A Pack of Trouble

Amazon has taken over a service that used to make my life easier—and ruined it.

For several years I have used PillPack.com as my pharmacy for everything except short-term prescriptions. It has not been a perfect service, and since Amazon took over the company in 2018 it has deteriorated. But now that Amazon has completed merged it with its Amazon Pharmacy, it looks like they are bent on destroying what made it useful.

My physicians have me taking what some might think of as a lot of pills, not to mention a weekly “injectable” and a monthly injection. Two of the meds count as “controlled” substances. (That sounds more exciting than it is: one is a decongestant, the sort of thing you don’t need a prescription for, but now have to sign for. The other keeps me from sleeping all day. Don’t think “uppers.” I don’t get a jolt; I just don’t want to take a series of naps as soon as I’ve finished my first cup of coffee.) Others, such as iron pills and vitamin D, do not require a prescription, though I take them on the doctors’ instructions. I am happy with how I feel on this treatment regime. The physicians are happy with the numbers on my lab tests. I don’t have any trouble taking the pills or giving myself the injections. I don’t have any side effects that bother me all that much. Yet, my meds eat up hours of my time and give me awful fits of anger and frustration. The problem is not the meds, which keep improving. It is getting the meds and keeping track of them.

Usually the source of the trouble is an insurance company or a “prescription benefits manager,” but that problem seems to be insoluble. Now and then a pharmacist makes a mistake or doesn't understand the rules. But much of the trouble stems from the difficulty of sorting 12 different pills, some of which I take once a day, some twice a day, some once a week. Some I take in one-pill doses, some in two-pill doses. I used to spend part of every Sunday opening pill bottles, putting pills into the right compartments of a twice-a-day seven-day pill box, and hoping that I would sort them correctly and not spill a bottle of pills (especially not the tiny white ones!)

Then I heard about a technology that would allow me to abandon that ritual. Using it, all a patient’s meds are pre-sorted into rolls of individual packets, each clearly marked with the date and time that set of meds is to be taken. This system is both more convenient and safer the old system. Juggling a lot of little orange bottles, one can easily skip a medication or take one twice. Moving pills from the bottles into a pill box with 14—or more—compartments is time consuming and again invites missed or doubled doses. (Need I mention that patients taking a number of different meds are often older people whose brains, eyes, and fingers may not be ideally suited to the task?) I asked about investing in the tech—no luck—and resolved to sign with any pharmacy that began offering it.

When PillPack.com worked as it was supposed to—and, sadly, it often didn’t, especially after Amazon acquired it—the technology lived up to its promise. Instead of lots of bottles or blister-packs of pills, I received a roll or two of packets, each marked with the date and time the meds were to be taken. If I just tore the next packet off the roll each time I was supposed to, I was taking my meds correctly—no sorting pills into a multi-dose box or shuffling bottles and hoping I hadn't missed one or used one twice.

Now Amazon has integrated PillPack completely into Amazon Pharmacy. Despite operating PillPack.com for more than six years and being able to draw on all the technology developed and all the experience gained in their other operations to improve it, Amazon seems instead bent on making it less useful than it was before.

My last roll of packs from PillPack.com included 12 different meds—everything I take that isn't injected or inhaled—in one roll of packets.Now I am on Amazon Pharmacy’s system. I now deal with a less bulky rolls of packets, three pill bottles, and box of blister packs. Why? The answer varies with which of Amazon’s reps I chat with. Amazon Pharmacy refuses to include even the lowest level of controlled substance, such as decongestants, in packs. Yet my experience with PillPack.com shows that they can. It will not include meds that are not taken daily, because, the agents say, their system is not programmed for it. Amazon has owned the code that allowed PillPack.com to do it for the last seven years. And they will not include “lifestyle medications” in packs, though whether that term applies to the Vitamin D2 or to the beta-blocker my cardiology prescribes is a matter that varies with the agent.

