Be Careful What You Wish For May 8/19

It has been somewhat of a surprise that there has not been much more outrage/comment about recent proposed changes to the Ontario Drug Benefit Program coming out of the Ministry of Health & Long-Term Care.  These are pretty big changes.

First news, which came out of the OPA, was gushing with delight and self congratulating superlatives re the government’s decision to begin to allow pharmacists to prescribe and treat some 30 odd minor ailments.  On the surface this seems a very positive development.  Finally, pharmacists get to employ some of that knowledge which they garnered over years of university study.  So far though, only a tepid comment by government that it will pay for these services, but nothing about how much.  I am guessing a lot less that the $30 odd bucks a doc gets.  Same diagnosis, same outcome, but different remuneration levels?

Unfortunately, recognizing that 80% of all pharmacists toil as unrepresented retail employees of Big Pharmacy Retail (BPR), really clerks with not even minimum protection under the Employment Standards Act, what does this new era of professional privilege entail for the everyday working community pharmacist?

Here is a recent comment by a practicing pharmacist reacting to these new privileges which sums it up:

“Personally, as someone who has worked for years for a major retail chain, I feel absolutely no interest in this move towards diagnosing and treating minor ailments. We all already know what will happen is the Shoppers/Rexalls of our world.  They will require all of their pharmacists to take the courses and participate, then implement quotas requiring x number of billings per week, add no extra work hours thereby requiring you to squeeze even more into your workday, and share absolutely none of the extra profit the company may make with these billings. I will make no extra money with doing these services, but I will have the threat of losing my job if I am not interested in participating because they’ll fire me and hire someone who will. I will be taking on the additional liability for diagnosing and treating patients at no additional benefit to myself. Why should I be excited for this?”

A bit of a dispiriting  reaction, but then the truth always hurts.

Those bean counters at BPR are already cloistered in their subterranean chambers calculating how many UTI’s they can suck out of each of their employee pharmacists.  They work with algorithms not people.  They see big bucks here with no extra costs. Those lobotomized district managers will be marching up and down the aisles hunting for people coughing or scratching or whatever fits their dictated orders to set new quotas on.

So expanded scope is a great thing theoretically, but where the rubber hits the road, reality may tell another story.  More quotas, more work, less help, and maybe even less money.

And let’s not forget what the OCP is going to do with this one.  Although pharmacists may now hold a PharmD, it’s pretty well a foregone conclusion the OCP will mandate all manner of “mandatory” courses before allowing pharmacists to exercise any new practice privileges.  This kind of stuff is like honey to a bear to bureaucrats like the OCP; it just puffs them up.  Look to even more new hires at the OCP, and even higher annual fees  to pay for all this in the near future.

Then there is the small matter of $140 million that the Ontario government wants to take out of pharmacy, on top of the 700 Million already take out since 2015.  Is this after or before any compensation for minor ailments?

MedChecks are cooked. Done, Finished.  Pharmacists did this to themselves.  Some through sheer greed, but most through being forced trough BPR quotas to produce as many as possible with no attention to quality.  This golden goose has laid its last golden egg. The gravy is gone.

The so called “transaction fee” will cost another 17.4 million…minimum $1,000 a month right off the bottom line of the average pharmacy.  Bang.

The LTC game now goes under capitation.  Great idea for government but it may spell history to the business model of the big players in that game.

And to top it all, now that government has seen all those CBC/Global News programs on TV, there is going to be a whole heck of a lot more oversight over these pharmacy guys who appear to be crooks by inclination unless you watch them like a hawk.  Just watch those documentary reruns and see those pharmacists in their undershirts peeping through their front doors and complaining that it wasn’t their fault

Well at least the OPA is “disappointed”.

Hope some of those pharmacy undergrads are reading some of this stuff & may give them consideration for a mid course correction.  Just don’t tell the professors sipping coffee in the staff common room enjoying tenure and dreaming of retirement life at the cottage.

46 thoughts on “Be Careful What You Wish For May 8/19

  1. Zing!

    Perhaps there isn’t much outrage because some of these changes could have been predicted. I would imagine that even OPA was not surprised.

