This is an excerpt from Dennis Miller’s explosive new book The Shocking Truth About Pharmacy: A Pharmacist Reveals All The Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.
Are You Concerned About the Number of Medications You Take?
Pharmacy customers occasionally mention to their pharmacist that they’re concerned about the number of drugs they’re taking, and that they would like to take fewer drugs. Customers want to know what their pharmacist thinks about the situation.
That seems like a fairly straightforward question, but unfortunately the pharmacist’s answer can be a minefield. If your pharmacist feels that there may be drugs that are excessive or unnecessary, what is the likelihood that he/she will share that opinion with you?
Is your pharmacist concerned that you will contact your physician and say, “My pharmacist says that I may be able to eliminate one or more drugs that I’m on”?
Tell Your Doctor “I want to take as few medications as possible”
Would it be simpler for you to just tell your physician directly that you want to take as few medications as possible? That would put your physician on notice that you are interested in eliminating unnecessary medications.
In my opinion, if your physician replies, “I agree,” that is a sign that he/she is a good physician. If, on the other hand, your physician is annoyed or angered by your statement or implies that you don’t have enough knowledge about drugs to comment on the matter, then maybe you should consider finding another physician.
Angry Phone Calls from Physicians:
Pharmacists clearly don’t enjoy angry phone calls from physicians in which the physician states or implies that the pharmacist should just shut up. Many physicians have an attitude such as “I’ll write the prescriptions and you fill them. Period.”
When It Comes to Pills, Our System Says “More Is Better”:
Telling one’s doctor that you would like to take as few medications as possible should be viewed as an entirely reasonable statement. Unfortunately that statement flies in the face of the pill tsunami in the USA.
Our medical system is absolutely biased toward the concept “more is better.” Thus you may be fighting an uphill battle if you tell your physician that you would like to decrease the number of medications you take.
Of course, one reason why physicians prescribe like there’s no tomorrow is a fear of a lawsuit for not treating a disease aggressively enough. Another reason is that insurance companies prefer to pay for pills rather than pay doctors to educate patients about prevention.
Are Pharmacists Your Ally in Your Quest to Take as Few Medications as Possible?
Is your pharmacist likely to agree with you or be supportive of your view that you would like to take fewer medications? To get out of a touchy situation, I have seen pharmacists tell customers things like, “Your doctor wouldn’t have prescribed those drugs if he/she didn’t think they would help you.” I hate to admit that I’ve given that same cop-out answer on occasion myself to avoid discussing this touchy subject.
Why Is the Term “Polypharmacy” Used Instead of “Overmedication”?
Because the term “overmedication” is so unsettling to many pharmacists, in my opinion the peculiar term “polypharmacy” is used much more often. Maybe pharmacists prefer the term “polypharmacy” because it helps to hide the reality that many of our customers take too many drugs of questionable safety and effectiveness. It is also possible that the term “polypharmacy” is employed in a pompous attempt to impress the public with a highfalutin scientific-sounding word. “Overmedication” sounds exploitative whereas “polypharmacy” sounds scientific.
What Many Pharmacists Would Like to Tell You:
I have heard many pharmacists make statements to other pharmacists or techs like “If people would just eat healthy food, lose weight, and exercise, they wouldn’t need so many pills.” I believe that is what many pharmacists would like to tell you, but such a statement is likely to offend many of our customers. Any mention of the customer’s weight certainly risks an angry response from that customer.
After filling six to ten or more prescriptions for the same patient, pharmacy techs often make statements to other pharmacy staff like “I wonder how he has any room left for food!”
Several Pharmacists’ Views on Overmedication:
I have received a lot of feedback as a result of my commentaries in the pharmacists’ magazine Drug Topics. Regarding overmedication, here are several e-mails I received from pharmacists:
Pharmacist #1 asks: “Why are we even playing this game?”
As a 55-year-old retail pharmacist, I think about this every day. In fact, I joked to my wife that I would prefer to practice ‘Farmacy’ instead of pharmacy. Our diet and lifestyle make so much of what we treat preventable. We (our US population) eat too much sugar and meat and not enough fruits and vegetables. We don’t exercise. Smoking is just a given as far as something that one can give up and instantly see improvement.