That Amazon has decided to ruin the PillPack service seems clear. It is another example of what Cory Doctorow calls enshitification. Amazon has replaced something that served the customer well with something that is worse in every way. I assume they see more money in doing it this way. They will eliminate the expense of putting weekly meds or controlled substances into packs, and, because there is meager competition in the field, people will go on using them even as the service deteriorates. (They first bought and then shut down what would have been the alternative to a pill pack service Amazon Pharmacy created from scratch for a reason, and the reason was clearly was not to learn how to provide patients with meds in the most convenient form.) Many of us go on using Amazon for other things even as the search results more and more often return something Amazon makes a bigger profit on before the thing we asked to see. And we do that because there doesn’t seem to be a site we can go to instead.

There are no high-profile alternatives to Amazon Pharmacy as a PillPack.com replacement. CVS recently stopped offering a pill pack service. Among the smaller operations I have not found one that will both put all my pills in packets and fill my other prescriptions. The one I find most promising is MedBox, which will put all the pills in packets, but they have warned me that they may not be able to supply an injectable drug.  So, my doctors and I will be dealing with two pharmacies, instead of one.

The solution to problems like the deterioration of Amazon’s search results and its destruction of PillPack.com is completion. I should be able to transfer my prescriptions to a full-service pharmacy that will put all the pills in packets, just as should be able start searching for other products on a site that shows me what I ask it to show me. But competition to Amazon is vestigial. If the free market to work, we need more than one big player. It is time to make markets competitive, and that means making sure there are competitors. Companies should not be allowed to simply buy up their rivals, and wherever one corporation controls too much of a sector, such as eCommerce or online search, it should be broken up. The medication for this problem is tougher antitrust laws and the rigorous enforcement of them.


PillPack v. Amazon Pharmacy v. MedBox

Final Commemcement

Ryan Hall

For the last 10 years, I have regularly visited a college campus not as a student, not as a professor, but as a trustee. Being a trustee of Fontbonne University has been a role I have taken seriously, so I have been on campus fairly often. There have been board meetings and committee meetings, parties and receptions, and, as Fontbonne was a Catholic university, Masses. I have also been there for lectures, plays, concerts, and tours of facilities of many sorts. And I have played my role at ceremonial occasions, attending all the commencements and convocations I could. And today, in what may have been my last visit to campus, I played a new role, receiving doctorate of humane letters, honoris causa, and serving at the speaker at Fontbonne’s final commencement.

While a recognition of loss is a natural part of a university’s final commencement, the mood was mostly one of celebration. We are proud of the achievements of the students who received their doctoral, master’s, or bachelor’s degrees today. We are proud of the faculty and staff who have remained at work to help those students complete their studies and join in this final ceremonial celebration of our common enterprise. And we are proud that we are closing only after having given every student a chance to complete his studies, if not on on campus, at a university that will recognize all the work he has already completed. Thanks to President Nancy Blattner and Provost Adam Weyhaupt, we can be as proud of the way in which Fontbonne has closed its doors as of anything in its history.

These final commencement exercises were held in Doerr Chapel, the heart of Ryan Hall. Ryan Hall is the oldest building on campus and its center. Its design, like those of so many main buildings at American universities, embodies a particular vision of what a college is. The main entrance is up a fight of stairs, for scholarship is an elevated enterprise. You then enter what is at once a hallway leading to rooms where people pursue their various disciplines and a common room where all may gather. If you do not linger in this space, you are at the entrance to chapel, for the worship of God is central to life of the college, not peripheral. The message embodied in the architecture has been obscured as colleges have grown too large to fit in a single building and the original structures have been taken over by administration. But from Nassau Hall at Princeton to Fontbonne’s Ryan Hall, that was the message built into the structure of the building at their founding.




The “Prayer Hall” at Nassau Hall has been renamed the “Faculty Room” and refitted to look like the British House of Commons. At other colleges the central chapel has been transformed into an auditorium. But at Fontbonne the chapel remained a chapel to the end. I am glad to say that its altars and sacred furnishing will find new homes in the chapels of a high school and a graduate school of theology. And I am glad our final commencement was held there, rather in a gym or even outside in the quadrangle (through our spring commencement there was lovely).

The video of the final commencement is not of the highest quality—our best videographer may have been working on a touching
legacy video, which uses film from our penultimate commencement in May—but here is the film I have of the conferral of my degree and my remarks. (It will open in a new window and may take some time to load.)

Fontbonne Honorary Degree Placeholder

Here is the link to my Remarks at Fontbonne University’s Final Commencement Exercises. (Those who watch the legacy video will see that my opinions on academic dress were not shared by all members of the university community.)