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    • I believe these poor guys at the OPA just may be too naive to be surprised, They negotiate alongside the Neighbourhood Pharmacy Association of Canada, the very entities which control the profession to the detriment of individual pharmacists. Go figure.

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  2. At the risk of holding an unpopular opinion, I think these changes are a good thing. In fact, I am excited for policy changes that lead to the dessimation of the current community pharmacy model. The current community pharmacy model is terrible for pharmacists. Only til we reach rock bottom may there be any change. So, I say, bring on the cuts Ministry. Pharmacists need to wake up. Real, not incremental, change is needed. We are in dire need of a leadershift, which will only come when pharmacists say enough is enough. So if it takes more Ministry cuts to move this along, I am all for this.

    Liked by 1 person

  3. I love it. Only through total destruction can regeneration have a chance at a new beginning. Maybe you are right. This may be the only way. Certainly what we are witnessing today is not working. This is what innovation is all about.

    Liked by 1 person

  4. 700 million paid out to pharmacies for medchecks over the years?! Woww. I am all for medchecks, don’t get me wrong, but not on the public purse. Have the patients pay for them and see if those 2 minute medchecks will be welcomed by the patient?

    Liked by 1 person

    • WE KNOW THAT THE PUBLIC WILL SWITCH PHARMACIES TO SAVE A $2,00 CO-PAY. THIS NOTION OF GETTING THE PUBLIC TO PAY FOR SO CALLED ‘PHARMACEUTICAL SERVICES’ IS ENTERTAINED BY THE SAME PEOPLE WHO BELIEVE IN THE TOOTH FAIRY.

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  5. William, again, you have brought to light the concerns many of us have. While in Alberta, the powers that be will continue to crow about what a great thing it’s been to have prescribing for us in Alberta.
    I think it’s a good move overall, moving in the direction away from product driven profit…However, our model in Alberta is far far from perfect. Perhaps being one of the first to adopt it, we have had major hiccups…
    Here is a quote recently that I pulled from the Facebook page, Community Pharmacy Network.
    It’s a candid quote from an Alberta Doctor explaining the concerns…..

    from today’s CHN, a physician comments re. pharmacist prescribing in Alberta: “I would like to know how and where the pharmacist is going to do a physical exam on these patients, if they will be permitted to order labs and swabs, and how they will follow up those results. Pharmacist prescribing where I live has been a disaster – I’ve had pharmacists change medications without notifying me, choosing medications that require lab work to follow up and either not doing the labs or asking me to do them – just generating extra costs to the system because if I want to get paid for ordering and monitoring labs I have to call the patient in. I’ve had them give antibiotics for yeast infections and yeast treatment for BV, every sore throat gets penicillin and every red eye gets eye drops without a proper exam to rule out other issues. Why can a
    Pharmacist who gets paid per filled prescription prescribe when I cannot hold stock in a pharmacy? If it’s a conflict of interest for physicians, why isn’t it for pharmacists? There’s nothing good – except convenience – about pharmacist prescribing.”

    I think the biggest issue we have had to face here is the way we get our APA authorization is answering a few questions then submitting 3 case studies (before we can even prescribe, so what’s the point???).
    Then it’s carte blanche….
    We do NOT have a list of Minor Ailments, and I think this Doctors quote clearly shows why that has been an issue here.
    I personally have now applied for my APA under duress from my employer, but in my application I made it clear that I plan to follow the Minor Ailment list from other provinces, and I guess I will now have to “train myself” to assess and diagnose, and to figure out how to properly document all this if something comes up that puts my liability in danger….

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    • Thanks for sharing Loretta. Here in Ontario, it seems like Alberta is also spoken about as the mecca of pharmacy practice. I’ve always wondered about if it sounded too good to be true. I means, the corporates still rule the roost in Alberta I imagine as well.

