Saving Lives: The Role of The Pharmacist in HIV

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Today with I chat with Dr Pam Tarlow

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What you will learn

  • Role of Pharmacists in Integrative Medicine
  • Role of Pharmacists in Functional  Medicine
  • How to speak to your patients about supplements
  • Covid-19 and the Integrative Pharmacist

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Transcription

Michelle:
This is Michelle Sherman, president of Michelle RX Pharmacists Consulting Services and your host for the conscious pharmacist podcast. A podcast is a proud member of the pharmacy podcast network and we’re extremely excited to bring you our show today. We have an amazing pharmacist on our shape show today. Pam Tarlow, who is a specialist in integrative pharmacy and integrative medicine and she’s has many years of practice in this arena and she’s going to talk to us today about integrated pharmacy and tools that we can implement in our daily practice to help our patients not only every day, but you know, through this health crisis, this pandemic that the world is going through right now. So welcome to the show, Pam, and thanks for being on the show and talking to us today. Thank you for inviting me. No, my pleasure. Let our listeners know what your field of practice is and what, what integrative medicine integrated pharmacy is and how you got into that field, the pharmacy.

Pam:
I’d be happy to share briefly and then if you have more questions, please ask me. I’ve been doing it so long. It’s almost fun to think back that there was a time when I didn’t know about integrative medicine and wasn’t practicing it, but it was a significant portion of my career. I’ve been a pharmacist for almost 40 years. All I’ve ever done professionally is community pharmacy, outpatient, pharmacy, and loved it at the beginning. Loved it in the middle and love it right now. And nationally. Right now, Michelle, we are in our pharmacy being called on to really help people a lot. And that’s how it started for me. I had no intention of becoming an integrative pharmacist that knew about vitamins and herbs and homeopathic medicines and meditation techniques. That was definitely not on the radar. About 25 years ago, I was working for an independent pharmacist, cute little place, Elsa Gundo, California and customers’ patients that trusted me to fill their medications, started asking about herbs, natural products.

Pam:
The two first questions I ever got that I remember, I probably got hundreds but just brushed it off. But that fateful day I remember somebody asking me if Jen Singh would give them energy and I only knew what I had heard. I didn’t know. I didn’t even know Michelle, how to approach that question and that. And the second question was whether Yucca could help with her arthritis and if someone asked me about a drug that I don’t know, I know how to frame it. I’ll look up what class of drugs it is and then I already know something about it unless it’s a new mechanism of action new in its class. And if it’s a new in its class, I know that I have to really concentrate, watch some videos, read some papers. So with natural products at that time I didn’t even know how to frame it, where to put it and was tempted previously probably to just say, Oh, it’s not proven.

Pam:
There’s no studies on it, which Michelle, believe it or not, pharmacy students that come to study with us, they still tell me that, which of course is not true. I just found as I investigated that the level of evidence was a little different and it required a different set of skills related to knowing pharmacy but slightly different. Opened myself up to what are the risks, what are the benefits, what’s known, what’s not known? And then I found that I really liked it. I found it fascinating that molecules and complex plants could improve function in the body rather than hear disease or prevent disease per se. It would improve function in the body. And that set me off on a whole spin of looking at how does the body keep us safe? How does the body naturally prevent viral infection? How does the body get over viral infection? What are the things in the body that keep blood pressure normalized for blood sugar normalized and then seeing what kind of evidence there was about how supplementation and lifestyle practice could help them. That’s a long answer to your question.

Michelle:
It was a fantastic answer because it really makes me so excited because, you know, I became a pharmacist because I wanted to be a healthcare provider and take care of people and you know, we, we went to pharmacy school and learn things in the traditional, the traditional way learning about all these drugs or these molecules. And as we went into our careers, I specialized, I’m an HIV pharmacist so we, we became more myopic in, in what we did everyday and the drugs that we utilized. And you know, Western medicine focuses so much on just the traditional drugs and medications. And you know, I have patients who have 10 different doctors for each part of the body and we really got away from looking at, first of all our patients as a whole being like the mind, the body, the spirit and everything. We were just focused on the cardiovascular system or the HIV infection or the arthritis and when we’d look at our patients is like a whole being changes everything.

