Dennis Miller, RPh

I believe that a large number of pharmacists would agree with the proposition that medicine sometimes feels like a religion. For example, do you agree that physicians resemble priests, nurses resemble nuns, pills resemble communion wafers, and ancillary health professionals-pharmacists, physicians’ assistants, optometrists-resemble acolytes? The use of Latin in prescriptions mirrors the use of Latin in Mass.

Physicians serve many of the functions today that priests served in past centuries. When you pass a physical, your physician gives you his ‘blessing’ that you are in good health. In many ways, the medical check-up resembles the confession in the Catholic Church. The confession involves the confessor and the priest. The medical check-up involves the patient and the physician.

If physicians were true scientists, would we be told to “have faith in your doctor” or “have faith in modern medicine”? We are not told to “have faith” in true scientists like chemists, biologists, physicists, geologists, and astronomers. So why should we be expected to have faith in physicians unless they indeed play a quasi-religious role in society?

Many healthcare-related schools recognize student achievements in what is known as a “white-coat ceremony.” A relatively new ritual in such professions as pharmacy, medicine, dentistry, and nursing, it marks a student’s transition to the study of clinical health sciences. Many students consider it a rite of passage in the journey toward a healthcare career.

Critics believe that these ceremonies create a sense of entitlement to trust and respect that is unhealthy and likely to foster an elitism that separates patients from healthcare professionals. Many allege that white-coat ceremonies have taken on a quasi-religious significance that symbolizes the conversion of a lay person into a member of the healthcare profession, similar to ordination of a priest into a religious hierarchy.

White coat ceremonies at many pharmacy schools have a distinct religious feel wherein students are initiated into the brotherhood of modern medicine. They are initiated into a molecular, cellular, and reductionist view of human health in which pills are better than prevention, and in which there is a powerful bias toward pharmacological approaches to illness rather than dietary/nutritional and lifestyle approaches.

Pharmacy school resembles a seminary in which young impressionable students are force-fed a narrow mechanistic view of human health. Social, cultural, psychological, political, economic, and environmental factors are largely ignored because these factors do not coincide with the tidy, product-centered, pill-for-every-ill approach to health favored by the powers-that-be in the world of pharmacy.

Modern medicine is much like a religion in that both require a suspension of critical thinking. We cannot see a god, but we are expected to believe that one exists. Similarly, when watching drug commercials on television, we are expected to ignore what our brain is telling us, for example, that the long lists of potential side effects are very scary.

Both medicine and religion depend heavily on the power of suggestion. For example, the placebo effect is recognized as an important factor in the effectiveness of many drugs. Surprisingly, the FDA often approves drugs that show only marginal benefit over a placebo. But when one factors in the adverse effects associated with actual drugs, the placebo might logically be considered the superior agent.

A Google search yields a surprising number of serious articles and books discussing the proposition that much of modern medicine resembles a religion. An article titled "Is Medicine A Fundamantalist Religion?" by Lissa Rankin, MD, (

I was religiously trained to worship the dogma of medicine as if it were the Bible, and it was made very clear to me that I would be excommunicated should I ever turn my back on what I’d been taught.

Physicians were our priests, the war on disease replaced the fight against sin, and pills were my communion. Those who questioned the dogma of my religion were persecuted as “quacks” the way the church persecuted heretics.

Until my mid-thirties, I was a devoted practitioner of my faith. I bowed to evidence-based medicine, technology, pharmaceuticals, and the idea that physicians are gods with superhuman powers, who never make mistakes and should always be trusted. I believed that patients couldn’t be trusted with their own bodies, that only physicians trained in gross anatomy in prestigious universities had the knowledge and experience required to heal a body, and that a treatment is only effective if randomized controlled clinical trials prove that the treatment is more effective than a placebo.

Hospitals are modern-day cathedrals where disciples worship the latest drugs and technology being promoted by representatives of the medical-industrial-pharmaceutical complex. Perhaps a more humble attitude among health professionals is appropriate given the abundant uncertainties surrounding many of the products and services we provide.

Dennis Miller, R.Ph. is a retired chain store pharmacist living in Delray Beach, Florida. He welcomes feedback at dmiller1952@aol.com.

Articles

Physicians are our priests, the war on disease has replaced the fight against sin, and pills are our Eucharist. 

Opinion: Is Modern Medicine a Religion?

