Pharmacy Wars

1. Fascinating article, Grainne. I had never thought about that before, but it makes sense; the medical field is very money-motivated, so of course there could be two warring factions battling it out–the doctors and the pharmacies. Of course, maybe the key here is that good doctors who dont push pills piss off the entire industry.

2. Mitch I think you’re on to something there. In particular Doctors who don’t push “NEW” pills. Because it’s the new stuff that makes money. Drug companies and probably their compatriots Pharmacists want to get you moved on to the new stuff.

   What we have seen in the last 10 years is a slew of NEW meds that cleared the FDA causing problems in less than 2 years of their release. Also for a lot of people synthetic medications don’t work as well as natural based ones. Anymore you cannot but non-synthetic meds at the drugstore. Patients now have to find specialized Apocethary shops that can compound these “out of date” meds by hand.

3. […] This post was mentioned on Twitter by Pharma Si. Pharma Si said: Pharmacy Wars http://bit.ly/gTfeUd […]

4. As a naturalist, the rising use of synthetic drugs has concerned me for awhile. One of the things i’ve noticed among those who consistently use synthetic drugs is, after awhile the skin has a plastic look to it. This seems to me like a short term interest plan because once America is diseased enough, who is going to work?

5. Great article. This kind of thing really gets me peeved. Being in this field I deal a lot with Doctors, pharmacies and pharmacists as well as pharmaceutical companies and their Reps.. I see this kind of power play often. I also see treatment decisions made not on what works best or is in the best interest or desire of the patient but by financial factors only. This is appalling and unethical if not grossly negligent. We this type of thing happens people need to feel empowered to effect change by writing the companies in question informing them why you will no longer be doing business with their company. Other actions can be taken as well. Like reporting to regulatory agencies like the state’s Attourney General and/or the Licencing boards of the pharmacist in question. A little knowledge and power positions can do considerable damage to individuals. Take some teachers for instance. Don’t get me wrong. Much respect and appreciations go out to the great ones. But all too ofter I find myself doing hours of damage control with my younger clients and their families in my private practice because some teacher told a student and their parent(s) that their kid has “bipolar” or “ADHD”. Umm. I dont think a class in the DSM and biopsychosocial assessments is part of the teaching credentialing the last time I looked. Labels can be so damaging. Bottom line? Listen to the patient/client. Have them be an active participant in their treatment.

6. That’s very interesting. Having lived in, and visited, only nations where pharmacies aren’t quite so restrictive, and where you can pretty much buy anything that isn’t poison sans a prescription, it makes me wonder again why a nation which allows anyone to purchase a lethal firearm should be so uptight about medication. What are the priorities?

7. The truth is rights of conscience are part of Divine and Natural Law. Pharmacists are not slaves. They are licensed and practice to heal, rather than damage moms and potentially kill their babies with high powered synthetic steroids. You ought to thank your pharmacist with a conscience for caring, rather than being indifferent to your health. Contrary to popular belief, physicians know little about drugs, usually studying them for a semester or so, whereas pharmacists study them for a minimum 6 years in the US. Most doctors get their info from drug reps, non-health professionals who maybe were selling cell phones 6 months ago.

8. Bill, good point we tend to forget in the “Land of the Free” that the rest of the world has a lot more freedoms over things like this than we do. It is incredibly telling what we chose to allow people to purchase easily.

9. @EastSideHunky, I agree pharmacists are not slaves however neither are the masses. If a pharmicist does not want to dispence they should have another on staff that has a different opinion.

   I understand that a licsenced PharmD has a 6 year degree in pharmacutecals. They still are not given liscence to write prescriptions. I agree the drug rep issue is abomidable. However not every doctor gets thier info from the reps. As I stated I am more concerned about these reps and their ongoing pushing of new drugs over old ones that are getting classed out but sometimes work better.

10. It is amazing that the “modern woman” so intent upon castrating the male of the species, should herself accept chemical castration along with a host of physical and psychological side effects associated with the Pill with such an uncritical, carefree attitude. The abortifacient Pill and its pharmaceutical analogs have long been associated more than 50-metabolic abnormalities and thromboembolisms including changes in libido, changes in appetite, disfiguring skin pigmentation, cystitis-like syndrome, backache, nervousness, dizziness, fatigue, migraine headaches, hirsutism, depression, infertility, liver disease, uterine cervical pathologies, hypertension, and other iatrogenic (physician-caused) disorders. For the first time in medical history, physicians are dispensing disease producing chemicals for use in the healthy rather than the sick. Women on the Pill and other abortifacient drugs are ready-made and superb guinea pigs: They don’t cost anything, they clean their own “cages,” feed themselves, pay for their own Pills, and in many instances, even remunerate the clinical observer. The Pill and Co. is chemical warfare on women. Randy Engel, Director, U.S. Coalition for Life.