Michelle:
I mean you made a great point like how does our bodies function? Instead of trying to bandaid and get our bodies to the point where we started having disease and symptoms, why can’t we keep our bodies healthy, let our bodies work the way they were designed. I mean the design of the human body is like a magnificent organism and for hundreds of millions of years we’ve been existing. When we look at the first drugs and pharmaceuticals, they were like herbs and clients. When we look at native American medicine, Chinese medicine, homeopathy, those were herbs until we got into the best use of corporate farmers that we have today. So your answer was beautiful and it’s really exciting to me because looking at those modalities of taking drugs or utilizing herbs and supplements and then looking at other modalities like you, you mentioned like meditation. Those things help lower blood pressure and how do those things just meditation and breathing keep us calm in this absolute global crisis that we existing in today. So your answer was absolutely perfect. So how do you see what you do change the role of pharmacists, the traditional role of pharmacists and how do the pharmacist listening incorporate that in their practice? You made a great point. I mean you’re a community pharmacist, so many of our listeners are too. How do they do this or how do they learn to do this in their practices to improve the lives of their patients? Then for asking that question, and the answer is going to be broad. It’s going to be different for each pharmacist

Pam:
Or healthcare professional depending on their setting. If you’re an owner of a store, you may have more leeway if you are an employee might be constrained by your practice model and Oh, I’m so many different things I want to say at once, which is partially what happens when I do integrate a pharmacy consult. What you’re noticing with me right here in live on the OnAir is that often I’ll pause just to think about the person who asking me the question and probably ask them a question or two to know where to start. And I, so that pause helped. The way I’d like to start to answer this is for each pharmacist just right now to think about their practice and the patients that they come in contact with, what their practice scope is, and then personalize it to themselves as I did for me at the time when I was learning natural medicine, I had a health issue.

Pam:
It was a low grade chronic issue that would never land me in the emergency room or the hospital, but it was a chronic actually respiratory condition. And so that’s what I first learned about. So I would highly suggest a couple things. One, listen to your patients. As I began to Jensen, what did I need to know about Jensen? Well, it turns out Jen sing is just a name. It’s a common name. I didn’t know that when I was first asked that question. There are many different species of Jensen and they all have similar yet different properties and there’s ginseng is used not botanically correct in to describe Indian geofencing or Arctic geofencing or different things. But Jensen ha, I like to go to the botanical name if I’m giving detailed information. So I hope that gives you a little window and how one might start start with either what the healthcare practitioners interested in or what kind of questions do you get? I would imagine most of us are getting questions now related to the immune system.

Pam:
Absolutely. And we’re not going to do an, I are not going to talk about what’s best for the immune system because I was what’s best for the patients that I see in Santa Monica might be different than the patients who are HIV patients, which might be different than an oncologist, pharmacist patient. It might be different than pregnant patients, et cetera. But there are some basic thoughts about how does the immune system work. And so I spent years revisiting physiology, revisiting biochemistry when I had time. And so I’m, I think that’s one place to start is what interests your patient, what interests the individual practitioner mostly to listen half of the time or a quarter of the time. Who knows? I haven’t looked when I’m talking to somebody either on the phone or in person. Just the fact that I listen that I’ve heard of course attend that. I know they’re talking about that for immune system.

Pam:
Just help the person I’m talking to, whether it be a patient or a healthcare professional. Sure. I’ve heard of course the ton, I know how to map it in my mind that it is a polyphenol, which foods it’s in with possible drug interactions, so over the years I’ve developed a frame of reference much like I did when I was learning drugs. You and I know what beta blockers are and we know what certain kind of antibiotics are. Kind of put those natural products into rough segments so that I have a frame of reference and then can make some intelligent decisions. Mostly extrapolate them because we don’t have the level of evidence or something like the polyphenol course atten as we do for beta blockers or chloric Wynn or whatever the drug of interest for every day is.

Michelle:
That’s you make a great point. A couple of things you know to take away is to learn that that I heard you say is to learn about the information, but most importantly is to know who the person is sitting across from you or on the phone, on the phone with you or now on the video screen in front of you. Listen to them, listen to what they telling you about themselves, about the conditions, about their body. Because I think that way you can customize the plan for them and that’s why this font, this podcast is called the conscious pharmacist podcast because I’m a firm believer that we ourselves have to be conscious in every activity that we do every day, especially as pharmacists in listening to our patients. Instead of us doing all the talking when they front of us, if we just listened to what they say, we can find out exactly what’s going on with them and then come up with the plane.

