From the Inside Flap
Here is a sample of the feedback I've received from pharmacists as a result of some of my Drug Topics and People's Pharmacy commentaries.
Skeptical Pharmacist #7:
Our entire healthcare system revolves around the quick-fix consumer culture that ensures grand profits for corporations and unfortunately most people buy into it. I enjoy having the conversations with customers who are tired of the pills and want to investigate other options. These conversations, however, are the exception. Most people I encounter want to be told what to do and aren't interested in the details or thinking for themselves. Better to depend on the big pharma-trained MD to solve their problems with a pile of meds or the many pharmacists I know whose mantra is "better living through chemistry." It is MUCH easier to swallow pills than it is to take responsibility for one's health.
Skeptical Pharmacist #8:
I was privileged to work at one time for the Air Force and then for the VA, and I respect the philosophy of those organizations. Funny thing - when the facility is assuming most of the cost of the treatment (as is in most federal pharmacies), suddenly prevention of disease states becomes extremely important to the system. I witnessed the processes in place to emphasize education of the patient and encouragement of the patient to exercise more control over his/her own outcomes when possible. Of course, meds were dispensed (and lots of them), but when the focus was on behavioral management when possible, it was gratifying to see many patients take that control and make significant improvements with fewer medications. Also polypharmacy [overmedication] was more easily addressed when the pharmacist had an overview of most of the patient's medications. No doubt in my mind that as long as the numbers (how fast and how many scripts filled) have such importance, the money will be winning out.
Skeptical Pharmacist #9:
[This] is something that I have thought about for years. A large percentage of patients I see in the pharmacy have health problems because of their lifestyles. It would seem that the logical course of treatment would be to try and get them to alter their lifestyle. The drugs only keep them alive and functional but do not address the root cause of their ailments. A patient goes to the doc and his blood glucose level is high. The doc gives him a prescription for metformin. This is the easy approach. The doc will probably mention diet and exercise. This is really about all the doc can do. The underlying cause of the patient's problem is his lifestyle. Until our healthcare system can reach people in a way that nudges them into changing their life style, we are going to be bombarded with a costly and overloaded healthcare system.
Skeptical Pharmacist #10:
This is a frequent conversation in our pharmacy. We constantly wonder why people don't make simple lifestyle changes that would reduce or eliminate the need for medication. Why does that seem so hard to understand?
Patients demand a pill to feel better now (they saw one on television!), doctors supply another pill to satisfy the patient, and no one in the medical profession has time to stop and think much about it anyway! When was the last time a doctor (or other practitioner) has had time to sit down with a patient and explain the benefits (and the dangers) in lifestyle choices? Lose weight? That's too hard. Eat more healthfully? Who has time to cook? Stop smoking? That's my right! Feeling blue? There's a pill for that!
I read Andrew Weil and Susie Cohen, and they make so much sense to me. I preach to everyone who will listen about what we're doing to ourselves in the long run - how America is overmedicated and none the healthier for it. I watch the drug interactions pop up on my screen for patients who take multiple meds, and cringe. Doc says "I think that will be OK." I watch the medications given to elderly folks who really shouldn't be taking them, and wonder if they just need someone to talk to instead.
I'm tired, and I just don't know what to do about it - I learned long ago that I can't save the world. After all, we're battling a billion dollar drug industry and direct-to-consumer advertising. Maybe the new kids coming up, if they will pay attention, can change things. But first, they have to see the problem.
Skeptical Pharmacist #11:
Our society is often too quick to name-and-blame rather than admit that many social and physical challenges in life are not best solved through prescribing another medication. There are billions of dollars backing those chemical company assertions that cannot be substantiated by evidence-based review.
Our true value (and survival) as pharmacists will be found in communicating truth, not in pushing even more medications to an all-too-trusting public. Being so bombarded with clever advertisements and "convincing" clinical trials, pharmacists have transformed from the "most trusted" to the "most trusting" profession.
Skeptical Pharmacist #12:
I would love to spend time counseling all my patients on lifestyle changes. Preventative medicine is the best type and the most cost-effective. Unfortunately until pharmacists are recognized federally as healthcare providers, we cannot bill for these type of services. If we can't bill for these services, we cannot generate revenue. Our current revenue comes from pills, so to remain employed, that is what we must do.
Skeptical Pharmacist #13:
Whenever the doctor's office had not called back with the customers' refill authorization, besides being annoyed, many customers would respond by saying, "I don't know why the doctor does not give more refills. I'm going to be on the medication for the rest of my life."