The switch to the PharmD was ostensibly in response to some perceived need or deficiency in pharmacists’ ability to perform their job. But I don’t recall ever seeing a clear explanation of that need or deficiency.

 blog is a place for pharmacists to share their opinions and does not necessarily reflect the views of the publication. We welcome any alternative viewpoints at David.Frabotta@ubm.com. 

Presumably, the idea was that more education would enable pharmacists to perform their jobs better. The tremendous energy expended on the switch to the PharmD could have been spent much more wisely by addressing the elephant in the room that everyone is afraid to discuss: the stranglehold that the big chains have on our profession and the resultant threat to the public safety by rampant understaffing.

The powers-that-be in our profession realized that requiring more pharmacist education is much easier than requiring more staffing in drug stores. Requiring adequate staffing results in tremendous resistance and push-back from chain drug stores-the biggest employer of pharmacists. So, the powers-that-be decided to focus their attention on pharmacist education levels rather than pharmacy staffing levels.

I realize that pharmacy schools can’t force the big chains to provide safe staffing levels. But the pharmacy schools, American Pharmacists Association (APhA), American Association of Colleges of Pharmacy (AACP), state boards of pharmacy, and National Association of Boards of Pharmacy (NABP) collectively have tremendous ability to shape a compelling narrative. All of these entities should have joined forces to inform state and national legislatures and the general public that the big chains are endangering public safety by using a business model based on understaffing.

I think that most pharmacists would agree that our primary responsibility is to assure that the right drug is dispensed to the right person, in the right dose, with the proper directions, and with adequate screening for drug interactions and contraindications. Using these criteria, I don’t see how the switch to the PharmD has benefited patients/customers. The switch to the PharmD has benefited the occupational and intellectual interests of pharmacy faculty far more than it has retail pharmacists and the customers they serve.

I’m retired now, but as I look back on my long career, it seems to me that the primary causes of pharmacy mistakes belong in two main categories: 1) carelessness, not paying attention, not concentrating on the task at hand and 2) understaffing, (i.e., not having enough staff to allow pharmacists to perform their job properly).

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I can’t recall observing a single error during my career that was due to a deficiency in a pharmacist’s education. The nice thing about pharmacy computers is that they are capable of storing much more information about drug interactions, drug allergies, contraindications, high-low doses, etc., than even the most highly educated pharmacist can carry in his/her head. The problem is that understaffing does not allow us the time to address as many of these drug utilization review (DUR) alerts as we would like.

With more PharmD’s in the profession, why aren’t there fewer pharmacy mistakes?

Accurate statistics about pharmacy mistakes are hard to come by. The big chains aren’t willing to release internal data regarding the incidence of pharmacy mistakes that occur in their stores. Nevertheless, I think most pharmacists would agree that the number of pharmacy mistakes is not decreasing. With a higher percentage of PharmDs in the profession every year, why hasn’t there been a commensurate decrease in pharmacy mistakes? Is the PharmD degree irrelevant when it comes to preventing pharmacy mistakes?

The core concept in pharmacy school is patient counseling. The problem is that the biggest employer of pharmacists is opposed to the core concept taught in pharmacy school. Thus, pharmacy faculty are not living in a real world.

A pharmacist sent me an e-mail relating a story of when he asked a pharmacy school dean how pharmacists are supposed to implement the patient counseling model in a workplace characterized by dangerously low staffing levels. The dean gave a very disappointing answer, responding something like, “We teach students to be drug experts and then it’s up to them to figure out how to implement the drug expert/patient counseling model in the real world.”

The big assumption in our profession is that more pharmacist education makes more competent pharmacists. If there is a direct relationship between pharmacist competence and years of education, are we to assume that requiring even more education would make even more competent pharmacists? Rather than requiring six years of college to become a pharmacist, aren’t we shortchanging the public by not requiring seven or eight or ten years of education? 

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The more logical assumption is that big chains have complete disdain for the product of today’s pharmacy schools: the PharmD graduate.

In order to do our jobs competently, we need adequate staffing in the pharmacy far more than we need more education. The switch to the PharmD degree was accompanied by tremendous fanfare-as if some critical problem had finally been fixed. What if the intense focus had instead been directed at addressing the real problem in the world of pharmacy: dangerously understaffed pharmacies? Would pharmacists be happier and would the public be better served?

Pharmacy schools self-servingly promote the false premise that pharmacist competence is directly proportional to the number of years of schooling. In my opinion, pharmacist competence has a much closer correlation to staffing levels than it does to education level. Requiring adequate staffing is far more important than requiring more education. Understaffing means that we don’t have the time to use the education we have.