Michelle:
Just like you say. And, and now our patients are hearing all these things in the news and about all these drugs and about all these supplements and people drinking, rubbing alcohol and all kinds of terrible things to like fight covert 19, but when they come to the source, to the pharmacist to an expert like you, you can provide good guidance and help them navigate through that. So to the pharmacists that are listening what kind of resources can they utilize to find that information? I know I personally, you know, the doctors I work with, a lot of them aren’t familiar with a lot of the supplements and things that our patients are taking. And my go to sources like the natural database cause I like a lot of information on drug interactions and things. I mean besides that, is there any other resources or go to places that

Pam:
A pharmacist can go to? There are a lot of them and I’d be happy to provide you with a list. I have both an infographic and a list and the natural medicine database. Then natural medicines certainly is my main resource. It’s not my only resource because I find that in natural medicines there’s a lot of theoretical, most of the drug information, drug interaction, drug supplement, drug herb interaction, information that I’ve read is theoretical and that needs to be interpreted for the patient if they’re coming to us, I believe instead of just reading in natural database that natural medicines, that something can increase bleeding risk. It’s, I feel it’s imperative in my practice to go beyond just saying it could increase bleeding risk and patient, here is what you need to look for for bleeding risk. Even before that, Michelle, I’ll say, what did your doctor and your dispensing pharmacist tell you about bleeding risks?

Pam:
What do you monitor? And they, and if they tell me that they know what to monitor, that product has just become safer. If they don’t know what to monitor, that product has just become more dangerous and that’s an interpretation. It’s an interpretation based on knowing the drug and having some idea of the properties of the supplement. Very often I do consultations and I don’t really know the supplement that well, but I know some of its properties. And by reading in this database, again, an idea, just like when I don’t know the drug that much I don’t dispense much anymore of medications, but when patients come into the pharmacy and tell me about the new drug, they’re on a quick one or two minute look up on a property’s or Micromedics, then I kind of got it. And so playing with these supplements, I’ve gotten an an idea of how to assess whether a particular person is at risk for that increased risk or if they’re probably not at risk for that increased risk.

Pam:
Because very, very often when people say, is it okay to take X, Y, and Z with my drugs, they’ve already been taking X, Y, and Z, and they have not had those increased risk. And it makes I feel really foolish when I tell someone, well this could increase, this could cause bleeding. And they said, well I’ve been taking these two things together for 10 years and my doctor says it’s okay. That’s just me. I need to step back and ask them a couple of questions. I’ll very often what I’ll ask is what concerns you? Just something like that. And people will say, I’ll get concerned that it’ll hurt my liver and they’re taking a drug that’s not metabolized by the liver and they are talking about a supplement that has very little to do with liver. And so just even that little bit can help a patient that establishes validity and confidence. And then Michelle, you’ll hear what they start saying. Then they tell me they haven’t been on their Metformin for a few months cause they heard something about it or they’re afraid to take this particular drug, which is an important life saving drug for them. I imagine with the patients that you work with too, there might be some fears about their medication and they need to be on it for viral load.

Michelle:
Right, right, exactly. And, you know, again, you make a great point if we just like, listen, you know, we, we, we are like computers. We’ve gathered all this information on all the drugs and you on all these supplements and everything, but this no one shoe fits all for, for everybody what our patients are unique people and we have to customize our responses to the information that they provide to us to come up with the best plan for them. You’re right. Like, just because something increases bleeding might have no bearing on the patient in front of you or the consultation you give them might actually like to save their life. So it’s not just a one shoe fits all kind of process. And I mean that’s what makes me as a pharmacist love what I do. Because sometimes you feel like a private eye, sometimes you feel like an artist because you creating the best plan for the patient in front of you to have the best possible outcome on the disease state and everything that they taking. So yeah, it’s, it’s, it’s just, it’s just amazing. And you mentioned some other resources and things you use. So definitely email those to me and I’ll put all those in the resource list for the show notes so that everybody when they, they listen to the podcast can look at those and maybe download some

Pam:
Those resources to help them take care of their patients. Sure. I, I’d be very happy to and I will hope this could be a two way street also that if others are using resources that I haven’t heard of. I love being in a field that is a little less than conventional because there’s always learning to be had, but I think we need to complete that last thought that we were talking about. While it is important to look at each person as an individual, I’m an employee and I have a certain number of hours and I need to get a certain amount of work done. So I can’t always give people what I want and I can’t always look things up at the moment. And so it’s a, it’s really a process of what can I do for this person in this circumstance to the best of my ability and then go home and read it if I can, but I also need a life also just focused on my work doesn’t, it doesn’t work out that well either.