11. 1) A conscience clause is not “a pharmacists right to deny service based upon his personal belief”.
    There are many kinds of conscience clauses contained in law which may excuse various medical professionals from involvement in participating in the act of killing a human. Such a thing is attached to the law allowing medically assisted suicide in Oregon. Pharmacists are not required to dispense medication for that purpose, for example. A very few states have laws which excuse pharmacists from dispensing drugs which kill humans very early in development. In most areas, pharmacists will refuse to dispense for that purpose based upon long standing legal protection of religious freedom and conscientious objection to killing. There have been some requirements for signage to be placed at pharmacies in which the pharmacist has a conscientious objection to killing, which are not related to any new legal protections of the human right not to willfully kill others.

    I am eager to hear of any specific cases in which a pharmacist refused to dispense life saving medication citing the laws which protect him from being forced to help kill another human. The laws are actually unrelated to this. I have heard of none thus far. The author of this article appears to know of such things and can perhaps provide the references.

    HIV patients tend to gravitate towards specialized pharmacists for treatment, as their problems are complex, and the anti-retrovirals have many drug and food interactions which must be juggled for the patient’s safety. Pharmacists in some states are required to take continuing ed in this topic, but it is really a subspecialty of pharmacy as is oncology, for example.

    It is not the pharmaceutical industry, but rather academia and state and federal law which influenced the placement of pharmacists more prominently between the physician and patient. Pharmacists are educated that they are morally, civilly or even criminally liable for not addressing safety hazards of medication therapy and stopping medication errors.

    A non-traditional Pharm D is not a bachelors degree. It requires graduate education after obtaining the pharmacy degree and license. Non traditional means that it is likely done partially on-line, partially in the classroom and with a different array of experience to make up the clinical requirement.

    If one medical professional trashes another medical professional when speaking to a patient, he runs the risk of legal reprisal for anything said which is not completely accurate. He also runs the risk of violating the privacy of other patients.

    The standards of safety regarding any drug, and the legal requirements for prescribing and dispensing it can be altered at any time, and when pharmacists become aware of it, they often have to give the patients and the physicians the bad news. This is usually greeted with resentment.

    One recent example is the sudden removal of propoxyphine/acetaminophen from the market based upon 53 years of aftermarket experience. It has been decided that the drug bears too much risk for causing cardiac arrhythmia relative to it’s rather modest potential for pain relief. Some physicians were not at all pleased to hear this news, and might have had a temper tantrum similar to the one to which the author above alludes.

    The article above is filled with so many inaccuracies regarding the function of pharmacists, and the driving forces behind them, that one wonders about the accuracy of the story regarding the pharmacists interaction with the physician.

    I do not frequent this blog, but was directed here to append some pertinent information to an article which misrepresented the purpose and function of existing conscience laws.

12. […] There’s an interesting and confused article called Pharmacy Wars, which should be read in order to understand the reason for posting this article. […]

13. @Randy Engel:

    You, sir, are showing signs of pushing an agenda which has nothing whatever to do with this article. In fact, I would suggest that you are shoehorning a completely irrelevant topic into this discussion, very like a spammer. I would even go further and call you a spammer; only, you are selling an agenda, not a product.

    Thank you for not wasting everyone’s time further.

14. I do agree that the term “Pill Nazi” is both unwarranted and inaccurate, exactly as the term “Tablet Terrorist” would be. Both the words “Nazi” and “terrorist” have been overused (especially but not solely in the US) until they have become largely meaningless unless the user can provide proof that what he is saying is comparable to Nazism or terrorism. In this case I would suggest that a Nazi would be more likely to suggest experimental treatment, or withhold it completely. Therefore it is unfair to compare the pharmacist to a Nazi.

    At the same time, I have this to say: that the pharmacist is not the right person to declare that the patient’s prescription “must be changed”. At the very most, he may feel himself morally obliged to inform the patient as to his reservations about the medication – no more. He is not the prescribing authority and has no right to unilaterally modify the schedules advised by the prescribing authority. Medicolegally speaking, he can also raise major complications. Suppose, going by the pharmacist’s advice, the patient changes medication, and has an adverse reaction, or treatment failure. Who is liable for this?