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      • well here’s an example….I have a long term opioid patient who is on a pretty short leash…He also abuses his sublinox and ran out a month early.
        I told him sorry, you will HAVE to see your DR. to work this out…
        So this patient goes next door to the Medicine Shoppe where he gets prescribed 14 days of zopiclone….
        And so it goes……

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    • SUZANNE. MY GUESS IS THAT THIS WHOLE INITIATIVE WILL END UP LIKE THE MEDSCHECK PROGRAM. IT IS FRAUGHT WITH PIT HOLES AND REALLY SERVES ONLY THE INTERESTS OF BPR. I GIVE IT A YEAR. TYPICAL GOVERNMENT INVOLVEMENT…A TOTAL SCREW UP.

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  6. Hi Bill
    OPA may be patting themselves on the back, but regular pharmacists are probably cursing them. They were gushing with delight when they negotiated the flu shot fees. None of which goes into our pockets. We took a course on injecting, and started providing a service that benefited millions, and reduced the work load of physicians. However we have not seen any pay increase. They are gushing with delight with the minor ailments scheme. And again we will not see a dime. In fact our insurance premiums are likely to increase.
    There is a sense of apathy in pharmacy now. Pharmacists have lost the will to take back the profession. There is no organisation which exists that will come to our defense. (,At least in the UK, we had the the PDU. Pharmacists defense union) .
    The minor ailments scheme will attract quotas, just like the useless med checks on someone taking BC and eczema creams. The only difference now will be that people’s lives will be at risk. OPA are incapable of grasping this. We need to stop paying their subscriptions and bring them to their knees. Force change. Many have called for a union. We have the resources of the OPA. We only need to force a change.

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    • Fayaz, you are correct that your insurance premium will go up….my liability is now over 300$ for 5 million, and I am honestly considering increasing this somehow…
      While my employer does pay us $20 for each $100 med review we do, I still don’t see much benefit for me or most patients. They don’t have a quota but always make sure to crow about which store does the MOST clinical billings…funny thing is one of the stores actually had a massive reduction in profit a year ago when they got caught doing the daily and weekly billing scheme….It has affected that store 30% to 40% in loss of profits and the owners “can’t figure out why?!”

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      • I would also comment that not only is our liability increasing, our responsibility, our education requirements, and our documentation requirements….in Alberta our suggested documentation is now akin to what a Dr. does in a hospital chart….every conversation or clinical decision has to be documented on our software…How in the world does a pharmacist working in a 400 Rx a day dispensary have time to type all the conversations and all the counselling into a patient chart???
        So we are being called upon to do more and more and more and more….
        Yet we are NOT autonomous, we CANNOT bill personally for our services, and our wages are not only stagnant, they are going DOWN?!?!
        What other profession can you even think about where they are allowing this to happen????
        I for one am totally disgusted with this profession.

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      • I dont work in BPR anymore, but your comment about how your employer hints at other stores performance hits the target dead on. I don’t think anyone is immune to the pressures. A credible union would help. But i think that will never happen in our time. The profession will have to be completely destroyed first, and then whatever rises from the ashes, can think about restructuring with a union in place. Remember the professional typist ? We may be joining them into the history books.

        Liked by 1 person

      • I AM BETTING THAT THE INSURANCE ON THIS IS GOING TO BE VERY HIGH CONSIDERING THE RISK INVOLVED. DIAGNOSING WITHOUT PROPER SKILLS CAN ONLY LEAD TO DISASTERS. IF THIS WAS THE USA, NO INSURANCE COMPANY WOULD TOUCH IT WITH A TEN FOOT POLE.

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  7. Glad I found your blog site, Bill. Love the title referencing julius caesar point of no return. Pharmacy to has gone past the point of no return. I have stopped contributing my comments on the CHN site due to censorship and writers being unable to take criticism. Just look at the new article asking pharmacists with only positive comments to contribute to the post. Ref. “Are you a happy pharmacist “.
    Keep it up Bill. Enjoy reading your blogs.

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    • Fayaz!
      Had a good laugh over that “happy pharmacist” post this morning on CHN….

      Many of my very disgruntled co pharmacists messaged me first thing this morning to say what the hell?

      I for one have had enough of the mentality of “just pull up your bootstraps guys!” Pollyanna BS..