Pam:
So some kind of a balance, but I also find that by listening carefully to my patients, I often ask them when they’re taking supplements, who suggested it and does your dispensing pharmacist know about it and would they ever like to talk to me about what my thinking about giving you this particular probiotic or why I would steer you away from this or that. Get them talking about that. Because a big pet peeve that I have is that our electronical medical records do not have spots that are easy to put supplements and therefore out of sight, out of mind, it’s not taken into consideration. Also, a lot of us have job where the supplements are in a completely different section. Metrics are completely different. The pharmacist who takes time to talk about a supplement or counsel is taking time away from the metrics they’re being judged on. These are all problems. And still it took a while to learn that I could be a little helpful and that would just have to be enough for a while until the person came back to me and we had more time to talk. I hope that makes sense. What I’m trying to say instead of an all or nothing, be an expert or not do it at all. There’s little areas where we can start making some help.

Michelle:
Oh, absolutely. I mean I completely agree and you know, we can do, like you mentioned, so many pharmacists work in situations that are so high traffic very busy. They don’t have a lot of time to talk to patients and anything that you can do, just the tiniest little tweak for somebody can make a huge difference. And then you can talk to them further down the line if you need to. But just one interaction could, you know, change somebody’s life you know, helping them with the supplement or a potential problem with one or assistance with one could potentially even save their lives. So every little bit does matter. And, you know, while we take care of our patients, you mentioned another great point is balancing our own lives. We only as good to our patients if we’re good to ourselves and taking care of our own selves so we can take care of our patients to, to the best of our abilities. Another, another question I had. You know, a lot of pharmacies carry supplements and you know, the big box stores have aisles and aisles of them. What are your thoughts on like types of supplements? I mean, you know, buying, you know, vitamin D at Costco versus, you know, maybe integrative therapeutics, vitamin D or the types, I mean, I, I, I believe that the types of supplements do matter. What are your thoughts?

Pam:
Very good question. Very, very good question. And one that I deal with every day with the people that I serve and also ask myself over and over. And again that depends. It depends on the intended youth. Like I think we need to bring this up to our listeners right now. So your listeners, our listeners is that dietary supplements, in fact, all medications are based on intended use and drugs are approved for their intended use. Pre-Marketing post-marketing dietary supplements have an intended use. And so if the intended use is just to check it off the list and take a vitamin D supplement, I’m not sure it matters much where the person gets it. If somebody is looking for a very specific function and there are studies with that particular supplement, it’s delivery form. It’s so sad when we can get a little more exact. There are studies around and so I’m also would like to mention, and it’s kind of a disclaimer, I work for a professional integrative health pharmacy and we stock professional brands.

Pam:
So I am just biased because my paycheck comes from making sure that we sell professional supplements. If everyone got their products at Costco or some other kind of store like that, you can see the inherent conflict. I am a little bit biased about that. My general thought is that the more serious the effect somebody wants, they probably should start with a professional brand. I have a lot of competence in professional brands because they’re intended to be used by healthcare professionals for their patients. Some of the other products that are less expensive that are for the general public are not really so focused on that. There might be some cost saving manufacturing practices, not contaminants, but it isn’t as important for general use as it is for professional use. And frankly not everyone can afford professional grade supplements and there may not be an indication for that. So I know that sounds a little funny coming from somebody who’s devoted 25 years to to doing this, but I want to be reasonable. And Michelle, I found that this makes me much more approachable where I’m not going to say they have to get the highest quality on everything. Let’s look at what’s being suggested. Either I suggested or someone else suggest a supplement regime and where you might be able to save a few dollars and get it at a cheaper location or where it’s really important because stability is a factor or delivery system as a factor.

Michelle:
Oh, that’s, that’s a great answer. Thank you. And I think that clears up a lot of questions that, you know, maybe some of the listeners head as to which supplements to provide to their patients. And then that fits. Great. Thank you so much. So now, now I’m going to ask you the big question, especially at this time that we that there, that we’re all living in right now, this research, so many people are fearful. There’s so much misinformation out there and you know, people around the world are terrible. What integrative approach could we as pharmacists take in helping our patients maneuver through this covert 19 pandemic and outbreak?

