday and Sunday. Start with one doctor in the morning, have the second come in later in the day, say around 11am or noon, and doctor #1 goes home around 4-5pm while his/her colleague stays until late. This is what retail pharmacists do, and I expect you'll see variations on this theme for doctors once they start feeling the pressure from retail clinician availability. Get an NP or a PA to see the urgent cases, and I think you could probably cut down on ER overuse in your area.
Are there problems? Yes. Are the insurmountable? No. Will it happen in the next five years? Probably. Think about it. 300 Minute Clinics in 2007 alone. If they become big hits, expect to see that number grow yearly. That's a lot of Minute Clinics. That's a lot of lost, easy revenue.*
*I think it was Flea(?) who said that these types of visits are the bread and butter of pediatricians because they're fast and easy. These are the types of visitors the Minute Clinics are catering to.
[tags]Medicine, pharmacy, CVS, Minute Clinic, retail medicine[/tags]