Dennis Miller, RPh is a retired pharmacist living in Delray Beach, Florida. He welcomes feedback at dmiller1952@aol.com.

Why one pharmacist thinks pharmacy education is being wasted.

Understaffing: The cancer on our profession

, I’ve often heard pharmacists admit things they would not otherwise admit. It’s at times like these that pharmacists sometimes let their hair down and make comments like, “If people would just take better care of their health, they wouldn’t need nearly as many pills.”

I suspect that every pharmacist has heard one or more of his/her technicians comment on the huge number of pills that our customers take. Techs often say something like this: “I wonder how Mrs. Smith has any room left for food.” 

But we pharmacists typically shrug our shoulders and laugh nervously because we realize the system has a powerful preference for pills rather than prevention. This attitude is like that old saying: You can’t fight city hall. In the world of pharmacy, a similar dictum is: We can’t fight the powerful corporations that long ago concluded the treatment of disease is infinitely more lucrative than the prevention of disease.

Related article: Pharmacists Trapped in the Middle of Drug Price Wars

Many pharmacists say that our healthcare has very little to do with health. Our system is about pills, not health.

In my experience, it is usually bad practice to say, in a group of pharmacists, that our customers would likely need far fewer pills if they learned to take care of their health. That view challenges pharmacy orthodoxy. It is pills that pay our salaries, not dietary and lifestyle advice about preventing disease.

There is a strong bias in drug stores toward treatment of diseases with pills, rather than toward the prevention of disease via lifestyle and dietary changes. Employers usually expect retail pharmacists to maintain a completely positive attitude toward the pills we dispense, rather than question whether the current system is the best way to make people healthy. Pharmacists who worry about potential adverse effects of drugs or who prefer prevention over pills are often seen as heretics who should be excommunicated from the profession.

Should we shun or ostracize our colleagues who are more enthusiastic about prevention than pills? Are these pharmacists “disloyal” to our profession?

Are we harming our customers by being complicit in the mystification of health? The pharmacist’s mechanistic, reductionist, and product-centered view of health convinces people that health is dependent on the technical expertise of people in white coats rather than on fundamental changes in diets and lifestyles.

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I have seen pharmacists give positive and reassuring answers in response to customers’ questions about some drugs even though I often suspect those pharmacists would never take those drugs or recommend them to a family member or close friend. Pharmacists should critique the pills we dispense as aggressively as some pharmacists critique the football and basketball teams at their alma mater. 

Skepticism is essential in any scientific pursuit. I would like to see our profession move to greater honesty with the public regarding the risks and benefits of drugs. For our profession to flourish, we must be seen as unbiased sources of information about the risks and benefits of drugs. We cannot debase our degree and our profession by becoming cheerleaders for drugs, even though our employers and Big Pharma surely wish that we would.

The large number of potential side effects should prompt people to do everything they can to prevent what are, very often, simply diseases of modern civilization. Hypertension, heart disease, elevated cholesterol levels, stroke, type 2 diabetes, many cancers, gout, and kidney stones account for the majority of prescriptions that pharmacists fill.

Our healthcare system is all about monetizing the maladaptation of humans to modern societies. We have an absurd healthcare system that gives priority to pills rather than prevention because there’s little money in prevention.

In the view of some pharmacists, prevention includes using drugs to treat elevated blood pressure and cholesterol so that these conditions do not progress to heart disease. This is known as medicalized prevention. But shouldn’t our healthcare system give priority to nondrug approaches like dietary/nutritional and lifestyle changes?

Related article: How Pharmacies Are Confronting Rising Drug Costs

Near my home, there is a large hospital and a large farmer’s market. I prefer the model of health represented by the farmer’s market rather than the hospital. I prefer a model based on whole (unprocessed) foods that exist in nature, rather than the mechanistic and reductionist model of modern medicine which uses drugs to overwhelm the delicate processes of Mother Nature. These processes have been fine-tuned over thousands of years of human evolution, yet modern medicine views humans as a rickety old machine that is constantly prone to break down.

There are, of course, many drugs that are essential and even life-saving. On the other hand, can anyone deny that prevention is better than treatment?

Dennis Miller, R.Ph. is a retired pharmacist living in Delray Beach, Florida. He welcomes feedback at dmiller1952@aol.com.

In this pharmacist's opinion, pharmacy is too focused on medicine and not enough on what's actually best for patients. 

Author | Dennis Miller, RPh

Articles

Opinion: Is Modern Medicine a Religion?

Understaffing: The cancer on our profession

Do Pharmacists Care About Prevention?