    Therefore, Pharmer, I must feel myself obliged to reject your arguments in toto, although I do agree that they are cogently put.

    Incidentally, I’d be mad as hell if a pharmacist tried to modify one of my prescriptions.

15. Rather than whine, people could request of their lawmakers that the practice of pharmacy be eliminated, technicians handle drug dispensing, and rely entirely on physicians for safe and efficacious treatment. Then, perhaps in the hospital it might be acceptable in your view to receive heparin and lovenox concurrently, or KCl 40MEq IV push, for example.

    Butcher and some others might not wish for a pharmacist to STOP these kinds of orders. 😉

    Natural selection……

16. In a free market, the seller can refuse to sell anything he wants. Calling such a seller a NAZI suggests that he is a national socialist, a ideologue who is the opposite of a proponent of the free market. Rather, compelling a seller to sell an objectional product is the mark of a socialist, national or otherwise. Allowing a national policy which foists dangerous steroids on the population through subsidized programs and propaganda is more consistent with socialism than allowing retailers to make up their own minds.

17. Bill, from your description, the pharmacies of India sound very much like those in Mexico. There, such life saving drugs as insulin, penicillin and albuterol were sold over the counter. Unhindered by buck-passing insurance laws, pharmacists often dispense anti-biotic and anti-viral injections from their knowledgeable positions.

    American law is nanny law, a wide based effort to remove common sense from the jurisdiction of mature adults, giving them a playground of bouncing cushions and tumbling mats for their own safety. A person isn’t allowed to decide whether or not an infection warrants antibiotics. The physician must make that decision. (S)he is not allowed to determine if a treatment is working effectively. There are proper guidelines, and if the guidelines aren’t followed, the treatment is considered invalid. Witness the number of US cancer patients who cross over into Mexico for treatment. It’s not just because it’s cheaper. It’s because Mexico isn’t afraid to explore new methods that bring results. The Mexican medical profession’s agenda is to find a cure, not a way of keeping the client coming back.

    I did find Randy Engel’s comment interesting, and not one to be ignored. I’ve always had reservations about the birth control pill, and from my own observations, have seen it as the most singular disruptive influence on the natural health of young women. There are other birth control devices, with varying degrees of success, and can be used to moderate the number of children a woman wishes to have, even if there is an occasional ill-timed pregnancy.

    The upshot is, i believe each mature individual has the right to maintain the general health of his or her body, whether the choices are wise ones or not. S/he must maintain the consequences of those choices as those consequences are the direct result of those choices. An uniformed public is not responsible for the harmful drugs prescribed to them by an industry motivated by money, but an informed public that chooses to accept chemicals that will alter their brains, attack their immune systems, create cancers or addictions, is. If the choices are clearly laid out, they can only accept the consequences for their actions.

    Our nanny laws tell us not to smoke, but they don’t inhibit the far more dangerous effects of industrial air pollution. They govern the use of addictive drugs by placing them under the protective umbrella of prescriptions. Addictive chemicals are consciously added to food products and drinks, further breaking down the individual ability to maintain sound physical health, but the nanny laws concern themselves only in finding faults with the consumer, not in the ability to find abundant,affordable healthy food.

    We don’t need nannies. We need the right to make our own informed and conscientious decisions. We need the right to make our own mistakes so we can learn from them. If we request the assistance of an authority., i.e., a medical doctor or physician, we have a right to receive an honest diagnosis, complete with an explanation of possible side effects,the risks involved and alternate methods, and the right to accept or reject treatment. A conscientious pharmacist should explain the properties of the prescription if asked, advise if concerned, but before with-holding a drug, i would think that person would have to know much about the general mental and physical health of the client, which usually falls under the jurisdiction of the medical doctor. Until we become a society that chooses its own health, the medical and pharmaceutical profession are the nannies that dictate it.

18. George Kocan, your definition of socialism is a prime example of how self motivated interests misrepresent words, creating labels instead of examining the underlying ideology contained within the word’s representative symbol. The root word of socialism is social. A person who works for the common good of society (again the root is social), placing the interest of family and community above self interest is considered well-socialized. People obey laws that involve common courtesy, respect and consideration for the rights of others when they are social. They recognize that these behaviors are the necessary implements for a healthy, harmonious society.