I always felt like going over to the customer and saying "How do you know that you are going to be on the medication for the rest of your life?" Did the customer ever think about starting an exercise regimen or changing their diet if their prescription was for blood pressure or cholesterol? Of course not. Because it is easier to just take a pill than become more healthy by working at it.
The same idea applies to people on antidepressants and anti-anxiety medications. I recall a woman who came to the pharmacy for her antidepressant medications. She was the most morbid, negative person I ever met. Once again, I felt like going over to her and saying, "You know, if you changed your attitude and outlook on life, you would not need to be taking all of these medications." She would also have saved a lot of money and avoided all of those side effects caused by the medications.
Skeptical Pharmacist #14:
There are too many temptations in this world and people readily jump in without thought of the consequences. The key to health is healthy living and prevention. Unfortunately because the current state of the insurance industry people are taking advantage of the quick fix scheme that these same insurance companies, PBM's included, have perpetuated.
Skeptical Pharmacist #15:
In the aggregate, pharmacists are the most qualified to help our patients differentiate between drug therapies truly necessary for them, the ones that seem solely to boost the drug economy, and discretionary therapies in between. About half of the drug products we sell are unnecessary or could be avoided. Most of the pharmacists I know live healthy lifestyles and would advise patients supportively about "pharmaco-avoidance" [avoidance of drugs] if given the chance to get to know the patient to be frank enough to offer lifestyle change advice, for instance.
From the Back Cover
Skeptical Pharmacist #16:
Allopathic/Western physicians (and physicians assistants and nurse practitioners who follow closely in their tracks) prescribe drugs at the drop of a hat or mention of a symptom. There is no time to drill down to the cause. And that excuse assumes that the prescriber even has the skills to connect-the-dots that would help him/her find a root cause or know what lifestyle/diet/exercise/sleep adjustment to make to "cure" the problem.
Pharmacists seem to be satisfied with filling as many prescriptions as they can so as not to upset the apple cart of income and push-back from prescribers. We should be siding with patients, re-evaluating the need for drug regimens, and calling doctors to get medications discontinued, doses reduced, lifestyle changes made. Our patients (who, by the way, hate being thrown another prescription that doesn't solve their problem) will love us for it.
The prescribers who, as we know, don't have the time to connect the dots or don't know how to interpret tests (e.g. thyroid) or know what nutrition and lifestyle changes to suggest will appreciate our efforts. So, when we think of Medication Therapy Management, instead of looking for compliance issues, adverse drug reactions, drug interactions, etc. we should, first and foremost, be thinking of how to titrate a patient off unnecessary medications, suggest lifestyle changes, advise on dietary interventions, and suggest OTC supplements (vitamins / nutrition / herbs / minerals) after we connect the dots. My 2 cents.
Skeptical Pharmacist #17:
I've been a practicing pharmacist now for 57 years and I am no longer shocked. The thing with hypertension and diabetes is that no matter how many times you tell them or how much guidance you provide them, they simply will not follow a balanced or safe diet. I work in a hospital, and the same people keep coming back in with elevated blood sugars. We have a diabetic counselor who works very diligently with these patients, even helping them get reduced or free insulin, and they just will not take care of themselves. We also have free cooking classes and free counseling sessions for anyone in the community who wishes to take advantage of our programs. Few do so. The problem is that you can't cure stupid.
Skeptical Pharmacist #18:
We are continually burdened by the pressure of our chain pharmacy to increase volume and push sales. Frankly, I feel it is a good thing for the general public if the need for pharmaceuticals diminishes. That would mean our patients are getting healthier. Why would pharmacy sales or volumes increase if we are doing things right? There is no denial to this truth: We must change our nation's rotten healthcare system.
Skeptical Pharmacist #19:
I just wanted you to know that I enjoyed reading your article, "10 Shocking Things I've Learned As a Pharmacist." I wholeheartedly agree with all your points! I graduated from XXXXX in 1997 and do hospital work in XXXXX. I guess the same B.S. applies throughout the medical field and all over our fine nation. I also believe good nutrition and daily exercise with a little good old fashioned fresh air could probably cure much of what ails us and eliminate the need for many of the pharmaceuticals polluting our bodies and waterways at present. Keep writing. I think more people need to understand.
Skeptical Pharmacist #20:
I am a pharmacist who has been with XXXXX for 17 1/2 years and was laid off in June due to my store closing (as a result of the then-pending merger with XXXXX). I saved an article you wrote in the May edition of Drug Topics titled "Pharmacy Schools Should Focus on Health Rather Than Pills".
