State senator (R) offers an alternative to costly EpiPen - and a response (not mine)

[question everything]

Last week Sen. Paul Anderson hosted a town hall with Sen. Michelle Benson as guest. One man asked what our leaders could do to fix skyrocketing drug costs. His grandson has anaphylactic allergies and the family can no longer afford his EpiPen. Sen. Benson’s answer was that people “need more skin in the game” and his grandson could carry a glass vial of epinephrine and a syringe to save money.

To that end, I have attached directions for injecting Epinephrine from a glass vial:

1. Time is of the essence. Do the following without delay:

2. Locate the 1cc tuberculin syringe with 1/2 or 5/8 inch, 25, 26, or 27 gauge needle.

3. Break the neck of the glass vial at the scored site in one fluid motion to avoid glass shards.

4. FULL CONTENTS OF THE VIAL MUST NOT BE GIVEN IN ONE DOSE. Give only the correct dose based on patient’s weight.

5. Turn vial at slant without tipping or contents will be lost. Loosen plunger with 1-2 dry pumps. Draw up slightly more than calculated dose.

6. Turn needle up, tap side of barrel, when air bubbles go to the top, push the plunger tip up to exact dosage. Give (calculated amount) cc of 1:1000 Epinephrine.

7. Clean injection site with alcohol (if no alcohol proceed anyway).

8. Give injection intramuscularly in upper arm, deltoid, or middle third of outer thigh.

9. Pinch two-inch fold of flesh. With fluid motion inject the needle fully at 90 degrees.

10. Release pinched tissues. While holding barrel with one hand, retract plunger, looking for for blood. If there is blood, pull the needle out and try a new site.

11. If no blood, push plunger to inject Epinephrine. Pull the needle from the skin. Apply pressure.

12. Transport patient to nearest emergency room.

Although Sen. Benson recommends the above substitution to save money, as a physician I can’t recommend it. Instead, I recommend our leaders grow backbones and stand up to predatory pharmaceutical pricing.

Allison Stolz, MD
Minnetonka

http://abcnewspapers.com/2017/04/20/letters-to-the-editor-for-april-21-2017/

[ProfessorPlum]

1. that's actually more humane than what I expected Benson's reply to be

Thought for sure she would say "get a better job".

[riversedge]

5. Benson is a rural Mn Senator, while the Dr. in the Letter does not rec. that procedure. It is not

clear from the letter to editor where that recipe came from. In addition, what physician will write a prescription for a vial? of epi?? In the rush of an emergency, this is not practical, especially for an inexperienced person. A medic yes-. Just a stupid-and dangerous Letter to the editor to publish IMHO

[ProfessorPlum]

7. I think that's exactly the point of the letter

no patient (esp. one suffering anaphylaxis) could do this to themselves in the heat of the moment.

[question everything]

10. WebMd is one source

http://www.webmd.com/allergies/how-to-give-an-epinephrine-shot-to-a-child

[riversedge]

12. Those directions are for the Prepared "Epi-Pen" person to use. Not the vial. Glass vials are

very different. I have not seem them used in years and years. Just saying.

[Elwood P Dowd]

2. I have to keep an EpiPen

and it cost me $600.00 last year for a pack of 2. This idiot has no clue what the situation is like when that allergy shit hits you and you need emergency help.

[BannonsLiver]

9. He assumes everyone would remain calm

I bet it's pretty fucking hard to remain calm when your breathing is being cut off by an allergic reaction. Especially for a child. Exhibit Z that the GOP, every GD last one of them, are fucking morons.

[asiliveandbreathe]

3. There is NO reason for the Epipen costs..bigpharma is making money hand over fist...

The good Dr. from Minnetonka is just too PC...Benson is a POS!

[unblock]

4. funny. some of this is overstated, as epipens don't do half of this.

the advantage of epipens is that it's premeasured as the correct dosage (assuming you bought the right size), loaded and ready to go.

but you just jam it into your leg. no pinching of flesh, no retracting of plunger to look for blood. just jam it in and go.


so some of this detailed description is to allow for a more careful process (refining the dosage instead of picking one of epipen's two possible dosages, making sure it doesn't go directly into a blood vessel, etc.)

if it's ok for epipen to skip these steps, it's no worse to skip those steps when using a normal syringe.



still, the point is made. epipens are used in emergency situation, and normally by non-professionals, if not absolutely panicked parents. you don't want to make the process any more complicated than necessary.

[riversedge]

13. Epi pens (different brands but same principles) are common usuage in nursing homes and

hospitals for several years now. The article sucks.-that an elected politician would be advocating such an approach.

[Doremus]

33. I think epipens have a different needle

Certainly not an expert, but the epipens I've seen have a shorter needle than a regular syringe. Longer needles would potentially reach more blood vessels, even arteries.

Someone more knowledgeable will hopefully offer more info about that.

[unblock]

34. syringes come with many different size needles.

[ProudLib72]

6. This response is lame as hell

It's like Benson is throwing up his hands and saying "I can't do anything about the costs of epipens, so I might as well give you an alternative". What he should be doing is fighting for the man's grandson to be able to afford an epipen.

[sarcasmo]

8. @GOP motto: We got ours, F the rest of you.

[wildeyed]

11. An old friend put this suggestion up on his FB page.

That people with life threatening allergies should just carry a syringe and epinephrine in an old ALTOIDS box if they can't afford the EpiPen. I busted on him so hard he unfriended me. His explanation was that his grandfather was diabetic and gave himself insulin every day. After I got done rolling on the floor, I pointed out that an adult giving themselves a scheduled, daily injection was waaaay different then giving a hysterical child who was turning blue and maybe vomiting an injections. You need to train for that shit if you are going to do it. No one who is not a healthcare professional will handle it properly if they don't drill regularly.

