Watch John Oliver Break Down Compounding Pharmacies on Last Week Tonight

On Sunday’s Last Week Tonight, John Oliver tackled the issue of compounding pharmacies. The segment starts out with a clip from a 1940s pharmacy in grainy black and white, back when every prescription was “eyeballed” by “near-sighted pharmacists,” as Oliver points out. Surely things are much more regulated and accurate now, right? Wrong, we find out as Oliver continues. Oliver enlightens us on compounding pharmacies, which still make prescriptions in house, and as we learn more, almost make us wish for the skeptical but seemingly well-meaning 1940s version.

Compounded pharmacies differ from your typical corner drugstore in that they make medicines for people who may have allergies to FDA-approved, mass-produced versions of a drug, or who have trouble swallowing pills. They fill custom prescriptions for various reasons to accommodate people—and parrots. In an adorable deviation from the medical facts of the segment, a flock of feathered friends are introduced as beneficiaries of compounding pharmacies, as there aren’t prescription drugs made for birds. Oliver stresses that the work that compounding pharmacies do is very important for the people and creatures who need it.

Yet delve a little deeper and compounding pharmacies have glaring problems that Oliver highlights with humor, but the bitter truth is that the regulation and maintenance of these pharmacies has not been taken seriously at all. Compounding pharmacies don’t face the same scrutiny that large pill manufacturers do, and there simply aren’t enough inspectors per state to keep track of conditions in all of them.

When compounding pharmacies are investigated, many have been shut down for negligence and revolting conditions. One pharmacy was found to keep a compounded drug for lung disease next to staff lunches, while another had loose pills stored in a bathroom. One pharmacy led to a massive meningitis outbreak a few years ago, an example of how this irresponsibility can put lives at risk.

Where they have cut corners in cleanliness, some compounding pharmacies have gone over the top to make more money. These types of pharmacies are supposed to make small amounts of drugs based on need, but instead, they were mass-producing and shipping around the country. How? Regulations required them to have an individual prescription for each patient, so they invented some. Some fake patient names included “Big Baby Jesus, Bud Weiser.” (If they weren’t keeping their facility clean, they could have at least put the extra time into trying with these names.) They also utilized celebrity names like Jimmy Kimmel, Ru Paul, Sarah Marshall (Kristen Bell) and David Schimmer, to name a few.

Negligence by compounded pharmacies has lead to sickness and death in people across the U.S., and they’ve also duped the U.S. government financially. Tricare, the military’s health insurance program, was being billed an astronomical amount in a compounded scar and pain cream for veterans. Compounded pharmacies would add the most expensive ingredients they could find to creams that had virtually no impact on patients who used them, and in turn, Tricare would get charged for each individual ingredient, which snowballed into spending $2 billion dollars. “When we talk about overspending in the military, I don’t think anyone would have guessed a not insignificant chunk of that has gone to fucking lotion,” Oliver said. No, John, we definitely didn’t. The even darker side of this fact is the possibility of where that money could have gone: perhaps to underfunded schools or simply invested into healthcare in a way that’s actually effective.

It’s Oliver’s signature to connect humor with news, and it feels good to laugh while you’re learning a lot, even if the facts you do find give you a sinking feeling that’ll stick with you for a while after. Oliver’s ability to give anything an edge of hilarity is one of the reasons Last Week Tonight is an Emmy-winning show, of which Kimmel is quite jealous, we soon learn.

The segment brilliantly ends with a few celebrity cameos from the list of fake names, whose anger makes it clear that they didn’t order any of those prescriptions mentioned before (in case there was any doubt). There’s some banter, callbacks to the stars’ roles (seriously, don’t forget Sarah Marshall), and a parrot.

Watch the full segment below.