My typical encounter is an overweight customer in drive-through picking up their cholesterol, diabetes, blood pressure and pain pill. Often times a person picking up their asthma inhaler is smoking a cigarette. My thought is always ‘Why are we even playing this game?’ I hope it gets better but I doubt it. I am one of those who has gone vegetarian to avoid the same meds I dish out every day. Thanks again for the article and for listening to a pharmacist who struggles every day with the meaning of his job.
Pharmacist #2 says “We are just handing out pills like hamburgers.”
I am just recently retired from the chain drugstore business, mostly because I just could not stand it anymore. Lack of staff, unreasonable working conditions and workload, and the sense that we are just handing out pills like hamburgers made working no longer a pleasure. It was frustrating dealing with the public, who have been more or less brain-washed into thinking that every new pill coming down the pike is just what they should have, never mind whether or not it would really do them good or might even be harmful to them.
The military-industrial complex has nothing on the medical insurance / manufacturers / chain stores complex that has bamboozled and scared the public into believing that all these drugs and medical “care” are necessary and good for them. We are becoming a nation of legalized drug-addicts subjugated by an un-healthcare industry focused on how much money they can extract from our wallets.
Pharmacist #3 says we’ve become dependent on medications “for everything.”
Medications are important in ER, urgent care, chemotherapy, pain control, but we have become dependent on them for everything! It’s so sad and I’m disappointed in being a part of this. It’s not what I imagined as a pharmacy student.
Pharmacist #4 says: “What I really want to do is tell my customers to flush the medication and start taking care of their bodies.”
I can’t believe you can read my mind so perfectly! The cognitive dissonance you speak of is as familiar to me as getting out of bed in the morning, and much less palatable. How DO you reconcile what you know to be true with what you must tolerate to survive. For many years, I have felt “two-faced” or phony in my practice of pharmacy. What I really want to do is tell my customers to flush the medication and start taking care of their bodies. What I have to tell them is how the medication will “help” them, and how they should take it faithfully. I’ve played the part as long as I can. I’m getting out. I can’t in good conscience keep shoveling this stuff out. Keep up the good work!
Pharmacist #5 says that most people want “to solve their problems with a pile of meds.”
Our entire healthcare system revolves around the quick-fix consumer culture that ensures grand profits for corporations and unfortunately most people buy into it. I enjoy having the conversations with customers who are tired of the pills and want to investigate other options. These conversations, however, are the exception. Most people I encounter want to be told what to do and aren’t interested in the details or thinking for themselves. Better to depend on the big pharma-trained MD to solve their problems with a pile of meds or the many pharmacists I know whose mantra is “better living through chemistry.” It is MUCH easier to swallow pills than it is to take responsibility for one’s health.
Pharmacist #6 says that most drugs “do not address the root cause of [patients’] ailments.”
[This] is something that I have thought about for years. A large percentage of patients I see in the pharmacy have health problems because of their lifestyles. It would seem that the logical course of treatment would be to try and get them to alter their lifestyle. The drugs only keep them alive and functional but do not address the root cause of their ailments. A patient goes to the doc and his blood glucose level is high. The doc gives him a prescription for metformin. This is the easy approach. The doc will probably mention diet and exercise. This is really about all the doc can do. The underlying cause of the patient’s problem is his lifestyle. Until our healthcare system can reach people in a way that nudges them into changing their lifestyle, we are going to be bombarded with a costly and overloaded healthcare system.
Pharmacist #7 wonders “why people don’t make simple lifestyle changes that would reduce or eliminate the need for medication.”
This is a frequent conversation in our pharmacy. We constantly wonder why people don’t make simple lifestyle changes that would reduce or eliminate the need for medication. Why does that seem so hard to understand?
Patients demand a pill to feel better now (they saw one on television!), doctors supply another pill to satisfy the patient, and no one in the medical profession has time to stop and think much about it anyway! When was the last time a doctor (or other practitioner) has had time to sit down with a patient and explain the benefits (and the dangers) in lifestyle choices? Lose weight? That’s too hard. Eat more healthfully? Who has time to cook? Stop smoking? That’s my right! Feeling blue? There’s a pill for that!