      Its gotten waaay beyond that anymore.;

      I also appreciate Bill’s blog and well thought out opinion pieces…

      Perhaps these are all cautionary tales, but we are definitely if not already crossing the rubicon….
      and yes, I could get way more involved and way more vocal, but I have been a thorn in the side of many employers over the years, I pass the torch onto the next generation to fix it…
      A good book I recently ordered off Amazon is written by my new friend, Kim Ankenbruck…It’s called “Your Pharmacist is a Whore: How pharmacists lost control of their profession and why you should care”..Great short read telling her story of issues with the CVS company. Another USA friend, Dee Wigger (real name) is getting ready to blow the lid off CVS and some of their very unethical business practises in the USA.
      I was planning on co-authoring with Dee, but the format of Canadian and USA practise would not work.
      I also have to be cautious on the CHN website, as many non-pharmacists and “future” or current employers may be scanning this….
      If you like, I have my own Facebook page which is closed and secure and only for pharmacists called “Fabulous Female Pharmacists over Fourty”…Of course, anyone is welcome…caution, language, and NO SNOWFLAKES NO POLLYANNA’S….LOL

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      • I wonder how many will respond? Will the silence send out a loud and clear message. Bill , any chance you could write a rebuttal to this snowflake article?

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      • The great thing in the USA is, they have “qui tam” legislation (whistleblower). There have been many cases where, if you are the first to advise the DA of fraud, etc. they are then obliged to investigate. If they succeed in getting a conviction (whether by indictment or by “agreement”), up to 10% of the fines go to the original whistleblower.

        Given the millions in some cases to date, 10% is a lifetime’s income (plus) for many, and they can then happily retire on two fronts: financial security, and conscientious peace. 🙂

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      • See: https://corporate.findlaw.com/law-library/the-many-faces-of-health-care-fraud.html

        for a very interesting read on Qui Tam (False Claims Act) parameters. If you click on the hyperlink at the end of the first paragraph, then go to the 2nd page, read section “(b)(1)” as well as in particular, section “(d)” further down the page (“Award to qui tam plaintiff”). Note the range of awards when the government proceeds on the basis of the information brought to its attention. They do all the prosecuting; the supplier of the information gets a piece of the ultimate proceeds, which varies in the circumstances.

        Some of the healthcare fraud cases have resulted in hundreds of millions in fines/penalties, so imagine what 10% would provide to the “whistleblower…”

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  8. Can you drop me an e mail? Want to start a discussion with you about the future of pharmacy. Maybe rope Kim ruthig in too? Maybe we can start the building blocks to changing how we are represented?. Also any word on the funding for the pharmacist who refused to be the mailman? fayaz_ahmedali@yahoo.co.uk

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  9. haha,,I was just remembering when I used to work at Walmart, they INSISTED the pharmacy staff had to offer to sign people up for the Walmart Mastercard, like we were pushed into it..I told them where to shove it as I had enough stuff to do besides pushing credit cards on customers who had NO business getting into more credit card debt…the other issue there was we had a fancy schmancy computer tasco thingy that you had to use to “check” patients out at the till with..It was connected to the pharmacy filling software and all the staff were terrified of it…so more often than not, I ended up being at the cashout for HOURS and then being asked to sell or promote credit cards too!? Can you IMAGINE?

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      • Thanks for sharing your experience Loretta. One has to shake one’s head as to how far down our once proud profession has descended. On the short term I do not see much room for hope for change; too many power groups have much invested in the present quo. I was talking to a mature well placed pharmacist today who told me the word is out among potential students that pharmacy school is not the best option. If we can save a few, this would be of some satisfaction.

        Liked by 1 person

    • How about the new one out that profiles Mark Scanlon? I have to wonder how this specific pharmacist was “chosen” out of all of the ones that experience similar incidents in their practices; it has been going on for a long time. Ironic, given the past story in the The Toronto Star about his being one of two past-presidents allegedly receiving kickbacks, following hot on the heels of the Costco fiasco.

