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A Pharmacist’s Opinion: The 15 Biggest Absurdities in the World of Pills

A retired pharmacist bemoans the neglect of preventive efforts and overreliance on medications. Are we serving the pharmaceutical industry?

Dennis Miller, R.Ph. is a retired chain store pharmacist. His book, The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets, can be downloaded in its entirety at Amazon for 99 cents. Here is his latest commentary.

My list of the biggest absurdities in the world of pills:

1 FDA is protecting you far less than you think
2 Pharma doesn’t want you to know that prevention is better than pills
3 No one really knows the real-world incidence of drug side effects
4 Pharmacists feel subtle yet powerful pressure to be positive about pills
5 Pharmacy mistakes are surprisingly common at chain drug stores
6 Powerful interests downplay the fact that most cancers are preventable
7 Many commonly-prescribed drugs may be carcinogenic
8 Clinical trials are sliced and diced to deliver results favorable to Pharma
9 Normal biological processes are portrayed as errors in human evolution
10 Only the USA and New Zealand allow advertising of prescription drugs directly to the public
11 The modern world is making us sick but our regulatory agencies won’t admit it
12 Many “chronic” conditions aren’t really chronic
13 Pharma has fundamentally mischaracterized pharmaceuticals
14 The brain chemical imbalance theory is a sophisticated ploy to legitimize the massive prescribing of pills for mental conditions
15 Schools of pharmacy legitimize Pharma’s approach to human health

[1] FDA is protecting you far less than you think

–FDA definition of “safe and effective” is vastly different from the layman’s definition.

–FDA allows the drug industry to cite “relative risk reduction” (rather than the far more meaningful “absolute risk reduction) to make drugs look far more effective than they really are.

–FDA allows drug companies to utilize surrogate markers or surrogate endpoints rather than decreases in all-cause mortality when drug companies market their drugs.

–FDA does not require drug companies to include the highly significant NNT (Number Needed to Treat) in commercials.

–FDA does not have adequate staff to inspect drug manufacturing facilities around the world including countries like India and China.

–FDA does not tell you that long-acting drugs are more difficult to manufacture than regular-release drugs, potentially resulting in erratic release of the active ingredient and poor therapeutic response. (The active ingredient can be released too quickly or too slowly rather than evenly).

–FDA does not tell you that acetaminophen (e.g., Tylenol) is the leading cause of acute liver failure in the United States.

To quote the online pharmacy source Up to Date,

“Acetaminophen is one of the most commonly reported products causing drug-induced liver injury and is the most common cause of acute liver failure in the United States, accounting for 50 percent of all reported cases and approximately 20 percent of liver transplant cases.”

–FDA does not tell you that the addition of “black box warnings,” often years after that agency has approved drugs, means that FDA didn’t really know the full extent of potential risk from drugs prior to approval.

–FDA does not tell you that the drugs it approves very often demonstrate only a tiny bit more benefit than a placebo. FDA does not tell you that once you’ve factored in the adverse effects of the active drug, the placebo might reasonably be viewed as the superior agent.

–FDA does not tell you that most of the benefit that people receive from antidepressants is due to the placebo effect.

–Even though doctors tell you that the general anesthesia administered before or during surgery will give you “the best sleep you’ve ever had,” FDA does not tell you that general anesthesia is, in fact, a drug-induced coma. Many people feel that they are not as sharp mentally for days or months after having been given general anesthesia.

–FDA does not tell you that even though pharmacy computers rate drug interactions as regards their potential significance and severity, for many drugs there are so many potential interactions that doctors and pharmacists are left crossing their fingers, hoping for the best.

–FDA does not tell you that the most poorly understood organ in the body is the human brain and that drugs affecting the brain are among the most poorly understood drugs in the pharmacy. The tremendous unknowns about the brain do not seem to dampen FDA’s willingness to approve such poorly effective drugs and drugs whose actions are quite often very poorly understood.

–FDA does not remind you that weight loss pills as a class have had a very poor track record for safety over the last several decades. Yet FDA and Pharma continue to be optimistic about finding a magic bullet to reverse the effects of overeating.

–FDA does not tell you that a significant percentage of drugs that are applied to the skin as creams or lotions end up being absorbed into the bloodstream to varying extents, with poorly understood risks to our body.

–FDA does tell you that it receives a majority of its funding from the pharmaceutical industry. FDA does not tell you that this can cause FDA employees to feel that they are beholden to the drug industry, not the consumer.

–FDA does not tell you that despite having the highest per capita expenditures on health care and drugs, the USA has among the poorest outcomes of the rich countries.

–FDA does not tell you that increases in life expectancy over the last hundred years are primarily due to public health measures, not pills.

–FDA does not tell you that diet, lifestyles, weight loss, exercise, avoiding tobacco and alcohol, etc. can often bring superior results in comparison to pills. FDA does not tell you that it (FDA) does not require drug companies to compare their drugs to dietary and lifestyle changes during clinical trials. Drug companies don’t make such comparisons because that would make pharmaceuticals look inferior in many cases.