His second point was that severe allergic reactions were rarely fatal, so why bother treating them. Pretty sure he would have a different opinion if it was his kid. I guess the un-friending was past due

[Kentonio]

14. I'm a little confused.

If he was saying it as a last resort kind of alternative for people who can't afford EpiPen, why is it bad? Yeah its certainly a crappy solution that's far worse than having an EpiPen available, but isn't it better than not having anything at all?

[Ladygrey]

23. Giving epinephren

I am an RN & I can tell you right now that no layperson can give epi this way without immense risk. If it still comes in those little glass vials (I haven't worked in ER for a long while) that requires the use of a filter needle to keep microscopic glass shards out of a person's bloodstream. The vial is difficult to break and it could break wrong , sending glass shards into the hand. And the correct dose is very important as it has bad side effects. No child could be trained to do this. And if it happened at school who would give it? Most schools these days are lucky to have a school nurse once a week. And it would have to be kept in the office, as no child would be allowed to carry around glass vials and syringes with needles on them. Nope. This asshat senator had no idea what he/she was suggesting. We just need to take control of pharmaceutical costs with a single-payer or medicare for all option.

[Kentonio]

24. Yeah, I wasn't trying to defend this jackass senator

Just wondered if Wildeyed's friend was just trying to suggest something as a backup option for people who didn't have the opportunity to have the proper treatment available. Obviously everyone should have access to EpiPen, having people priced out of life-saving medication is sick beyond words.

[Ladygrey]

25. Epipen substitute

I know. It just ticks me off when people like this senator make suggestions about subjects they know nothing about just to shut down pointed questions. if the Republicans pass this latest 'healthcare' abomination, people are going to be paying a lot more for all medications, including insulin and other meds necessary for life to continue. This is beyond sanity. They will be literally murdering millions of people who can't afford their meds. I wonder if there could be a class action lawsuit to stop this?

[Kentonio]

26. I've long held the opinion

That we need to start treating politicians actions like we do the actions of citizens. If you inflict a bill on the country that kills people, then I don't really see any difference between that and shooting someone. Obviously when it comes to politics there are always going to be winners and losers, but if you just make an ideological choice to strip millions of people of vital healthcare, then those deaths are on you and there should be some justice.

[wildeyed]

29. No, he was suggesting that this was an acceptable solution to the problem.

Rather than trying to get the price down, people should either go without or make their own.

[Kentonio]

30. Ah I see, I understand why you were angry now.

[riversedge]

15. Thanks. The whole idea of a pen is that it is easy to deliver the medication and premeasured.

Politicians should work to get the price down-not give out information that has the potential to be dangerous for patients-and their loved ones.

[Hekate]

16. Some here have missed the point by a mile. Dr Allison Stolz was demonstrating, in detail...

...how exceedingly hard it would be to follow those instructions for yourself or an incapacitated person (such as your child) in an emergency situation.

Dr Stolz, rather than losing her head and screaming bloody blue murder at Benson, took refuge in dry medical facts. She was apparently hoping that the full catastrophe of Benson's utterly stupid recommendation would get through to her readers if they just kept reading to the end.

Dr Stolz is telling our lawmakers to stand up to Big Pharma and grow a spine.

[Bernardo de La Paz]

17. The Epipen is a MECHANICAL device, not some rare weird drug. The drug it contains is cheap. . nt

[ismnotwasm]

18. I use a paper towel to break those kind of vials

And if someone has more flesh, the 5/8ths may not reach the muscle, for IM, you want 1 inch. And I can't believe we have to have this conversation

[Rural_Progressive]

19. Ya'll are just totally missing the point!!

From the republican perspective the clear alternative to expensive EpiPens is elegantly simple:

If you can't afford the device then don't come in contact with anything you're allergic to, now don't ya'll feel silly for missing the obvious and easy solution to the problem.

Don't worry, there will be many more of these easy solutions to complex problems and I'll do my best to inform all you bleeding heart liberals about them so ya'll won't sound so ignorant and silly.

Bless your hearts!!

[uriel1972]

22. I thought the obvious republican solution...

for someone too poor to afford an epipen(tm) was to choke to death.
I'm sorry, but that's what it looks like to me.

[trotsky]

28. You are correct.

In the ideal Republican world, if you can't afford healthcare, you don't deserve to live anyway.

[MADem]

20. A very kind and wonderful fellow I knew died for want of one of those epi-pens.

He was allergic to bee stings and was caught out in the woods alone without one.

Such a tragedy, it still troubles me to think of it.

I think he had the prescription, I can't imagine the daily terror of someone not having access to the thing that will keep them alive.

[stevenleser]

21. No one should buy Epipens, the generic alternatives are much cheaper. Case in point:

http://www.cnbc.com/2017/04/25/kmart-pharmacy-sharply-cuts-price-of-adrenaclick-competitor-to-epipen-anti-allergy-device.html

[question everything]

32. Hope COSTCO will do the same

I've recently paid $200 and my insurance paid the rest. I considered myself lucky but KMart idea sounds great. Thanks for the link.

[greymattermom]

27. All that sounds like a lot, but it really isn't

and most of that should be done if you use an epipen, starting with #7.

[sarah FAILIN]

31. I started saying the same thing when the price went up to force prices back down.

If parents learned how to do it and there was a massive number of customers that stopped buying the product, costs would drop. People could buy 1 real one for their child and keep the vial with the syringe for themselves. If my child could die from not getting epi, there is no way I would ever be caught without vials of medicine. I've heard of cases where a person used both of their epi shots and died anyway. I want the real thing, not a tool that puts it through clothes and an apparatus.

Giving an IM shot is not that hard, even breadkng the vial and drawing it up.