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Just Shut Up and Fill Prescriptions!

Should pharmacists educate you about deception, and dishonesty regarding pills? Or should pharmacists just fill prescriptions?

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.

A People’s Pharmacy reader comments that pharmacists’ sole job is to dispense prescriptions safely. In response to my commentary in The People’s Pharmacy on June 27, 2024, titled “Pharmacists Don’t Seem to be Troubled by These Critically Important Issues,” a reader named Barb posted the following comment on Facebook:

“The pharmacist’s sole job is to dispense my meds safely. They need to know about allergies, drug interactions and indications for drugs. They have no other role in my medical care.”

I think that this is the kind of comment that someone would make who is naïve about pharmaceuticals and the pharmaceutical industry. This reader seems to have a very negative attitude towards pharmacists. She seems to be saying that she’s not interested in hearing anything from pharmacists other than issues regarding drug allergies and drug interactions. That would tend to upset a lot of pharmacists who feel that we have a lot of useful and valuable information for our customers.

A pharmacist says pharmacy customers “told me to just be quiet and fill their pills”

In response to this same commentary, a pharmacist named Rick posted the following comment in which he says that he has raised with pharmacy customers many of the points I mentioned in my article.

He says that some of his customers “told me to just be quiet and fill their pills.”

I would bring these many points you have mentioned to my pharmacy clients. Basically they admitted they were too lazy to make the required lifestyle changes and that it was just easier to take the pills. Others told me to just be quiet and fill their pills, as their doctor knew best. And as we know, my job depended on filling as many prescriptions as possible because the company didn’t make money if people didn’t fill their prescriptions. Very frustrating to say the least. So glad when I was able to retire.”

A reader says that pharmacists should stick to their “job description”

As a result of a previous article I wrote for Peoples Pharmacy titled “12 Reasons Why Pharmacists Don’t Criticize Pharmaceuticals,” a reader named Frank posted the following comment:

“The scope of pharmacists should be limited to filling and dispensing prescriptions only. Patients should be seeing and talking to their family doctors instead. Patients should read and understand the circulars that come with medications. People expect too much of pharmacists for things that fall outside of their job description.”

Grab the product and slap a label on it

Some customers think a pharmacist’s job description only involves transferring pills from big bottles into little ones as fast as they can. Should pharmacists be limited to simply going to their pharmacy shelves and grabbing whatever medication a physician prescribes and slapping a label on it with the doctor’s directions? Many people, in fact, think that is all that pharmacists do.

Many pharmacists dislike interacting with customers and patient counseling

I agree that many pharmacists do a poor job counseling customers about medications. Many pharmacists hate customer contact and don’t feel that it is our job to educate the public about the risks and benefits of pills. Many pharmacists view most customer questions as naïve or stupid. That is, of course, because most of our customers did not attend pharmacy school or medical school.

Ideally your physician will tell you everything you need to know about the drugs he/she prescribes. But in our assembly line medical system based on herding people like cattle, that rarely happens. So, in my opinion, the public should be appreciative of any information that their pharmacist shares with them about their prescribed medications. The reality is that with dangerously understaffed pharmacies at chain drug stores, there simply isn’t enough time for pharmacists to have detailed discussions with customers.

Even though some pharmacy customers don’t seem to see much value in speaking with pharmacists, many customers do indeed ask pharmacists a lot of questions. For example, some customers say something like this to their pharmacist: “I don’t really like to take prescription drugs. But my doctor says I need this. What do you think?”

Do you want your pharmacist’s opinion on the following issues?

[1] Generic drugs

Do you want your pharmacist to tell you that the FDA has inadequate staffing to inspect drug manufacturing facilities in countries like India, China, and other countries around the world, thus raising the issue of the effectiveness of generic drugs?

[2] Commonly prescribed drugs may cause cancer

Do you want your pharmacist to tell you if your medication has been linked to tumors or cancers in lab animals, often at a dose that is not far from the human dose on a pound for pound basis?

[3] Weight loss drugs

Do you want your pharmacist to tell you about the dismal track record of weight loss drugs over the last several decades?

[4] Hormone replacement therapy

Do you want your pharmacist to tell you that Pharma views the menopause as an error in evolution and that hormone replacement therapy increases the risk of cardiovascular disease and uterine cancer?

[5] Statins

Do you want your pharmacist to tell you that Pharma views cholesterol as an error in human evolution which needs to be fought with statins even though cholesterol is ubiquitous in the human body and is essential for cell function and for making hormones?

