In this pharmacist's opinion, pharmacy is too focused on medicine and not enough on what's actually best for patients.
After working a grueling 12-hour shift, 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.
Many pharmacists say that our healthcare has very little to do with health. Our system is about pills, not health.
The Cult of Pharmacy
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.
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.
Up next: The true science of pharmacy
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?
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 email@example.com.