Pam:
Yeah, of course. That’s the question. Definitely the question important to start out by saying nobody really knows this is a novel virus and pharmacists and physicians that I talked to even before, let’s say last year about natural medicine when a lot of us have not been so comfortable with novel or not knowing. Here’s where meditation really helps. Thank goodness it was prescribed to me as part of my treatment plan 25 years ago because it’s really coming into play now of not knowing and just to, for me to admit every morning before I go to work, I actually don’t know. Nobody really knows. But in the field of not knowing what do I know that at least sounds reasonable, that has a chance of having a benefit and a strong possibility of having no risk or no unwanted effects. And in that vein, when people ask, should I take this or should I take that?

Pam:
My first thought is to assess whether it can harm them with our particular disease condition, their vulnerabilities, their medication. Once decided that it’s probably not going to harm them, then alright, let’s maximize or optimize what you’re taking. If it’s known truly nobody knows how much vitamin C to take, but does it seem reasonable to take vitamin C? Yeah, it probably does. Always counsel about taking too much and getting loose duels. That’s a reversible, unwanted effect, and so you just slow down when you, if you get loose stools, do I absolutely know for certain that taking a certain formulation of vitamin C will protect us from viral infections? I don’t know if any of the listeners know. Please contact me. I want to hear what you have to say, but does it seem reasonable at this time when there’s been some evidence that Corona type viruses, common colds, there’s some studies that have sort of indicated yes.

Pam:
While there are some that say no, probably not a lot of harm in doing it and people want to be able to do something, but they want a health care professional to tell them when it might harm them. So that’s a model of how I’m working with all these different supplements. The other thing to tell you is that many of us don’t wait for an epidemic or certainly a pandemic to begin supporting with viral protection. And it’s been a practice of mine every August and September to become and to begin a regime that will protect me from exposure from all kinds of things that happen in the winter months. And so really what I’ve been doing is just upping what I already take and feeling very happy that I’ve been open enough to know that in my line of work exposure to a lot of different infections that my body responds to certain products.

Pam:
I’m not going to tell you what they are because it might be different from what works for you, but this is probably the 24th or 25th flu season that I had supported my immune system cause I’ve always been a community pharmacist. I think one of them for now, the answers are unknown, but pharmacists can at least investigate whether it might harm the patient, but we should all remember and have this conversation again next September, October. And what might we have learned from this period of time? So, that we can protect our immune systems next year for, for whatever comes next year.

Michelle:
Oh, absolutely. Thank you. And, and the, and I think that’s the whole key to, you know functional medicine is to [inaudible]

Pam:
Keep your body as healthy as possible every day so that your immune system is as strong as it could be to fight off any viral, bacterial, any infections, any invaders that come, that come your way so that you can always maintain that health before you get sick. Yes. But now the people coming to us now and in groves are, they can’t start a few months ago or so and and making little mental notes about some education I want to do at the pharmacy as next year when summer is turning into fall. Just to say, remember how motivated we were in February and March of 2020. Bring some of that motivation. But, but that’s, that’s for then for now, as long as patients aren’t harming themselves, then let’s, we can have a discussion about what might be the best thing to take.

Michelle:
Excellent. And, and again, every patient’s different and every conversation is different. So those, those are things that we as pharmacists do every day with, with, with, with our patients. What, what, what is farm supplement?

Pam:
Foreign supplement is a project and a drug information service and educational platform that are PGY one resident, dr swarthy bar and Aussie and I are putting together, we’ve been working on this throughout her residency and we’re going to launch it probably this summer needed more than ever and it is an integrative approach to just what we have been talking about. How does a pharmacist or healthcare professional deal with the influx of question and how might they frame it, what resources might they use and what background is needed in order to answer some of these questions and to really complete a medication therapy management. Because my experience is in a lot of others that if we are somewhat knowledgeable about them then our patients are not going to tell us they’re going to take them anyway and they’re not going to tell us they’re going to talk to the person in the aisle of the health food store they go to or they’re going to talk to their friends about it.