      Is this possible “posturing” for reduced consequences, if/when it even gets to a College hearing? Dead silence to date over some 2+years now on the Star story, but suddenly this….

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    • I almost fell off my chair reading that Scanlon article.
      The first line of it – “Peterborough pharmacist Mark Scanlon loves what he does.“
      Sheesh.

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      • Well, he must be one of those “happy pharmacists”. Too bad CHN used the same mug shot as the Toronto Star used regarding Scanlon’s taking illegal kickbacks from generic drug companies. I reckon the OCP is trying to bury this one.

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    • Well I had to just shake my head, take a deep breath and refuse to comment…
      next week, same gal had an article about burn out and snapping at a customer….lol

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  10. Seems like all is well and dandy in La la land aka Canadian healthcare network! Wonder if there is a pot of gold for all the subscribers at the end of the rainbow. I think it’s an insulting, delusional, and arrogant article to ever have been penned by a so called professional website. I wonder if all negative comments will be put aside for moderation and subsequently deleted.
    And BTW . WRT to the forgery piece…..has there not been a serious privacy breach? I wonder what would have happened to me if I posted it? Probably been skinned alive now.

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  11. I have been banned from commentating by viki…maybe some of you who are more influential, can somehow put them right. Viki would not dare ban Bill or Kim! The nobody’s like myself are fair game.

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    • Sorry to hear this Fayaz. One of my favourite expressions which I will share with you is this:

      “Revenge is a dish best served cold”

      Stay low for a while & then eventually come back with this expression in mind.

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      • Great advice. I will keep that in mind. However, when i received the threat, i told her not to bother suspending my privileges, as I would not comment on any blog for the foreseeable future.
        Lively discussions are the lifeblood of these sites. I dont lose anything , but they do. If they continue to alienate the contributors with snowflake articles, and demanding that only positive comments are allowed, then they will ultimately pay the price.
        For now it’s just entertaining to read the snowflake blogs.
        I pointed out to the editor, that if you ask me how my personal work environment is….the answer would be “great”. I work for an independent in a small town. I actually have what I would regard as a perfect job. But we need to look outside our own little bubble. There are small pockets of literal pharmacy osasis around. But the desert is slowly encroaching on these perfect places. That’s why I’m vocal when I read all these pharmacists try to spin positive vibes around, without noticing that their heads are in bubble. You challenged one bubble head. Still waiting for z response. I doubt you will get it though.

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    • I agree with Bill, Fayaz. I have no idea what Vicki’s justification is for this, other than she does not like ot hear any black roses when she sees red beauty. As for me, I have absolutely no respect for her; she’s not a pharmacist. And when you invite comments, then censor someone who has a lifetime experience based on FACTS that you can never have, for setting misinformation straight, the column loses all credibility.

      Do you not find it odd that of all the pharmacists who have experienced such scams, they chose Mr. Scanlon to do a profile on, as if he has magically saved the profession with his “catching the forgery” scam? I mean, should I start to list all the similar scams (and others, not even similar) that I have uncovered over my career?

      That is why I ask: why now are they profiling him in this regard? Why didn’t they go to other geographic areas where similar “rings” operate? Such as the Russians operating from Toronto to Barrie in a similar scam to divert drugs via forgeries? Didn’t even merit a column when that happened.

      But this one does. Again: why? What is coming up that we don’t yet know about, that need bolstering of a person’s alleged credibilty when this is a standard of practice for everyone in the profession (i.e., dispense legal prescriptions, be gatekeepers, etc.)?

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      • I did find the blog rather entertaining. It was like reading “breaking news”…..forged narcotic prescriptions found!! I have seen more authentic looking rxs before. But I could not understand why the photo of the rx was not edited to remove the identities.
        Interesting character though. Past president, under investigation for rebates, physically thwarting a robbery (thief apparently was high on something, so silly thing to do as he could have killed him or an innocent bystander), and now forgery catcher numerous uno. It’s no wonder our profession is in the state it’s in now.

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  12. My advice to all of you who live in the real world, dont criticize any articles too harshly, lest you upset the delicate feelings of the la la land writers. Otherwise you may find an e mail threatening to suspend your privileges. Treat the delicate writers with super soft kid gloves. They get very upset very easily you know!!