I read Andrew Weil and Susie Cohen, and they make so much sense to me. I preach to everyone who will listen about what we’re doing to ourselves in the long run – how America is overmedicated and none the healthier for it. I watch the drug interactions pop up on my screen for patients who take multiple meds, and cringe. Doc says “I think that will be OK.” I watch the medications given to elderly folks who really shouldn’t be taking them, and wonder if they just need someone to talk to instead.
I’m tired, and I just don’t know what to do about it – I learned long ago that I can’t save the world. After all, we’re battling a billion dollar drug industry and direct-to-consumer advertising.
Pharmacist #8 says he has “consistently advised patients over the years to try exercise instead of popping a pill, vitamin or herb.”
I have not been reading much of the pharmacy magazines the past few years, due their pro drug biases, and lack of evidenced based medicine information. What a surprise to see a kindred spirit with the same ideas about the practice of medicine and pharmacy today.
I agree with you 100% about the overuse of medications. I have consistently advised my patients over the years to try exercise instead of popping a pill, vitamin, or herb. Most of my colleagues, including doctors, nurse practitioners, physicians assistants, etc, just don’t get it, or just are in it for the money.
Pharmacist #9 says our survival as a profession depends on “communicating truth, not in pushing even more medications.”
Our society is often too quick to name-and-blame rather than admit that many social and physical challenges in life are not best solved through prescribing another medication. There are billions of dollars backing those chemical company assertions that cannot be substantiated by evidence-based review.
Our true value (and survival) as pharmacists will be found in communicating truth, not in pushing even more medications to an all-too-trusting public.
Being so bombarded with clever advertisements and “convincing” clinical trials, pharmacists have transformed from the “most trusted” to the “most trusting” profession.
Pharmacist #10 asks why pharmacy customers don’t “ever think about starting an exercise regimen or changing their diet” instead of taking pills.
Whenever the doctor’s office had not called back with the customers’ refill authorization, besides being annoyed, many customers would respond by saying, “I don’t know why the doctor does not give more refills. I’m going to be on the medication for the rest of my life.”
I always felt like going over to the customer and saying “How do you know that you are going to be on the medication for the rest of your life?” Did the customer ever think about starting an exercise regimen or changing their diet if their prescription was for blood pressure or cholesterol? Of course not. Because it is easier to just take a pill than become more healthy by working at it.
Pharmacist #11 says that “about half of the drug products we sell are unnecessary or could be avoided.”
In the aggregate, pharmacists are the most qualified to help our patients differentiate between drug therapies truly necessary for them, the ones that seem solely to boost the drug economy, and discretionary therapies in between. About half of the drug products we sell are unnecessary or could be avoided. Most of the pharmacists I know live healthy lifestyles and would advise patients supportively about “pharmacoavoidance” [avoidance of drugs] if given the chance to get to know the patient to be frank enough to offer lifestyle change advice, for instance.
Pharmacist #12 says that physicians “prescribe drugs at the drop of a hat or mention of a symptom.”
Allopathic/Western physicians (and physicians assistants and nurse practitioners who follow closely in their tracks) prescribe drugs at the drop of a hat or mention of a symptom. There is no time to drill down to the cause. And that excuse assumes that the prescriber even has the skills to connect-the-dots that would help him/her find a root cause or know what lifestyle / diet / exercise /sleep adjustment to make to “cure” the problem.
Pharmacists seem to be satisfied with filling as many prescriptions as they can so as not to upset the apple cart of income and push-back from prescribers. We should be siding with patients, re-evaluating the need for drug regimens, and calling doctors to get medications discontinued, doses reduced, lifestyle changes made. Our patients (who, by the way, hate being thrown another prescription that doesn’t solve their problem) will love us for it.
Pharmacist #13 says that he is “continually burdened by the pressure of our chain pharmacy to increase volume and push sales.”
We are continually burdened by the pressure of our chain pharmacy to increase volume and push sales. Frankly, I feel it is a good thing for the general public if the need for pharmaceuticals diminishes. That would mean our patients are getting healthier. Why would pharmacy sales or volumes increase if we are doing things right? There is no denial to this truth: We must change our nation’s rotten healthcare system.
