We Missed the Bus the First Time Around

Michael J. SchuhI was waiting at the Pharmacist Expertise Opportunity bus stop one day 22 years ago, waiting for the dietary supplement bus to arrive. That bus arrived on time as expected via the Dietary Supplement Health and Education Act of 1994 route.

But I had been hit by a different bus that contained uncompensated pharmacist mandates, implemented for my pharmacy practice in 1992-93, called the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90). I had been so angry and distracted about the extra, unfunded clinical mandates from the OBRA wreck, I couldn’t see straight. And so I couldn’t see the Dietary Supplement Bus arrive, nor did I see it leave.

I missed that Dietary Supplement Bus in 1994-- and so did the pharmacy profession.

The profession, with the usual good intentions, had endorsed the OBRA plan to add clinical pharmacist services provided to the public, but with no plan to pay for those services! So when implemented in 1992-93, the extra OBRA clinical workload in outpatient pharmacies was just added to already heavy pharmacy workloads. Great! More uncompensated clinical work and increased liability. The pharmacy modus operandi! But I digress…as this is another missed opportunity for the profession for another column at another time.

The Dietary Supplement Health and Education Act of 1994 made the widespread sale of nutritional supplements possible. These supplements immediately started being used by the public as drugs, but they were primarily regulated as “foods.” Supplements are–to this day– widely sold in pharmacies by pharmacists. They can interact with Rx and OTC medications, other foods, and each other to cause adverse drug reactions.

So how many pharmacists out there are confident and competent to advise patients on supplement use? Raise your hands. I thought so… I don’t see many. But who are the most qualified to counsel patients on supplement use? We are! Who has taken courses in pharmacognosy, pharmacology, therapeutics, biochemistry, medicinal chemistry, and pharmaceutics? We have!

Most of the above supplement “experts” have none or very little of the applicable training pharmacists do. They sell supplements because they have high gross margins but do not necessarily consider the Rx/OTC meds the patient is already taking or a patient’s general health status just to push product sales. I have seen how this can result in patient harm.

The Supplement Bus still runs the same route 22 years later. That Pharmacist Expertise Bus Stop is just across the street. We can easily walk to it. How about putting our training and accessibility to another good use? Let’s become knowledgeable about these products and reclaim our traditional, natural product turf. Many dietary supplement users will pay out of pocket for consultations about these agents because they are already spending significant sums each month, uncovered by third party payers, to use them….many times incorrectly.  

Maybe this Bus can still offset losses from the omnibus hit.

We can still catch that Supplement Bus. It isn’t too late.