–FDA does not tell you that it does not require drug companies to submit raw data from clinical trials to the medical journals that publish articles about those drugs. (See the book Sickening by John Abramson, M.D., NY: Mariner Books, 2022.) FDA allows the drug companies to submit a summary of data that, in fact, has been sliced and diced by the drug companies.

–FDA does not require drug companies to emphasize that withdrawal from many commonly prescribed drugs can be a nightmare.

[2] Pharma doesn’t want you to know that prevention is better than pills

Pharma does not want you to know that diet and lifestyle changes can be superior to pills. Pharma does not want you to know that most of the prescriptions pharmacists fill are to treat what’s variously described as diseases of modern civilization, diseases of modernity, lifestyle diseases, diseases of affluence, diseases of advanced societies, and Western diseases.

[3] No one really knows the real-world incidence of drug side effects

No one really knows the true incidence of side effects in the real world because no one, except patients (consumers), wants to know. Pharma and physicians don’t want to know because people would become less enthusiastic about drugs. FDA doesn’t aggressively seek data on side effects despite claiming to do so.

FDA does not know the long-term adverse effects even though people take drugs for 10, 20, or 30 years. Such long-term studies are extremely expensive to conduct and the drug industry doesn’t want such studies to be carried out.

No one really knows the incidence of muscle pain and weakness from cholesterol-lowering statins or the incidence of tendon damage from fluoroquinolone antibiotics.

[4] Pharmacists feel subtle yet powerful pressure to be positive about pills

Pharmacists don’t necessarily tell you what they really think when you speak with them partly because they are under subtle yet powerful pressure from our corporate bosses to be basically positive about the pills we dispense. Maintaining a skeptical attitude toward the pills we dispense–or believing that prevention is better than pills–can take a heavy toll on the pharmacist’s psyche, causing cognitive dissonance. So pharmacists find it easier to maintain a positive attitude about pills.

Pharmacists are typically more critical of drugs in conversations with close friends and family in comparison to discussions about drugs with our customers.

During patient counseling, pharmacists may mention 1 or 2 possible side effects, usually mild ones. Pharmacists rarely mention the most serious side effects because that could scare you from taking the drug. Or it could prompt you to call your physician and say that your pharmacist has questions about the safety of a prescribed medication.

When pharmacists mention something scary about a prescribed medication, patients/customers understandably want the pharmacist to expand on that worrisome information. But with dangerously inadequate staffing at too many chain drug stores, pharmacists simply don’t have enough staff that would give them the freedom to have detailed discussions with our customers about the risks and benefits of pharmaceuticals.

This lightning quick counseling may give customers a false sense of security about the safety of the drugs their doctor has prescribed given the fact that there may be 100 to 200 (or more) possible side effects listed in the official prescribing information.

[5] Pharmacy mistakes are surprisingly common at chain drug stores

Chain drug stores are an accident waiting to happen. Corporate executives at chain drug stores have chosen a business model based on understaffing. Understaffing forces all pharmacists and technicians to work at unsafe speeds for their entire shifts. The inevitable result is that pharmacy mistakes are shockingly common.

The big chain drug stores consider settlements for harm caused by pharmacy mistakes to be simply a cost of doing business. The role of state boards of pharmacy is to protect the public but, in the real world, state boards of pharmacy are intimidated by the immense political and legal clout of the mighty chain drug stores.

[6] Powerful interests downplay the fact that most cancers are preventable

Given the fact that up to 90% of cancers are preventable, it is absurd that our medical system focuses on treatment rather than prevention.

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.

The National Toxicology Program updates its “Report on Carcinogens” every few years. The latest (15th) edition lists 256 substances.

The drug industry hopes you will believe that “no one knows what causes cancer” so that you will willingly, passively, and unquestioningly submit to chemotherapy with strikingly toxic chemotherapy drugs.

If no one knows what causes cancer, why are there lots of lists of cancer prone jobs? See, for example, “What Professions Are at the Highest Risk for Workplace Cancer?” This article lists rubber manufacturing jobs, construction workers, agricultural workers, nail salon workers, firefighters, mechanics, miners, flight attendants, pilots, and office workers.

[7] Many commonly-prescribed drugs may be carcinogenic

FDA does not tell you that it has lots of data about the potential carcinogenicity of pharmaceuticals. This is data that the public doesn’t know exists. Many commonly prescribed drugs are linked to tumors or cancers in lab animals, often at doses that are not far from the dose used in humans (on a pound-for-pound basis).

Perhaps nothing illustrates the crudeness of pharmaceuticals more than the fact that “about half of prescription drugs are potentially carcinogenic,” according to Thomas J. Moore in Prescription for Disaster (New York: Simon & Schuster, 1998, p. 96):

Despite the complexity of cancer causation, prescription drugs ought to be ranked second only to cigarette smoking as a cancer hazard. While certain industrial chemicals are more potent carcinogens than any drug, there are few chemical agents to which so many people are exposed at relatively high doses for great lengths of time.

…evidence suggests about half of prescription drugs are potentially carcinogenic.

