Integrative pharmacy: Changing public perceptions

Someone once said, "Don't tell me what yer agin', tell me what yer for." Leaven this with "Start where you are. Use what you have. Do what you can." And that’s generally the best approach. But I'm going to ignore that advice now and talk about what you might experience in the form of opposition, disbelief, resistance, and pushback to your New Pharmacy practice, and what to do about it.

The media

The first roadblock comes from the media, through radio, magazines, blogs, and newspapers, and their so-called “science” correspondents.

Every day you can find a piece by some self-righteous blogger whose science education appears to be minimal but who can quote someone who really is a scientist - which apparently justifies calling the rest of us uninformed or practitioners of pseudo-science if we hold views that are not mainstream. If the scientist du jour is from Harvard, Yale, Stanford, Johns-Hopkins, Cleveland Clinic, or Mayo Clinic, well, that’s that. Case closed.

For an excellent recent example of what I’m talking about, take a look at Jerome Groopman’s “Inflamed,” in the November 30 issue of The New Yorker (http://bit.ly/Groopman). Do you see the bias?

Your patients read these articles, which multiply or go viral on social media with "likes," "shares," and "retweets." My advice: Either ignore them or, better yet, post the truth in the comments section, with a bona fide reference from the medical or scientific literature. Let readers know the shallow understanding reflected in these pieces. Then keep doing what you're doing right.

Allopathic physicians

The next roadblock is the opinion of the allopathic doctors in your neighborhood.

When you start helping patients and getting results, local doctors and nurse practitioners are going to hear about it, and they won’t be happy. At least, not at first. Your patients will be telling them about things you said, advice you gave, drug therapies you want discontinued, supplements or foods that you recommended, and the great results they got from your consult.

Don't worry. They'll diss and dismiss you for only so long before they stop by your office for a consult for themselves and thank you for all you do for the community.

You will become a force in your area - a powerful one. So don't be thin-skinned. Praise and recognition will come with time.

With the 12 to 15 minutes that practitioners have to see a patient and write a script, they can't do what you do. And they're stuck in that model.

When you communicate your thoughts to your patients' physicians, explain your reasoning with the same patience and respect and simplicity that you show to your patient - but add references. Remember: This subject is new to physicians. They know nothing about nutrition, and even less about herbs, supplements, vitamins, and minerals - even though they and their families take them. (They will be a tiny bit duplicitous about this.)

The literature

Lastly, there is a universe of medical literature that purportedly supports the "standard of care” (SOC). Attached to each choice is an ICD-10 code and an RSV procedure code with tests, imaging, drug therapies, and $$. Since this represents how medicine is practiced in the United States today, when you go beyond the SOC, you’ll come up against physician resistance.

We like to believe that what we practice is evidence-based medicine (EBM). Physicians, however, will demand randomized controlled trials (RCTs). Animal studies won't cut it. Anecdotal evidence won't satisfy them. Commonsense physiology, biochemistry, and pharmacology won't cut it.

Physicians will cite RCTs to support their position. They will, understandably, be reluctant to go outside the SOC, since they can be judged by their degree of adherence to the community standard.

Also, you will be asking them to order tests that they are ill-prepared to interpret. If a lab test is outside of the SOC, what will physicians do with the results, even if they do know how to interpret it? What prescription would they write? What procedure would they order? To what specialist would they refer?

Your professional response

Your job is to have your references (which you download and save in tidy, easy-to-find folders on your computer) at the ready, to copy and paste into your faxes, e-mails, and letters to these physicians, both to support your recommendations and, many times, to expose the flaws in their RCTs when they are shoddily done, conclude on relative risk numbers to justify questionable therapies, perpetuate old and disproven medical myths, or are just plain unsupportable by the literature.

Your job is to make physicians comfortable in the knowledge that you have relevant literature references, you know how to interpret the labs, and you have a plan that won't put their judgment on trial or threaten their reimbursement model.

Your payoff

There's the satisfaction you feel as you watch your patients' health improve. And there's the gratification you experience as you win public recognition and the respect of the allopathic community. And then there's the professional reward that comes as you collect cash for your expertise through practice of a sane business model, without having to rely on codes and tiers and SOCs.

How does that sound?  Post your comments or e-mail me with your thoughts. And let me know what you'd like to see next in this series.

Mark Burgerowns Health First! Pharmacy and Compounding Center in Windsor, California. He welcomes your questions and comments at Mark@healthfirstpharmacy.net.