Why Are Pharmacists Reluctant to Speak Out About Overmedication?
There are a large number of factors that influence how pharmacists react to being asked whether we feel that our customers can eliminate some medications or indeed whether we think they’re overmedicated.
If you are looking to your pharmacist for an ally in your quest to take as few medications as possible, you may want to keep in mind these factors which may skew your pharmacist toward a strongly pro-pharmaceutical stance.
The big drug store chains do not provide enough staffing that would allow pharmacists enough time to have significant conversations with our customers about overmedication and the safety and effectiveness of drugs. Expressing opinions about overmedication opens a huge can of worms in which pharmacy customers rightly expect us to elaborate on our concerns. With dangerously low levels of staffing in too many chain drug stores, pharmacists simply don’t have the time to provide thoughtful answers to our customers’ questions about overmedication.
- Chain drug store corporate management doesn’t want pharmacists to criticize overmedication.
- Physicians don’t want pharmacists to criticize the number of pills they prescribe.
- Pharmacy customers don’t want lectures from pharmacists about dietary and lifestyle changes that can eliminate the need for many medications.
- Pharmacy customers don’t want pharmacists to question their belief in a pill for every ill.
- Most pharmacy customers are just interested in getting out of the drug store as quickly as they can, before the ice cream in their car (which they just purchased at the local grocery store) melts.
- Pharmacists have an economic self-interest in being positive about the pills we dispense.
- Many pharmacists see their jobs as fundamentally a business, rather than a profession in which the health of the public is the primary focus.
Have Pharmacists Been Complicit with Overmedication?
In my opinion, pharmacists deserve significant blame for the overmedication of the population. Pharmacists have been basically complicit with Big Pharma’s narrative of a pill solution for every problem in life.
You might think that pharmacists function as a watchdog over the pharmaceutical industry. You might assume that Big Pharma can’t stray too far from the truth without pharmacists blowing the whistle. You might assume that Pharma can’t exaggerate the benefits of drugs or downplay risks without pharmacists crying foul.
Unfortunately, in my experience, that is not the role that pharmacists play. Regardless of pharmacists’ personal views on overmedication, the medical system pushes pharmacists into the more is better mode.
Pharmacy Schools Contribute to Overmedication:
Pharmacists’ views about pills have been strongly shaped by pharmacy schools which teach a very narrow view of health based on pharmaceuticals, not prevention. Pharmacy students and pharmacists who stand up and say things like “I prefer prevention more than pills” are likely to be viewed as outcasts or troublemakers by pharmacy professors, pharmacy students, and pharmacists.
Pharmacy Customers Contribute to Overmedication:
Customers play a significant role in their own overmedication by expecting a quick-fix pill for every ill, by asking physicians for drugs they saw advertised on TV, by not being willing to make significant changes in their diet and lifestyle, by having an exaggerated belief in technological solutions for every health problem, and by evaluating their pharmacists on how fast he/she fills prescriptions.
As a result of an article I wrote for The People’s Pharmacy titled “10 Reasons Why Doctors Prescribe Drugs So Eagerly,” a physician posted this comment:
It takes time to explain to the patient the pathophysiology of their illness and the various non-pharmaceutical measures that could be used. It’s far easier and more expeditious to write a prescription and send them on their way.
And time is money!! Furthermore, they have come to expect a prescription rather than a lecture when they leave your office.
Try to convince a mother of an infant who has been up for the last 72 hours with a baby crying and showing a runny nose. The doctor knows it is almost certainly a viral illness–but Mom expects the miracle antibiotic pill or potion.
I’ve been in practice for the last 54 years and have seen it up close and personal!!
Pressure from Spouses and Parents to Conform to the System:
Many pharmacists get push-back from their spouse or parents for expressing doubts about our medical system’s pill obsession. After all, we and/or our parents have invested so much time and money in our education. Clearly our spouse and parents don’t want to see that we have serious doubts regarding whether we made the right career choice. My parents were always very upset when I tried to discuss with them my disillusionment with overmedication and with modern medicine’s advocacy of pills for every problem in life.