    Free market enterprise, with no concern for any intent other than profit is anti-social. The largest number of anti-social behavior traits are found among highly successful businessmen and corporate executives. The agenda is to create a free market for their products with no concern for personal responsibility. It’s propaganda, an emotional appeal through convoluted language to maintain the freedom to expedite immoral and unethical conduct. Present your argument without labels, because you’re very lousy at definitions.

19. Pharmer, you are quite correct.

    I’m a qualified professional, and I try my best to serve my patients in whatever way I feel will be in their best interests. As part of an ethical treatment regimen, I prescribe medication which should not cause adverse side effects, isn’t needlessly expensive and does solve their problems.

    Therefore, the last thing I need is a pharmacist with an agenda trying to shove his oar in. As far as I’m concerned, a pill pusher who sells what I prescribe is infinitely better for the patient than some guy with no medical degree who second-guesses my treatment regimen.

    Thank you for your thoughts. I doubt if we can ever find common ground, since I am instinctively suspicious of the line of argument you’re trying to forward.

20. Pharmer is vastly amused, but also quite concerned for Butcher’s ‘patients’.

    Darwin award!!!

21. The nation today is celebrating the memory of Dr. Martin Luther King (may he rest in peace), the great proponent of Civil Rights. His conscience drove him to espouse a position which cost him his life. Given the significant physical harm that especially oral contraceptives can cause, can we not “celebrate diversity” by respecting this noble pharmacist’s conscience – particularly since he has the physical well-being of his customer in mind? The pharmaceutical industry makes billions of dollars annually in the sales of contraceptives, hence they are engaging in collusion in the suppression of voluminous evidence of the link between the widespread consumption of steroid hormonal drugs (i.e. – the estrogen-progestagen containing oral contraceptive pills) and the explosion of incidences of breast cancer in women in recent decades. As well, in the spirit of Dr. King, it is especially inappropriate this day to use the very rash, inflammatory, and hateful term “Nazi” in reference to a man of moral integrity (namely, this courageous and compassionate pharmacist).
    Oh, and by the way, he has a personal stake in all of this – his eternal salvation, as he doesn’t want to aid and abet the grave sinfulness of contraceptive use.

22. *Shrugs*.

    Your amusement is no concern of mine.

    If you’re happy, that’s fine. I really can’t be bothered with your burblings any longer.

23. Bill the Butcher may think he’s qualified, but we can see he has little in the way of logic, reason, compassion and conscience when dealing with human beings who need caring, thinking medical care, not liberal claptrap and drugs and surgery for death.

    Good to know the Obamatrons continue on as mind-numbed robots.

24. I think some of our pharmacists are more upset over the use of the term “pill Nazi” than they are with the content of the article. Over recent years, “Nazi” has become a slang word, used to describe someone who takes an authoritarian, invasive or bullying view. The issue of the article was a pharmacist’s right to interfere with the prescription given by a medical doctor, to the point of even delivering false information. Quote: “Your Doctor has directed that your prescription should be changed. It exceeds the current recommended amount and we will be changing your prescription at your next refill.”

    The author did not state the nature of the prescription; whether it was for birth control pills, a chronic respiratory problem, a debilitating disease or a bad case of nerves. In the body of the article, she did acknowledge there are pharmacists who will refuse certain prescriptions, such as birth control, methadone, and narcotics, for moral reasons. Her objection was not with the individual pharmacist who objects on moral grounds, but with the directorship of this particular company, which apparently makes the choices on the drugs they are to dispense. Even if this company does not merit the literal use of the word, “Nazi”, i can see why the slang word was freely tossed around.

    Eastside Hunky, i fear you are badly misinformed. Bill the Butcher is one of our International writers and has little interest in Obama’s politics. I am curious to know how you came to define a man who professes medical skills and claims he “prescribe medication which should not cause adverse side effects, isn’t needlessly expensive and does solve their problems,” is delivering liberal clap-trap. What surgeries and drugs for death has he advocated? Are you suggesting the pharmaceutical companies should be the judgment of what we, individually, can take into our bodies? Are they so pure, so ethical, they should be our guardians?

    Struggling through the barrage of questions that come to my mind following your emotive attack, i can only come to one conclusion; that liberal clap trap must mean humanitarian.