Pam:
So this is a both a, an information service and an educational platform to use what we’ve learned in pharmacy school and in our practice to a reasonable framework for working with dietary supplements, integrative practices, meditation, homeopathy, and a homeopathy is completely different than dietary supplements. And so that there’ll be education on that and where homeopathic medicines may have a place along with herbs and supplements or not. And it takes a little bit of juggling to do that. Just like anything that we learn at the beginning. You go one at a time through basics and then learn how to integrate it together. So we’re very excited about it and it’s been such a pleasure working with her, taking somebody like myself cause it’s been doing this quite awhile and her who has a natural interest in this and all of her rush out of pharmacy school skills and she’s quite an innovative new pharmacist. It’s really a pleasure to be working with her on this.

Michelle:
Oh that sounds so exciting. And when will it be launched? Well, things are on hold a little bit now that we’re hoping for the summer. Oh fantastic. Why I really look forward to, to seeing it for sure. And w one of the last questions, and this is a question I always ask my guests is what’s the most rewarding experience in your field so far?

Pam:
Impossible question, answer. May I ask? You answered on different levels. Absolutely. Of the last couple of weeks. The most rewarding thing is for me is to already have these skills in place to be able to be the kind of pharmacist I wanted to be in pharmacy school all throughout my career so that I can handle a lot of information at the same time. And center it and personalize it for the person that’s asking. Often. It’s my question that elucidates the answer rather than my first answer. So I’m, I’m, it’s very satisfying to me that all that’s come before is helping me be the best pharmacist I can today. And I think that may be what I want to say. The other thing that, one more thing is even our conversation now, Michelle, ways of connecting with pharmacists have really for most of my time in integrated pharmacy, I’ve kept to myself or other kinds of practitioners the last five or so years making some very, very strong deep connections with other pharmacists that are interested in this. That is extremely satisfying. That a few minutes talking to them, you can see the light bulb come on and then I know they’re going to be able to help hundreds of other patients just from our conversation.

Michelle:
Oh, that’s, that’s, that’s awesome. And you know, I w when I first, you know, started realizing the amazing work you do was last year at the Western pharmacy exchange. I attended your session on integrative pharmacy and it, it was just mind blowing to me. Just, you know, when we’re looking at all these, you know, nontraditional or different routes that pharmacists can take in today’s healthcare arena. It was, it was just extraordinary to me that you have such a deep knowledge and deep level of this modality over all these years that really make an impact. So, so many, so the pharmacists and the pharmacy students, I mean have so much to learn from, from your work. So it’s extraordinary. Thank you.

Pam:
Thank you for mentioning that. I, I want to pay tribute to the patient anonymous patient that came into our pharmacy. That was the inspiration for that call. He was on Tamoxifen and she wanted to take an herb that inhibited two D sick and I happened to love us sermons, Tamoxifen, hormone related topics and I just bolted right up when she told me that she wanted to take this or like, Nope, we’re going to find something that will serve the purpose you want but will not inhibit the enzyme that activate your breast cancer drug. Please. I didn’t say it like that, but that’s what inside my mind I heard it was very rewarding. And so I, I based the case for that continuing education program on her.

Michelle:
Well, yeah, I mean I found it fascinating and it’s such a field that’s so interesting and evolving. Thank you. Thank you so much. And before we end if for anyone who wants to reach you, what’s the best way they can contact you and then we’ll put it in the show notes and the resources to,

Pam:
Sure. Best place to contact me would be through LinkedIn. That is how I’ve been in contact with a lot of pharmacists and others. And so I’ll put my LinkedIn information. I can give that to you and I do a lot of responding to posts and by contacting me at LinkedIn, you’ll be part of my network and I invite everyone to be part of the network. We can share information. There’s some tough things to look at right now and LinkedIn is one of the ways that I’m communicating and sharing information with people.

Michelle:
Yeah, it’s a great, it’s a great platform for, for good information. Out of all the social networks, I find that, you know, just just like you, I’m reading articles and connecting and commenting on other people’s posts and co conversing with them is really how we all get to grow through this pandemic and learn things. And absolutely. Thank you so much and I know you’re so busy and everything and it was an absolute pleasure having you on the show and hopefully we can, we can, we can do a another show after the pandemics over and it was a pleasure having you on the show and to all the listeners out there and all the pharmacists, you, you’re, you’re my hero. We’re, we’re on the best pharmacist on the front lines of this, of, of this pandemic and you are just like your light, your light shine in the extraordinary way that it always does and you, you’ve come up to bet and you’re all hitting home runs so far. So be safe, protect yourselves and remember, we are the pharmacists and be the change.

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