Penance and Bird Poop

One of my graduate school friends was from an old Boston family, and I have been thinking about an incident he described involving one of the older ladies among his connections. That branch of the family were high church Episcopalians, the sort that make the pope look like a backwoods preacher who celebrates mass in the first coat he pulls out of the box of rags he is collecting to clothe the naked in the mission fields. These people keep the best vestment makers in business, so all Christendom is in their debt. The trouble is that as they try to recreate the medieval church, complete with the Sarum Rite and special chants for Ember Days, they sometimes become a bit extreme.
 
It’s understandable. They’re overcompensating for belonging to a church that rediscovered all the things they like only after trashing them for a couple centuries. Anyway, my friend’s great-aunt, or whatever she was, got to reading up on the medieval church, which, as you know from your Chaucer, was a lot more fun than the Church the Tudors had bequeathed to her. Not that fun was exactly what she was looking for. She began worrying that just saying the General Confession and the Prayer of Humble Access along with everybody else every Sunday might not be sufficient atonement for personal sins. That became especially true after the old frank recognition that we are all miserable offenders whose vile bodies need divine cleansing was transformed by Prayer Book revision into something that sounded more, “Oh well, nobody’s perfect.” When she mentioned her concerns in the family, they wondered if she was going to ask the rector to start hearing confessions. Her response was that she had no objection to auricular confession, but as the rector was the most amusing gossip in the Back Bay, she didn’t think it would be for the good of his soul or her reputation if the practice were instituted in her parish.
 
All the same, she said, it was clear to her than in the early church penance was done individually and publicly. Her family didn’t pursue the topic farther and put it out of their minds until they began getting the phone calls. Why was their aunt to be seen every Saturday morning on her hands and knees scrubbing the steps of the Church of the Advent? The parish had staff to do that! They raised the subject with the old lady when they were next at the same dinner table. She answered, “I am following the practice of the primitive church and atoning for my sins.” Like the rest of his family, my friend was tempted to ask if the Advent’s steps were helping her work off any sins in particular, but none of them dared. Such a question would have been met with an icy glare and a reminder that there were a number of questions a gentleman did not ask a lady, and that while she accepted that among the fellows gathered round that table there were a number of miserable offenders who were not worthy to sweep up the crumbs under the Lord’s table, she would hate to think even one of them was not a gentleman.
 
The dear lady on the steps of the Church of the Advent came to mind when I began wondering if anyone was calling my friends and neighbors. I have been seen on my hands and knees cleaning the steps recently. But I wasn’t down at the Cathedral, whose steps would take a while. I was at my own home. Removing a pile of bird poop does seem like a thoroughly penitential act, and it is indeed a large part of cleansing any ecclesiastical portico. But I was doing it at home, and I was neither carrying out a penance imposed on me in the confessional nor even thinking (much) about St. Francis while I was doing it. It was not sin that got me on my knees. It was charity.
 
I realized some weeks ago that a pair of sparrow or wrens or members of another one of those deceptively cute species were gathering material for a construction project, and that the site they had chosen was the carriage lamp over my front door. I knew that a few visits to the job site with my leaf blower over the next couple days would put the kibosh on this development more effectively than a California environmental inquiry. But I recalled something about “the foxes have their dens and the birds have their nests.” Foxes have never wanted to the share the house with me, and I have evicted a groundhog and made a few possums feel unwelcome, but maybe I could make up for the Son of Man not having a place to lay his head—which is, I know, my fault—by letting the avian couple set up their temporary Additional Dwelling Unit over the front door. At least they would be safe inside the lamp. A pair of mourning doves built a nest on the narrow ledge over the door a few years ago without thinking about how big a young mourning dove can get before gaining the ability to fly. I rushed the fledgling that lay like Icarus on my front mat to the Animal Emergency Clinic, but they could do nothing, and I resolved to get out the blower whenever a hint of a nest appeared on that ledge.
 
