10 shocking things I've learned as a pharmacist

I assumed that pharmacy school would largely reflect the real world. How wrong I was! The culture shock between pharmacy school and the real world is mind-boggling.

Dennis Miller, RPhStudents graduate with egos that professors have built to stratospheric levels and with a belief that they are God’s gift to our healthcare system. Then, in the real world, they are immediately confronted with the realization that the only thing that matters is how fast they fill prescriptions.

What about you? Did you graduate from pharmacy school with noble ideas about promoting health? Did you find yourself becoming more skeptical, the more you experienced the real world?

Here’s my list of what shocked me the most. What would yours look like? (This is not a rhetorical question. Please write and tell me.)

Pills rather than prevention

1. I was shocked to see that our healthcare system prefers to throw pills at people with elevated blood pressure, elevated blood sugar (type 2 diabetes), elevated cholesterol, and other diseases of modern civilization rather than aggressively focus on a diet of whole, nonprocessed foods, lifestyle change, and weight loss.

The Merck Manual (16th edition, p. 984) says that most cases of hypertension and type 2 diabetes are preventable: “Thus weight reduction will lower the BP [blood pressure] of most hypertensives, often to normal levels, and will allow 75% of type 2 diabetics to discontinue medication.” Ninety percent of diabetics have diagnoses that fall under the heading of type 2.

2. I was shocked to see that our healthcare system gives priority to treating cancer rather than preventing it. The Merck Manual (17th edition, pp. 2591-2592) essentially states that up to 90% of cancer is preventable: “Environmental or nutritional factors probably account for up to 90% of human cancers. These factors include smoking; diet; and exposure to sunlight, chemicals, and drugs. Genetic, viral, and radiation factors may cause the rest.”

Where is the health in healthcare?

3. I was shocked to learn that our healthcare system has so little to do with health. I was shocked to learn that while disease prevention and health maintenance get plenty of lip service, in the real world our healthcare system is all about disease maintenance: Patients are fodder for the ravening maw of the medical mega-machine.

4. I was shocked to see the mechanistic and reductionistic focus of modern medicine on molecules and cells. This focus completely ignores the social, cultural, economic, political, psychological and dietary/nutritional factors that are so important in the causation of human illness.

5. I was shocked that the placebo effect is such a significant factor in the effectiveness of so many drugs. I was shocked to see that so many drugs have only marginally more effectiveness than a placebo.

APhA

6. I was shocked to see that the priorities of the American Pharmacists Association have had so little to do with improvement of pharmacists’ working conditions. I had no idea that the issues of greatest concern for retail pharmacists, i.e., dangerous understaffing, oppressive performance metrics, no time for meal or bathroom breaks, etc., would receive such little attention from a leading professional organization.

State boards of pharmacy

7. I was shocked to see the reluctance of state boards to call for adequate staffing to ensure the safe filling of prescriptions. I was shocked to see state boards of pharmacy take the position that staffing levels are employer/employee issues rather than public safety issues. I was shocked to realize the heavy influence that retail chain pharmacy must have upon state boards of pharmacy.

Food and Drug Administration

8. I was shocked to see how aggressive lobbying can cause Congress to push FDA to speed up the drug approval process. In my opinion, FDA too readily approves drugs that are of questionable safety and effectiveness, and then passes the buck by requiring that the risks be listed in the labeling.

FDA expects doctors to read all the warnings and precautions in the labeling before they prescribe drugs. But busy doctors assume that if a drug is approved by FDA, it must be basically safe. Thus, too many doctors ignore or underestimate serious drug warnings.

9. I was shocked to see that FDA does not regulate vitamins and dietary supplements, even though there have been abundant reports in the media that these products very often contain less than their labeled quantities of active ingredients. In addition, potentially toxic contaminants have too frequently been discovered.

See, for example, the investigative report aired on PBS on Jan. 19, 2016: “Supplements and Safety: Frontline, The New York Times and the Canadian Broadcasting Corporation examine the hidden dangers of vitamins and supplements, a multibillion dollar industry with limited FDA oversight.”

10. I was shocked to see that FDA’s definition of “safe and effective” conflicts so fundamentally with the layman’s definition of these two words. I was shocked to see that so many commonly prescribed drugs are linked to tumors in lab animals. I was shocked at how long it takes FDA to add prominent warnings to drugs or to withdraw drugs from the market.

For example, tendon problems have been a well-known adverse effect of fluoroquinolones for decades, yet it was not until recently that the FDA finally advised that these popular antibiotics be prescribed much less frequently.

A May 12, 2016 FDA Medwatch communication states:

FDA is advising that serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections who have other treatment options. For patients with these conditions, fluoroquinolones should be reserved for those who do not have alternative treatment options. An FDA safety review has shown that fluoroquinolones when used systemically are associated with disabling and potentially permanent serious side effects that can occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system. (“Fluoroquinolone Antibacterial Drugs: Drug Safety Communication-FDA Advises Restricting Use for Certain Uncomplicated Infections”)

Pharmacologist and nationally syndicated columnist Joe Graedon recently compiled a list of serious adverse effects linked to the very popular acid suppressors known as proton pump inhibitors. These drugs are linked to a higher risk of pneumonia, Clostridium difficile infection, weakened bones, kidney disease, dementia, thrombocytopenia, heart attacks, adenocarcinoma of the esophagus and malabsorption of magnesium, iron, zinc and vitamin B12.

Given the fact that proton pump inhibitors have been on the market for decades, one wonders how well the FDA really understands the drugs it approves. Does it take decades of widespread use by millions of people before the FDA really knows the side effect profile of a drug? How well does FDA know less commonly prescribed drugs?

Watch for: 10 more shocking things I learned as a pharmacist

Dennis Miller is a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at dmiller1952@aol.com. His books "Chain Drug Stores Are Dangerous" and "Pharmacy Exposed" are available at Amazon.com.