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    • I too have had to rope in my overly harsh comments or pseudo harsh language….There are plenty of great Facebook pages I belong to where you can let fly! Fayaz, please join MY FB page called Fabulous Female Pharmacists over 40…No snowflakes allowed….All comments welcome, but NOT if you get offended easily…NOT A SAFE SPACE….NO TRIGGER WARNINGS….lol
      It is a closed group and you will have a few pertinent questions to answer so I can determine if the folks joining really “get” what we do….I have pharmacists from all over North America, and many have now become good friends and allies.

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      • Just a big thank you to everyone for utilizing my website for all this cross conversation ; it gives me sense of security that I can get my message out without being overly dependent on CHN. Thanks everyone!

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      • We’ll all recall another column on CHN where they selectively removed my input on factual info re Greenshield data on its website, but left the comments of another contributor (a former OCP President & OPA Chair), now an “inspector” or “practice advisor” (for the snowflakes), yet who for some 18 years didn’t have his OCP workplaces accurately listed until I mentioned it. It got changed pretty quickly.

        As Fayaz has noted, they “edited” (removed) my comments (which were the GreenShield Board info publically posted on the GS site), but left the comments of the other person on the blog. Fayaz commented on how if you remove one, remove the other as well to keep it balanced, after I requested the same because the logic of the thread had been broken and it made no sense. Not done, however.

        So censorship is alive and well on that site, where their mission is “To be the one-of-a-kind online destination for healthcare professionals, where they will learn, engage and grow individually and inter-professionally to advance better health for all Canadians.” Provided you don’t challenge misinformation when it’s published there, of course.

        There was even an instance where editor, in her magazine column, spoke to an “exchange” from CHN without having notified me in advance she planned to do so (and I don’t read that rag)…the “hit ’em when they’re not there to respond” tactic. No big deal, because even if I had retorted, it would have been edited to something suggestive of what I didn’t even say.

        Thanks from all of us, Bill, for being there for pharmacists and techs. Heck, you could organize a gathering if need be where we could all come together on the repeat topics that never get addressed by the associations and others….just having an Ed Sheeran “thinking out loud” moment. I betcha you’d get a pretty darn good turnout…

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  13. Bill. Keep writing. You might try a spin off blog site, inviting guest bloggers. You might be pleasantly surprised. I’m sure the following will be good.

    Loretta, I will look into joining, once I have face book. I’m actually anti Facebook and Twitter at the moment due to security breaches.
    I have not “tested” my apparent suspension by viki yet. I did tell her to “stick it” etc. I will not contribute as long as she remains the editor.
    My suspension stems from criticizing the blog about the Canadian pharmacist complaining about not having access to otc insulin while in the states. In my opinion she “belittled ” the DPharm employee for doing his job. I pointed out that every country has it’s own laws, and should be respected. I criticized viki for “jumping” on the bloggers who were critical of the charity asking members to contribute. She actually edited her own blog after I challenged her. Most probably did not see her original posting, but I got her to admit it via e mail. She claimed the “insulin ” blogger was upset with having articles criticized and it would prevent her from posting other articles.
    Unfortunately I have been around long enough to realise that different rules apply to different people. She would not have threatened Bill, Frank or Kim.
    Loretta, you have admitted that you have had to “hold ” back. That means that the Canadian Healthcare Network has decided to follow a dangerous path which they will ultimately pay the price for.

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  14. I will just leave you with this comment. The “snowflake” article demanded that no negative posts were to be allowed. Frank being Frank, posted some hilarious comments. I very much doubt he has received any threatening e mails. On the other hand, if It had been me!!……well I’m sure you will agree that my inbox would have been filled with an angry response from the powers that be.

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  15. Boycott CHN! Seriously – now that I know censorship is alive and well I’m not looking at it anyone. Frankly it’ was only for Bill’s blog anyhow. Thanks for all the input people – and Loretta’s site is really great – safe space haha!!!

    Like

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