Pharmacists and Cognitive Dissonance:
Cognitive dissonance is the emotional conflict which results from the difficulty of holding two contradictory beliefs simultaneously (pills are great and pills can be risky). It’s therefore less painful for pharmacists to submit to the dominant narrative in our society and drink Pharma’s Kool-Aid about the wonders of pills. I can attest to the fact that it’s no fun feeling estranged from one’s profession.
In my opinion, most pharmacists are not interested in a critique of the pharmaceutical industry and overmedication. Many pharmacists view critical discussions of pharmaceuticals as a threat to their economic survival. I met very few pharmacists during my career in chain drug stores who welcomed a discussion of the issues regarding overmedication and whether pills are the best way to make people healthy.
The Socialization Process in Pharmacy School:
I once spoke with a professor who was a friend of Ivan Illich. Many years ago Illich wrote a seminal expose’ of modern medicine titled Medical Nemesis: The Expropriation of Health (NY: Pantheon Books, 1976). This professor told me that “the socialization process in medical school is stronger than a prison.”
In my opinion, pharmacy students go through a similar socialization process in pharmacy school where pills are presented as the most reasonable and effective approach to health.
Pharmacists Are Unwittingly Complicit with America’s Pill Culture:
In response to one of my previous articles (“Why Aren’t Pharmacists Critical of Pharmaceuticals?,” January 1, 2021) for The People’s Pharmacy, a reader posted a comment regarding my observation that pharmacists are heavily influenced by the fact that the most popular pharmacy magazines have a strongly pro-Pharma bias. This is because these magazines are very dependent on drug industry advertising.
This People’s Pharmacy reader wrote:
Pharmacists, like fish who live in and are dependent upon an environment of water, are as much a part of the culture, with all its ills, and therefore unaware of the extent to which they are a part of the problem. Confirmation bias found in trade publications puts blinders on their eyes so they do not see the negative impacts of the pharmaceutical industry.
Pharmacists have more than enough worries from their jobs and daily lives to burden themselves with the additional concern of overmedication and drug safety and effectiveness.
In response to this same People’s Pharmacy article, a pharmacist offered the following explanation for why pharmacists don’t want to read about things like overmedication and the critique of pharmaceuticals and Big Pharma. I believe this pharmacist’s comment, like the comment above, is precisely correct.
The pharmacist writes:
It’s very simple why pharmacists don’t want to read books critical of the pharmaceutical industry. It’s basically burnout from a system that promotes overwork, terrible schedules, and is already burdened by the complexity of being expected to be 100% accurate, learning and retaining the extensive knowledge of what drugs are used for, when they shouldn’t be used, minor to major interactions and contraindications, plus following an extensive set of laws and regulations, and then, after a stressful work day, dealing with the rest of life’s demands in everyday living and family life.
I practiced retail pharmacy for nearly 30 years. It becomes a nearly inescapable tyrant that invades every aspect of your life. Even if you get 3 or 4 weeks of vacation, it’s often not possible to take it when you want to. Then add Covid, politics, etc. I could continue on, but the simple answer is, after you invest large amounts of time and money getting educated, and still need to pay off those expenses, plus the everyday expenses of living, then face all the pressures of the profession, why would you want to add to your list of anxieties and problems more negative information to dog you and plant nagging doubts?
…By the way, I am NOT in the profession any longer. I watched manufacturers inflate prices for 30 years beyond any degree of necessity, while chains stomped out nearly all independent competition. I make less than 50% of what I used to, but I at least have my mental health back and can sleep at night. It wasn’t easy divorcing a profession, but it’s the best thing that ever happened to me.
Factors That Influence Pharmacists’ Attitudes Toward Pills:
Pharmacists’ views about pills are built and reinforced by our pharmacy school professors, by the corporate culture at chain drug stores, by our local and national pharmacy associations, by pharmacy magazines and journals which receive most of their revenue from drug industry advertising, by drug advertisements on TV, by drug salesmen (detailmen), by our economic self-interest like our need to pay off our college loan, car loan, house payments, and the need to save for our kids’ college education. For these and other reasons, pharmacists may not be very supportive of your desire to decrease the number of medications you take.
This is an excerpt from Dennis Miller’s explosive new book The Shocking Truth About Pharmacy: A Pharmacist Reveals All The Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.