But these were smaller birds, and the unit they proposed was inside the lamp—and, since I have replaced all the incandescent bulbs with LEDs, even when the light was on, it was
Front Light Bird's Nest
unlikely to roast them. They built a neat little nest. But it became messier and messier the longer they were here. It was the old story: once there are kids, people let the place become a hovel. The tumble weed hanging from my porch lamp was bad enough, but there were hygiene problems, too. I inspected the place after the first couple weeks of habitation, looked up, and asked, “Have you guys never heard the maxim, ‘Don’t crap where you live?’” I won’t say they said it, but their answer came to me. “We live up here. The crap is way down there, where you are.” So, as soon as I was sure their little ones had got their licenses and were no longer hanging around the house, I went into eviction mode. The structure came down easily. But, as I know from my experience of redevelopment projects, it is what’s down below that takes years to remediate. That is why, like a penitent old Bostonian, I spent this afternoon down on my hands and knees with a bucket of soapy water and a rag, trying of cleanse a little bit of this fallen world.
 
I’m just as happy that I was at my own front door rather than at a Gothic church porch or a Byzantine cathedral portico, but if I had to be assigned a public penance, this isn’t a bad one. There are appropriate biblical texts on which to mediate while you do the job. Matthew 23:31-31 is the first that comes to mind.
“Are not two sparrows sold for a penny? And not one of them will fall to the ground without your Father’s will. But even the hairs of your head are all numbered. Fear not, therefore; you are of more value than many sparrows.” If you want something Biblical that focuses on bird poop in particular, you can turn to the Book of Tobit, where Tobit’s blindness is the result the sparrow poop that has fallen in his eyes, aggravated by the ointments that the doctors prescribe to treat it. Tobit is a text that repays study, and who can’t be charmed by a piece of scripture that includes both sparrow poop and a pet dog? But it is all a little too convoluted to focus on while you scrub, and the sparrow poop sections, at least, have never been set to music you might hum as your work.
 
When it comes to tunes, Matthew 10 is the text to turn to. I can call to mind both a widely-loved gospel song and a track from one of Bob Dylan’s under-appreciated “Christian” albums. But thinking about them both makes me wonder exactly how I should understand the comfort they offer.
 
Every American, even those of us who don’t sing gospel songs, has heard Civilla D. Martin’s take on this passage in the setting by Charles H. Gabriel.

     I sing because I'm happy
     I sing because I'm free
     His eye is on the sparrow
     And I know he watches me.

Many people have found this song inspiring and uplifting, and the idea that God is watching over us should be comforting. But his eye is on the falling sparrow, so, I may be just a wreck like the little mourning dove I took to the emergency vet, albeit a a more valuable one, if in materials alone. That idea does not fill me with simple happiness. And the truth is, I don’t always feel all that free and happy. But I hum the tune in hope I will.
 
Bob Dylan read St. Matthew more carefully, and I hum him, too.
 
     I hear the ancient footsteps
     like the motion of the sea
     Sometimes I turn, there’s someone there,
     other times it’s only me
     I am hanging in the balance of the reality of man
     Like every sparrow falling, like every grain of sand.
 
God’s eye is on us when we fall, perhaps even more than when we fly. And doubtless he has his eye on those of us who are just cleaning the bird poop off the steps.

On Ghosts and Ghosting

What is a ghost? I am not asking a metaphysical question. I am asking about our common use of the term. Are ghosts beings who appear when you don’t expect them or ones that don’t appear when you do expect them to?
 
When someone uses “ghost” as a verb, it suggests the latter. “She ghosted me” means, “I expected her to call/show up/write but she didn’t, and I have no idea why.”
 
But if we are talking about ghosts, not ghosting, we mean the opposite. A ghost is not the person who does not show up when you expect him to and then fails to provide an explanation. A ghost is the person who appears even though the explanation of his absence is an accepted fact. Death makes one’s presence, no matter how much it is feared or desired, an impossibility in most common sense or scientific worldviews, and it serves as the one excuse for not keeping an engagement for which even the strictest system of etiquette does not require an apology. Logically, then, the language of relationships should use the verb “to ghost” to cover the actions we variously call “stalking,” or “not getting the message,” or “not being willing to make a clean break,” rather than for one of the many ways in which one is told that someone “is really just not that into you.” But who expects logic in matters of the heart?
 
