S6 E24: Compounding Pharmacies & Stupid Watergate II: Last Week Tonight with John Oliver

Trump-Ukraine Scandal

• A recent scandal has been dominating the news, involving a secret cover-up and a whistleblower complaint that has sent shockwaves through Washington, with President Trump at the center of the controversy (52s).
• The scandal revolves around a phone call between Trump and Ukrainian President Volodymyr Zelensky, during which Trump pressured Zelensky eight times to investigate former Vice President Joe Biden's son, Hunter (1m2s).
• Trump is accused of withholding nearly $400 million in military aid to Ukraine and using it as leverage to get dirt on Joe Biden (1m28s).
• The White House initially denied any wrongdoing and released their account of the president's call, claiming it exonerated him, but the account actually shows Trump explicitly asking for Biden to be investigated (2m7s).
• Trump also looped in Attorney General William Barr and his personal lawyer, Rudy Giuliani, to get to the bottom of the investigation, which is an abuse of power (2m20s).
• The whistleblower's complaint was released, revealing that senior White House officials worked to cover up the scandal by locking down all records of the presidential phone call (2m44s).
• The notes from the call were stored in a separate code-word level system meant for highly classified information, despite there being no legitimate reason to do so (3m7s).
• The scandal has been dubbed "Stupid Watergate 2" due to its similarities to the original Watergate scandal, but with a more absurd and ridiculous tone (1m57s).
• Volodymyr Zelensky, the President of Ukraine, was a comedian who played the piano with his genitals in one of his old comedy routines, and also played a sitcom president before becoming the actual President of Ukraine (4m2s).
• Rudy Giuliani, the former New York City mayor, played a significant role in the scandal, and his involvement is considered one of the most absurd parts of the story (4m40s).
• Giuliani did his part in plain sight, telling the New York Times in May that he was meddling in an investigation, and he insists he did nothing wrong (5m2s).
• Giuliani is not working for the government but is Trump's personal lawyer, and he's not being paid, reportedly working for free to reduce his future alimony payments in his divorce (5m52s).
• Giuliani's divorce is messy, and he has complained that his wife took his cable box and remote controls, leaving him to watch TV on his iPad, showing his lack of awareness that he can buy new remote controls (6m22s).
• The scandal involves President Trump pressuring a foreign head of state to investigate his political rival, and his staff trying to cover it up, which might actually hurt him (6m44s).
• The House has opened an impeachment inquiry, and even some Republicans are treading with caution, making it seem like this scandal might be different from Trump's previous controversies (7m6s).
• This scandal might be simpler and more damaging because it involves Trump abusing the power of the presidency, and there is hard proof that it happened (7m30s).
• The Trump-Ukraine scandal is considered a clear case of wrongdoing, as Trump pressured Ukraine to gain something for himself, which is easy to understand and not just a difference of political opinion (7m44s).
• This scandal is consistent with Trump's other behavior, suggesting a pattern that will continue until he leaves office, making it a reason for impeachment (8m42s).
• Trump's actions, such as pressuring Ukraine to get dirt on his opponent and hiding the action, are not acceptable for a president and are comparable to selling the White House or changing the national anthem (8m6s).

