Pharmacy Wars

By: Grainne Rhuad

I was mildly disgruntled recently after I left the Doctor’s office.  It was not because of the Doctor or anything wrong with me, but rather because my Pharmacy director is an ass and cost me and my Doctor 30 minutes (ok 60 min for me as he was behind) of our lives by being a pill Nazi.

It all started with a  phone call on a Saturday evening, past business hours at my home from the Pharmacist who told me,” 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.”

This was a confusing turn of events.  I have been taking this particular medication for over ten years and my Doctor and I see my Doctor annually.  In fact I had just seen him a couple of weeks prior and he hadn’t said anything to me about making changes.

When I pointed this out to the Pharmacist he began stumbling on his words a bit saying things like “Well yes, I see that this is a long term prescription.” And “Yes of course you should stay where you are at for now but you will absolutely need to change.”

I then asked him if I shouldn’t be discussing this with my Doctor who writes the prescription and has my medical history as well as a degree in medicine. He answered, “Well of course you always have the right to talk to your Doctor but this prescription will be changing.”

Hanging up the phone I felt like something wasn’t quite right.  The prescription in question is not a controlled substance or a narcotic or anything else of that nature.  It was odd that I would be getting a call after hours from a pharmacist to make changes.  In the past any changes necessary would have been made by my Doctor’s office and I would have received at the very least a call from them.

Making the appointment with my doctor the following week, I was told that he had never initiated any changes with the pharmacy.  In fact since my Doctor’s office is internet integrated he called up the entire conversation from the Pharmacist along with my Doctor’s answer that my regimen was not to be changed.

“What we have here, my Doctor informed me, “Is the case of a pill Nazi, and you are not the first patient to report this at this particular location, nor is this the only medication being targeted.”

The good doctor regaled me with some colorful euphemisms about this pharmacist and the role that some pharmacists like to play in treatment and recommended that I change to a different pharmacy altogether.  “It’s not worth the hassle.” He said.

What had occurred was the pharmacist in question was exercising his right to deny service based on his personal belief, also known as a conscience clause which is law in a lot of states.  It is posted in all pharmacies of these states by law and generally ignored by patrons and pharmacists alike.  The sign is probably in your own pharmacy.

This “clause” was generated mostly due to the fact that some pharmacists were voicing moral quandaries with giving morning after prescriptions to women. This quickly grew to include birth control of all kinds and in some places it has been reported that the clause has been used to refuse service to people needing HIV medication, methadone and other narcotic prescriptions.

But this is something new.  Usually in the case where the clause is used there are other pharmacists  working in the pharmacy who are willing and able to dispense the “morally unclean” drug.  In this case the head pharmacist in charge of the shop was calling the shots for the whole shop and this company CVS is notorious for doing so.

In addition the medication in question has nothing to do with anything controversial or moral, but it is true the guidelines of on-label usage had been changed.  Understanding guidelines in medical interventions is tricky and it is why doctors spend so much time in learning institutions getting hands on experience on how to work with medicine and individuals who react differently to them.

It was interesting that the morning after I had my doctor’s visit and changed pharmacies I chanced upon a couple of articles regarding pharmaceuticals in general and pharmacists in particular. In one I found out that there are special publications just for pharmacists pushing this or that drug but also telling them how they can “make a difference in health care” This seems to be driving the problem I was experiencing.

The publications for pharmacists produced by drug companies are hard to come by if you are not in that field.  One of the articles cited was written by a freelance writer who tells of having a hard time even finding the magazines he was hired to write for.

What the pharmaceutical industry seems to be selling to pharmacists is the idea that they can make a difference in people’s lives, that they due to this clause can control medicine in their very small corner of the world.  Imagine how this sounds to say someone who didn’t get into med school but really wanted to.  Not that I’m implying this is the case for everyone.  Imagine also how it may go down for someone who belongs to a religion that doesn’t believe in medical interventions and wants to help the world see that.  They can use their conscience clause to keep people from taking what they feel to be damaging medicines.  Then there are just those folks that meet the Freudian archetypes of someone who needs to be in a socially acceptable position of power, and medicine and its retail in the United States is big power right now.

While I really cannot speak to what motivated the Pharmacist in question, I do know he did not go to Med. school.  Most working pharmacists are working off of a non-traditional PharmD which is a Bachelor’s degree.  It no longer even includes apothecary (compounding) training.  A Traditional PharmD (doctorate in Pharmacy) is not a medical degree either; it is given to someone who is supposed to know how medicines are put together and how they interact with other substances.  I do not mean to say pharmacists are only pill pushers (those are the Pharm-techs) but they do not have my medical history and would not know what to do with it if they did.  And yet here I sit, dealing with a pharmacist who is refusing me and my M.D. service because he thinks he knows what’s better for me.  In addition, his professional journals are sometimes backing him up.

As with so many things good intentions as in providing a law that allows pharmacists to opt out of moral questions they would rather not deal with are quickly followed up with unintended consequences.  Like little men in white coats behind a glass counter who want to dictate their idea of  good health.