Should pharmacists be entrepreneurial?

Dennis MillerIn a recent article for Drug Topics [“Too many pharmacy schools? One dean says no,” February 13], Dean Ronald P. Jordan of Chapman University School of Pharmacy said, “We will develop students for a broad range of pharmacist employment opportunities in existing practice, advanced practice, entrepreneurial enterprise…”

Is entrepreneurship the right prescription for the future of pharmacy? The idea makes me nervous.

In every sector of the economy, it tends to lead to excess. When we have an excess number of practitioners in the various health professions, we get lots of overtreatment and overmedication. Here are some examples.

Physicians. Physicians are human, and human beings have a tendency to gravitate toward activities that are well compensated. In the case of entrepreneurial healthcare providers, you can’t blame Americans bankrupted by catastrophic medical expense for feeling as if the goal of the medical profession is to transfer their life savings into its own pockets.

Despite physicians’ apparent bias toward the most financially lucrative treatments and specialties, I don’t want my surgeon to, for example, have an economic incentive to recommend surgery instead of more conservative management.

USA Todayreported in 2013 that:

…[U]nnecessary surgeries might account for 10% to 20% of all operations in some specialties, including a wide range of cardiac procedures - not only stents, but also angioplasty and pacemaker implants - as well as many spinal surgeries. Knee replacements, hysterectomies, and cesarean sections are among the other surgical procedures performed more often than needed, according to a review of in-depth studies and data generated by both government and academic sources.- Peter Eisler and Barbara Hansen, “Doctors perform thousands of unnecessary surgeries,” USA Today, June 20, 2013

Dentists. When dentists embrace the entrepreneurial model, we get overtreatment and what’s known as “upselling.” They’ll push expensive crowns when a large composite filling might be satisfactory. They push very expensive implants when a crown might be satisfactory.

Dentists’ assessments of my teeth have ranged from You need very little work done to You need thousands of dollars of work done - and they were talking about the same teeth. I don’t want my dentist to have a financial incentive to recommend a costly crown or implant when a more conservative approach would be equally satisfactory.

More than 10 years ago, I consulted a dentist who told me that two teeth needed root canals and crowns. I opted instead for large composite fillings in both teeth and I haven’t had any problems with either one in all these years.

Chain drugstores. The marketplace is flooded with pharmacy schools and their graduates. With an oversupply of pharmacists, we must fight for scarce jobs. The result? Pharmacy becomes less of a profession and more of a dog-eat-dog business in which younger pharmacists actively hope that their older colleagues will retire.

Which pharmacists will prevail with the chains in an environment of scarce jobs? In my experience, it is those pharmacists who sling Rxs fastest and those with thick skins who can shrug off abuse from customers and bosses.

When pharmacists compete for jobs, the employer devalues the meticulous pharmacist. Meticulous pharmacists are too slow for the speed-is-all-that-matters attitude of corporate bean counters. While lip service may be made to patient counseling, it is seen as a major drag on productivity and is therefore discouraged.

The very meticulous pharmacist is slower because he/she worries about proper doses, drug interactions, contraindications, drug allergies, and, in general, the proper filling of each prescription. When the primary criterion of chain employers is speed, these very meticulous pharmacists are discarded.

The pharmaceutical industry. Is there a connection between Big Pharma’s embrace of the entrepreneurial model and the fact that Americans are grossly overmedicated, with priority going to treatment over prevention?

If patients were to significantly change their lifestyles, it is likely that many could greatly decrease the number of medications they take.

Does it bother you how many prescriptions you fill for ADHD drugs, HRT, proton pump inhibitors, H2 antagonists, anti-anxiety drugs, and drugs to lower blood pressure, blood sugar, and blood cholesterol?

Critics often claim that the cutoff points for treating elevated blood pressure and elevated cholesterol are periodically lowered so that a greater percentage of the population can be convinced they need to be medicated.

Does it bother you how many people in this society are taking antidepressants? When I became a pharmacist, one of my biggest surprises came when I found out how many Americans were taking antidepressants - including so many of my neighbors. Is this overmedication, or do we need to examine why so many people in this society are depressed?

Lawyers. What happens when lawyers embrace the entrepreneurial model? For starters, they file frivolous lawsuits and drag out litigation to increase their fees. Or they chase ambulances to drum up business.

Prisons. When government transfers responsibility for running prisons to the private sector, with its for-profit motivation, we get a massive overgrowth of institutions.

Military-industrial complex. The military has awarded multi-million- or multi-billion-dollar contracts to private corporations for weaponry (e.g., Lockheed Martin), support services (e.g., Haliburton), and private fighting forces (e.g., Blackwater). Critics say that these private corporations find it financially lucrative to encourage and prolong wars around the world. After all, there’s infinitely more financial profit in war than in diplomacy.

Public vs. private sectors

A nation’s economy can be broadly divided into the public sector and the private sector. When a governmental body is the primary driving force, an entity is said to be in the public sector.

In general terms, the public sector includes the post office, the military, public schools, Medicare, Social Security, etc., even though parts of some of these are becoming privatized.

Examples of entities in the private sector include corporations such as CVS, Walgreens, Wal-Mart, Glaxo, Eli Lilly, and Novartis. 

Should healthcare be the responsibility of the public sector? Or should it be a product managed by private sector interests?

In my opinion, the profit motive is fine for selling consumer products. I believe that the harder someone works, the more he/she is entitled to a big house, fancy cars, and expensive clothes, appliances, electronic gadgets, etc.

It’s a different story when the profit motive drives healthcare delivery.

How we do it here

The United States has one of the most privatized healthcare systems to be found among the major industrialized nations. And it stands at No. 37 out of 190 countries in the World Health Organization’s ranking of the world’s healthcare systems.

The United States is also the only major industrialized nation without some form of national health insurance.

The ACA, commonly known as Obamacare, did not establish national health insurance. The ACA is a massive giveaway from the federal government to Big Pharma and Big Insurance.

What’s the priority?

Are there some things in life so important that they should not be based on the entrepreneurial model?

Should the wealthiest country in the world be able to provide healthcare for all its citizens (Medicare for everybody) - even though the economy is unable to provide jobs for all of its citizens?

Or should human health be something that is left to the vicissitudes of the marketplace?

Is the bottom line the bottom line?

In the overall economy, growth is the Holy Grail. The stock market looks very unfavorably upon companies whose sales aren’t constantly growing.

In biology, out-of-control growth is defined as cancer.

We have out-of-control growth of pharmacy schools. Is requiring pharmacists to become “entrepreneurial” the solution?

Do you want to put your healthcare into the hands of professionals who have an economic incentive to overtreat or overmedicate you?

Dennis Miller is a retired pharmacist living in Delray Beach, Fla. He is the author of two books (Pharmacy Exposed and Chain Drug Stores Are Dangerous), both available at Amazon.com. He welcomes feedback at dmiller1952@aol.com.