[8] Clinical trials are sliced and diced to deliver results favorable to Pharma

Clinical trials don’t represent the real world. Volunteers in clinical trials are typically younger and healthier than the people (often senior citizens) who will take the drugs in the real world. Volunteers in clinical trials don’t take concomitant drugs because that can complicate evaluation of the drug being investigated. But, in the real world, people quite often take a half-dozen or more drugs.

[9] Normal biological processes are portrayed as errors in human evolution

–Stomach acid is not an error in human evolution as Pharma would like you to believe, necessitating an assault on stomach acid with antacids, H2 blockers, and proton pump inhibitors.

–Cholesterol is not an error in human evolution as Pharma would like you to believe, requiring the truly massive prescribing of statins. Cholesterol is essential for the proper functioning of every cell in the human body.

–Fever can be Mother Nature’s protective mechanism to fight infection. Fever should not be treated routinely unless it is severe.

–The decrease in estrogen at the menopause is a normal thing, not an error in human evolution as Pharma would like you to believe.

–The decrease in testosterone with aging in men is not an error in human evolution requiring testosterone supplements as Pharma would like you to believe.

[10] Only USA and New Zealand allow advertising of prescription drugs directly to the public

The rest of the world apparently believes that such advertising encourages overuse of medication or use of high-priced advertised drugs when there may be less expensive alternatives available including non-drug approaches.

[11] The modern world is making us sick but our regulatory agencies won’t admit it

Modern medicine pushes pills in an attempt to divert attention from the many ways that the modern world is making us sick, including the pervasiveness of synthetic chemicals which have never before been seen during the long course of human evolution. Why won’t FDA, EPA, NIH, CDC, NIOSH, etc. openly admit the risk posed by so many synthetic chemicals?

[12] Many “chronic” conditions aren’t really chronic

If a condition can be prevented, why should it be referred to as chronic? Referring to common medical conditions as “chronic” convinces the public that there’s nothing that can be done to prevent these medical conditions. Therefore we should passively submit to Pharma’s wonder drugs for decades.

Pharma often refers to elevated blood pressure, elevated cholesterol, and elevated blood sugar (in type 2 diabetes) as “chronic” diseases even though the reality is that these conditions can often be prevented or reversed with dietary and lifestyle changes, weight loss, exercise, etc. So these medical conditions are not necessarily “chronic” as Pharma would like you to believe.

[13] Pharma has fundamentally mischaracterized pharmaceuticals

Most pharmaceuticals are synthetic substances, produced in a laboratory, that have never before been seen during the long course of human evolution. These substances overwhelm the delicate biological processes which have been fine-tuned over hundreds of thousands (or millions) of years.

Pharma portrays the human body as a rickety old machine that is constantly breaking down and is in need of constant shoring up with these synthetic chemicals.

People think that the pharmaceutical industry is an enterprise based on science. The reality is that Pharma is an out-of-control marketing machine. We have allowed Pharma to promote the belief that human health is primarily a result of the prescribing of pills.

[14] The brain chemical imbalance theory is a sophisticated ploy to legitimize the massive prescribing of pills for mental conditions

Pharma hopes that you don’t realize that the chemical imbalance theory for mental problems means that psychology and psychologists are irrelevant because all mental problems are caused by a chemical imbalance in the brain requiring a chemical solution with synthetic chemicals known as pharmaceuticals.

This mechanistic and reductionist view of mental problems completely ignores one’s life circumstances like abusive spouses, abusive bosses, abusive siblings, abusive co-workers, poverty, scars that remain from childhood, as well as a culture which promotes the belief that one’s emptiness can be filled with material possessions.

[15] Schools of pharmacy legitimize Pharma’s approach to human health

Pharmacy schools legitimize and normalize Pharma’s pill for every ill outlook. Pharmacy schools focus on chemistry thus legitimizing Pharma’s mechanistic and reductionist focus. Pharmacy schools remove Homo sapiens from the natural world and do not focus on the health of the whole person or the effects of the society, culture, diet, lifestyles, and environment. Pharmacy schools are an entrenched impediment in opposition to our society transitioning toward a health care system based on prevention.

In conclusion

The world of pills is becoming more absurd each year as the profit motive corrupts the scientific basis of modern medicine. Marketing is the primary driver of the pill business, not science.

In my opinion, nothing captures the essence of the FDA more than its assertion that all the drugs it approves are “safe and effective.” What the heck does that mean? FDA’s definition of “safe and effective” is vastly different from the layman’s definition. How can a drug that can cause many very serious and even fatal side effects be considered safe?

It’s as absurd as the soothing trope: “Everyone is equal under the law.” The truth is that people who can afford high-priced lawyers very often get more favorable treatment by our legal system than people who can’t afford such lawyers.

In my opinion, the world of pills is a conglomeration of many absurdities. Being passive, trusting, and uninformed in relation to our medical system is a very dangerous posture.

This article was written by Dennis Miller, R.Ph. He is a retired chain store pharmacist. His book, The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets, can be downloaded in its entirety at Amazon for 99 cents.

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