For many years, I have had a strong interest in natural products and supplements. The more I learned about them, increasingly I preferred them to the often-toxic medications.
Conversely, the more familiar I became with medications, the less I preferred them to natural often safer (and many times equally or more effective) alternatives, including healthy lifestyle choices.
I would be interested to know if you have any suggestions as to a career path I might pursue. I would like to be involved in holistic health care in some regard, but am not sure where I would fit in. I have contacted a couple of local wellness centers which do acupuncture, massage, and/or the like but there does not seem to be a role for a pharmacist. I would consider non-pharmacy jobs. I have been disinclined to go back to school for alternate training, but am slightly more open to the prospect now. Of course, it would be nice to find something where I could earn a decent living as well, but right now my priority is just to find something. I would appreciate any feedback you could offer.
Skeptical Pharmacist #21:
I have always tried to live a healthy lifestyle, yet without sacrificing on things I enjoy. My motto is quality over quantity when it comes to eating. I do not smoke, drink moderately, and am still at the same weight of 100 pounds that I was when I was 22 years old.
I agree with many, if not all of the points you bring up. I too, am a pharmacist for the past 25 years, and I feel our western society is overmedicated and relies too much on prescription medicines as a solution. I really felt this way more than ever when I recently had a "western disease" of heartburn and GERD and was diagnosed with esophagitis and gastritis by endoscopy. I was prescribed Prilosec, and after 2 weeks, had very little relief and was switched to Nexium and was told to take it for 3 months to help "heal". I was unhappy to think that I would have to take something long term like that, and af ter 8 weeks total of being on a PPI [proton pump inhibitor], I decided to research other options and thoroughly examine my lifestyle to see if there was anything that I myself was doing to contribute to the gastritis.
I also reached out to my older sister-in-law who lives in India to ask what methods they utilize there.
After all my research, and knowing that PPI's do not really solve the underlying problem, I abandoned the Nexium and started multiple non-pharmacological therapies and made a few lifestyle changes. The first week after stopping the Nexium was the hardest, as the heartburn came back pretty severe. But I anticipated that, after the "channels were blocked for so long," that opening the floodgates again would perhaps trigger a major blowout. However after a week symptoms subsided and I continued all the other measures. It wasn't easy, but now I'm physically much better and psychologically better knowing that I am not taking a daily maintenance pill.
But I was lucky because I had the desire, drive and time to help myself. Others may not be inclined to do so.
I believe this can and should change in the future. Just like Michelle Obama's "Let's Move" campaign to get kids exercising, and Michael Bloomberg's push to limit soft drink sizes, people will slowly listen and catch on. I see more and more younger people than ever before who are now interested in healthier eating.
Maybe there needs to be some sort of "decrease your number of pills" campaign!!
Getting a pill-taking country like the USA on board will be difficult but it could happen.
There have to be a lot more people out there who also think like you and me. The food industry has done a lot of work getting people to understand the downside of processed foods and the public is slowly starting to listen.
People like us have to work to get the public to understand the downside of chronic prescription medicines and let them know that alternatives are out there and that we are willing to help.
I am still a practicing pharmacist however I am willing to dispense less pills and offer more to help the public help themselves. Maybe I'm the minority, but persistence can pay off.
About the Author
The author graduated from West Virginia University School of Pharmacy in 1975. During his career, he worked for three of the largest drugstore chains in America. He worked as a pharmacist in West Virginia (primarily in Charleston, Huntington, and Summersville) and in North Carolina (primarily in Raleigh, Durham, Chapel Hill, Burlington, Oxford, and Henderson). He has worked as a staff pharmacist and as pharmacist-in-charge. He was the manager of the entire store several years ago in Burlington, North Carolina when the Revco chain had pharmacist store managers.
The author has spent the last several years researching and writing his three books and writing articles/editorials for major national pharmacy magazines. He has written a few dozen editorials for Drug Topics over the last two decades. He has also written two articles for American Druggist which were subsequently reprinted in the physicians' newsmagazine Medical Tribune. He wrote a 25-page chapter on pharmacy errors for a book published in 2005 for lawyers and judges (Drug Injury: Liability, Analysis, and Prevention, Phoenix, Arizona: Lawyers and Judges Publishing Company). He was a major source for an article on pharmacy errors in the June 2005 issue of Good Housekeeping. He has contributed articles to The People's Pharmacy (peoplespharmacy.com) starting in 2017. Several of the author's editorials are available on the Drug Topics website (drugtopics.com) by entering "Dennis Miller" in the search field.
The author is not related to another pharmacist named Dennis Miller who wrote a book on manic depression.