Compounding Pharmacies

• Historically, pharmacies used to make medication on site, but this is now a relatively new phenomenon, with most pharmacies filling prescriptions with pre-manufactured pills (10m32s).
• Compounding pharmacies still exist and make medicine from scratch on site for people whose needs cannot be met by an FDA-approved product, such as those allergic to a specific ingredient in a pill (11m20s).
• These pharmacies can create tailored prescriptions for individuals with specific needs, which is their primary purpose (11m33s).
• Compounding pharmacies create customized medications for specific needs, such as changing the form of a medication or adjusting its concentration, and there are around 7,500 of these pharmacies in the US (11m37s).
• These pharmacies can also create medications for animals, as there are no manufactured medications made for birds, and they can tailor the volume and flavor to the individual animal's needs (12m19s).
• Compounding pharmacies are subject to less oversight than large drug manufacturers, and as a result, compounded drugs are not FDA-approved (12m59s).
• A former head of the FDA stated that they cannot guarantee the safety and effectiveness of every drug being used in the US, which is a startling admission (13m28s).
• The lack of oversight in compounding pharmacies has led to the industry becoming the "wild west" of the drug industry, resulting in fraud and many deaths (14m6s).
• One example of this fraud is the case of Tri care, the military's health insurance program, which saw a big increase in bills for specially compounded scar and pain creams that were later found to be ineffective (14m25s).
• These creams were found to be no more effective than treatments with no medicine at all, and the pharmacies were able to take advantage of a loophole to bill for the cost of each individual ingredient (14m52s).
• The lack of oversight and regulation in compounding pharmacies has led to the creation of fake or ineffective products, such as "Johnny gel," a fictional pain cream that is actually just mayonnaise (15m0s).
• The US military has been overspending on compounded medications, with costs reaching over $2 billion, and the situation has gotten out of control in a relatively short period of time (15m29s).
• Compounded medications have a high failure rate, with around 33% of drugs failing FDA tests, compared to a 2% failure rate for commercially manufactured drugs (16m4s).
• The Jonas Brothers are used as a humorous example to put the failure rate of compounded medications into perspective, with the drugs having a similar failure rate to the band's success (16m16s).
• Kevin Jonas is jokingly mentioned as doing well, despite the band's low success rate (16m22s).
• The worst-case scenario for compounded medications is not just ineffectiveness, but also contamination and poor manufacturing conditions, which can lead to serious health risks (16m38s).
• Investigations have found appalling conditions in some compounding pharmacies, including a Miami pharmacy where compounded drugs were stored in the same refrigerator as employee lunches (16m56s).
• Another pharmacy stored compounded drugs in the employee bathroom, which is unacceptable and unsanitary (17m4s).
• The lack of FDA oversight and shortage of state pharmacy inspectors contribute to the problem, with some states having only one or two inspectors to monitor hundreds of pharmacies (17m31s).
• The New England Compounding Center (NECC) was found to be the source of a massive meningitis outbreak, and inspectors discovered fungus in a vial of medicine that could be seen with the naked eye (18m15s).
• NECC was producing medication in bulk, despite being a compounding pharmacy, which is not supposed to make large batches of drugs (19m1s).
• The pharmacy's actions led to the deaths of over 100 people, and the incident highlights the need for better oversight and regulation of compounding pharmacies (19m21s).
• In 2012, a compounding pharmacy called New England Compounding Center (NECC) was found to be faking patient names and prescriptions, using names like Big Baby Jesus, Rory Rogers, Wonder Woman, and Bud Weiser, in order to get around regulations requiring individual prescriptions for each patient (19m49s).
• The scheme was incredibly lucrative, with the president of NECC, Barry Caden, making over $60 million in the three years leading up to the outbreak (20m46s).
• Caden seemed to know that what he was doing was wrong, as evidenced by a filmed employee training session where he was asked about keeping records of patient names and prescriptions, and his answer was comically suspicious (20m56s).
• The company's national sales director sent out an email with the subject line "huge importance" stating that all names must resemble real names and that nothing should be put in writing, which is an incredible thing to put in writing (21m57s).
• Caden eventually went to prison, and Congress passed a law toughening up enforcement of regulations among compounding pharmacies, but the law had massive loopholes, including making registration as an Outsourcing facility voluntary (22m19s).
• As a result, only 77 facilities are currently registered, which is just 1% of compounding pharmacies, and many pharmacies have continued to operate as they were, with some being pretty bold about it (22m55s).
• For example, Downing Labs was found to have sterility failures in 19 lots of drug products, but the co-owner, Ashley Downing, refused to recall the products when asked by the FDA (23m23s).
• A compounding pharmacy owner refused to acknowledge the FDA's jurisdiction and claimed to have followed all state requirements, despite the FDA's disagreement, and it took almost a year for the FDA to force her to comply with a drug recall (23m47s).
• A company called Guardian Pharmacy Services in Texas mass-produced medicine that was injected into people's eyes, which turned out to contain formaldehyde and acetone, causing nearly 70 people to become partially or completely blind (24m11s).
• Guardian Pharmacy Services was regulated at the state level but not very well, as it took six months from the first injections for state regulators to be notified of the problem (24m40s).
• The Texas State Pharmacy Board did not shut down Guardian Pharmacy Services, instead putting their license on probation, and the owner simply shut it down and opened a new pharmacy at the same location (25m44s).
• The new pharmacy, Medical Park Pharmacy, was opened at the exact same location as Guardian Pharmacy Services, with little to no meaningful differences (26m0s).
• Compounding pharmacists play an important role, but they should be properly regulated, with more inspectors at the state level, mandatory outsourcing facility registration, and a requirement for compounders to alert regulators whenever they change their operations (26m17s).
• A group of celebrities, including David Schwimmer, Method Man, RuPaul, Jimmy Kimmel, and Michael Bolton, are speaking out against compounding pharmacies that use their names in prescriptions to evade the law (26m44s).
• Compounding pharmacies should not be used as unregulated drug manufacturers, and they should not use names of well-known individuals to legitimize their operations (27m42s).
• Outsourcing facilities should allow themselves to be regulated, and compounded drugs should come from labs that fully comply with safety guidelines (28m4s).
• Many people, including those with pets, rely on compounded drugs, and it is essential to ensure their safety and quality (28m30s).
• Compounding pharmacies were initially designed to create customized medications for specific patients, such as making Pia coladas for birds, and they should stick to their original purpose until they are better regulated (29m1s).
• The lack of regulation in compounding pharmacies can lead to unsafe and ineffective products, including expensive skin creams and ointments (27m51s).
• Some individuals, including a parrot owner, are concerned about the safety and quality of compounded drugs and want to see better regulation in the industry (28m32s).
• The need for regulation is emphasized, with a warning to compounding pharmacies that they will face consequences if they do not comply with safety guidelines (28m9s).