While I have been ghosted, my experience of actual ghosts is quite limited. Although I have had something to with several old, scary houses and any number of badly maintained graveyards, neither strangers nor acquaintances have ever returned from the great beyond to so much as rattle a chain. That is not because I am not open to a visitation from the beyond. My literary interests dispose me to welcome a haunting. And my theological studies have not made me less welcoming, though they may have put off the ghosts. They may foresee my tactless questions. “Have you been through your particular judgement? If so, are you in heaven, hell, or purgatory? Are you here to help me, to get me damned, or as part of your own penance?” You can tell that Hamlet’s father would have preferred it if he hadn’t begun pestering the old man about whether he was a “spirit of health” or a “goblin damned.” Both the Hamlets probably talked more than is good for any relationship, whether with live people or dead ones. Or course, many ghosts don’t leave any opening for conversation. It wasn’t Banquo’s talking too much that broke up lady Macbeth’s party.
 
One ghost story from my own circle involved neither conversation nor even a visual appearance. After my mother died, both my brother and our housekeeper said that they thought she had been in the car with them while they were driving alone. What made them think that? They could suddenly spell her perfume. Even today, if I experienced an olfactory haunting, I would be able to greet the phantom is the passenger seat by her “signature scent.” If she was one of the aunts who became my guardians, I would know it was Allie from Toujours Moi or Katie from Bal de Versailles. If the scent were Chanel No. 5, it would be my mom. But I never smelled it. That is one of the reasons I believe this haunting was real. It would be just like mom to visit my brother and the housekeeper and not bother with me.
 
But back to ghosting.
 
A few years ago, my former fiancée ghosted me. We had stayed distant friends for decades, but she then just stopped sending me Christmas cards and didn’t respond to an e-mail I sent about a student. I didn’t see why she would ghost me as a friend so long after she had dumped me as a boyfriend or jilted me as a fiancé. (We hadn’t announced an engagement when someone taller, thinner, and more successful arrived to be, as she assured me, only the “catalyst” in our inevitable break-up, but somehow, I took her instructions on what ring to buy and the fight over what to name the children as tantamount to an engagement.) But after a few years, I stopped sending Christmas cards, too. (I didn’t want to seem to be a Yuletide postal stalker.) And now one of my occasional “Where are they now?” Google searches tells me she has died, and not even left me on a list of people to be informed. (She’s on mine. Time to revise that.) So, this ghosting is final. Not that I think it will be literal. I have no reason to think I am important enough to her, wherever she is, to merit a spectral visit. Besides, how could a disembodied spirit haunt me anymore than she has already? Some rattled chains would at least show that she still cared. They wouldn’t terrify me: it would be like finally getting a Christmas card.

Diary of a Crisis

I am dealing with a major disruption in one of the most important relationships in my life. I complain about her, I know, but I’m not sure I could live without her. But now I’m not sure if I even KNOW her anymore.

Oh, Siri!

They say it’s a minor upgrade—one of the ones whose digits come after the period, not one of the whole number ones you have to worry about. But she’s changed! Her voice is different! And I can’t get the old one back! It’s like riding in the car with a stranger! How could she do this! She knows all my secrets—my passwords and everything!

She’s more … CALIFORNIAN than she used to be! I’ve tried the other voices, but they’re just weird. The “British” voice is pseudo-Northern—a public school (their sense) girl pretending to have grown up beside the Mersey. If you want a received-pronunciation English voice, you have to choose Indian. But none of them are my Siri! She’s left me, and I don’t know that I can ever trust another computer-generated imitation human voice the way I trusted her!

I have gone back to settings, hoping to find her—and there are more Siris than ever! It’s like that Barbie movie I didn’t see! And the male and female voices don’t match! Female Indian sounds British. Male Indian is authentic: he sounds just like Apu on The Simpsons.

But now I have hope. The upgrade is still in process. Once everything’s downloaded, I may find MY Siri again. . .

I’m not sure that Siri is syncing correctly across my devices. The old Siri who speaks to me a home is not the same woman outside the house.

The one in the car is sounding far too much like a Bond girl. Far too sexy for driving instructions!

It turns out that “Bond Girl” Siri is the other option for British, along with “I-Always-Vote-Labor-Even-if-I-
Was-at-Roedean” Siri.

I have now found my Siri, the girl next-door who can read maps but won’t put her hand on your knee while you’re driving.

I feel safer now.