25. East Side Hunky, thanks for the laugh. I needed that.

26. Thank you Karla for pointing out the difference between socialism and what became of the NAZI party. I couldn’t have stated it better. I would like to point out that I did not say the pharmacist was a Nazi, it was a quote.

    Is it nice to call names in professional circles? No. Does it happen when people are frustrated? Absolutely. This was the point of the article. There seems to be a break down in the working relationship between some pharmacists and some doctors in some places. It is clear from the conversation here that this continues to be the case with both sides voicing valid concerns. It was for this reason that I deliberately did not state the specifics. It wasn’t the prescription that was the important thing, but rather the behaviors of all parties and the obvious schism in the working relationship that should be better. I have seen it work better and I wonder, where is all the animosity coming from?

    A doctor, frustrated calls names. A pharmicist, insulted makes insuations back, how and where in that is the client/patient served? This can work better but as Karla pointed out and I wrote in the article the pharmicist in this scenario lied, outright. For everything to work and for pharmacists to maintain their reputation things like this need to not happen.

    Bill the Butcher raised a very important question earlier in this conversation which was passed over by a lot of both education and emotion. Why are guns in America easy to procure, but medications have to be regulated in triplicate to hell and beyond? This is troubling on many levels.

    Just so I am clear, I am not against being able to buy and own guns. But please do explain how a bullet which is a sure death is on shelves in the same pharmacies-and for this purpose I will list those in my area-CVS, Walmart and several superstores like Safeway,Rayley’s etc. but an individual can deny to fill an amount or an entire prescription that a qualified medical provider has writen a prescription for, with thier name on it and license on the line? That fact is mind boggling to me.

    I also want to make clear that I know there are incredible, sensible and good pharmacists out there who have morals and do their jobs impeccably, with care for their customers. The difference as I see it is in their cooperation with the medical professionals and their professional behavior with their clients. (ie. not calling after buisiness hours and lying)

    I would also like to make it abundantly clear that this article is not about contraceptives at all. However it seems to me that maybe one should be done as the subject certainly strikes a chord.

27. On another note I find it incredibly interesting that politics popped up in this conversation, including references to Bill being an “Obama-tron”. I wonder why should one assume that the desire to have people stay out of their buisiness would equal some sort of liberal agenda (this is my assumption when I hear Obama slander, correct me if I’m wrong) I was under the impression that small government and personal responsibility was the battle cry of the Republican party.

    In anycase, this issue seems to me a buisiness/service one, which of course in our country crosses over to politics at several points but which I am surprised to find party lines being included.

28. Great article Grainne and the views which followed were fascinating.

    Let me preface my comment by stating for the record that I’m not a US citizen, hence my views are not those of an “Obamatron” (whatever that may be) any more than Bill’s are.

    I’ve read a lot of references to “conscience” in the comments and it is this issue I would like to explore in this response rather than the politics of the matter.

    Many of the comments here presuppose that somehow a pharmacist’s conscience overrules that of the people s/he is supposed to serve. No man or woman in their role as servants to the public has the right to assume that their morals and conscience are somehow more valid or right those of anyone else’s.

    The role of a health-care professional is to do just that… care for my health… not my immortal soul or the ever burgeoning profit margin of Big Pharma. I trust them to diagnose me when I place myself in their “care” and above all to INFORM me about the treatment and possible consequences of any medication they prescribe. That is their “duty of care”. That’s all. What I do with that information is MY right and thankfully I live in a country where, for now, that right is honoured and held to be sacrosanct.

    I have problems with granting any individual the right to make decisions of “conscience” on my behalf. No one has that right any more than I do to infringe on the rights of others to matters of conscience. They can, and I would hope any medical professional WOULD, inform me in their professional capacity of all the medical consequences of treatments… but they have no right to foist their personal, religious morals on me regarding which course of action I choose to take. That is NOT their role unless one is unfortunate enough to live in a theocracy where religion dictates law. Thankfully, in a democracy which safe-guards my religious and conscientious freedom, I am capable of making those choices for myself according to my own moral compass… not that of someone else.

    If any medication is legally available and I, with the help and information provided by my doctor, choose to take it, a pharmacist should be legally obliged to dispense it no matter what their PERSONAL belief may be. Being a pharmacist does not give anyone the right to play “god” and judge me, punish me or make my life inconvenient because my moral beliefs conflict with theirs any more than it is the right of anyone to deny me a service simply because it doesn’t conform with their own beliefs.

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