[6] Fever

Do you want your pharmacist to tell you that fever is nature’s way of fighting infection and that fever should not be treated routinely unless it is more than moderately elevated.

[7] Volunteers in clinical trials do not represent the real world

Do you want your pharmacist to tell you that volunteers in clinical trials do not reflect the real world because they are typically younger and healthier than the people who will take the drugs in the real world? Young and healthy people can usually withstand drug side effects better than senior citizens. Do you want your pharmacist to tell you that volunteers in clinical trials typically do not take any other drugs even though the people who will take the drugs in the real world typically take multiple drugs, sometimes 5 or 6 or more drugs?

[8] The full extent of adverse effects from pharmaceuticals is unknown or unknowable

Do you want your pharmacist to tell you that no one really knows the true incidence of drug side effects because no one—except consumers—wants to know. Doctors, pharmacists, Pharma, chain drug stores, and insurance companies don’t want to know because that knowledge could decrease enthusiasm for our medical system based on pills. For example, no one really knows the incidence of muscle pain and weakness from statins.

Do you want your pharmacist to tell you that it is impossible to know or predict all the biological and biochemical effects of pharmaceuticals at the molecular and cellular levels? Do you want your pharmacists to tell you that pharmaceutics can cause subtle yet very significant damage to human biology and biochemistry that is not recognized before the drug is approved? Do you want your pharmacist to tell you that adverse effects may, in fact, never be recognized? For example, given the fact that cholesterol is ubiquitous in the human body and is essential for cell functioning and the production of hormones, no one can even begin to predict the full extent of statins at the molecular and cellular levels

[9] Antidepressants

Do you want your pharmacist to tell you that most of the benefit that people get from antidepressants might be due to the placebo effect? Do you want your pharmacist to tell you that the drug companies promote their products based on a highly questionable chemical imbalance theory of depression? Do you want to know that even though this theory is the foundation for the prescribing of antidepressant drugs, it is pure conjecture which seeks to legitimize the massive prescribing of these drugs?

[10] Cancer

Do you want your pharmacist to tell you that The Merck Manual says that up to 90 percent of cancers are preventable? Would that fact cause you to be more concerned about and vigilant toward the ubiquitous synthetic chemicals in modern society which may be responsible for a very large number of cancers?

[11] Stomach acid

Do you want your pharmacist to tell you that stomach acid is not an error in evolution that must be counteracted with antacids, acid suppressors, and proton pump inhibitors? Do you want your pharmacist to tell you that stomach acid is essential for life, essential for digesting food, and essential for killing harmful microorganisms in food?

[12] Diseases of modern civilization

Do you want your pharmacist to tell you that most of the prescriptions pharmacists fill are to treat preventable diseases of modern civilization? Do you want your pharmacist to explain to you the significance of what’s variously described as diseases of affluence, lifestyle diseases, diseases of modernity, diseases of advanced societies, Western diseases, etc.?

[13] Drug effectiveness

Do you want your pharmacist to tell you that drugs which treat, for example, bone thinning, depression, psychosis, and dementia have difficulty demonstrating significant effectiveness? Do you want your pharmacist to tell you that the human brain is the most complex thing in the universe and that the drugs that treat mental conditions are extremely crude in comparison to the miraculous human brain? The drug companies march into the unknown with a tsunami of pills affecting the brain despite such ignorance.

[14] USA ranks poorly on many health metrics

Do you want your pharmacist to tell you that despite the fact that this country spends the most per capita on pharmaceuticals, the USA ranks very poorly on many health metrics?

[15] Systemic absorption of products applied to the skin

Do you want your pharmacist to tell you that products applied to the skin often enter the systemic circulation with unknown adverse effects? This includes sunscreens, moisturizers, cosmetics, depilatories, antiperspirants, insect repellants, hair dyes, shampoos, skin cleansers, exfoliators, acne products, hyperpigmentation products, wrinkle creams, anti-inflammatory creams, anti-aging formulas, fine line removal products, face oils, chemical peel products, etc.

[16] Direct-to-consumer advertising of prescription drugs

Do you want your pharmacist to tell you that only two countries (USA and New Zealand) allow direct-to-consumer advertising of prescription drugs? Do you want your pharmacist to tell you that the rest of the world presumably feels that these advertisements encourage overmedication and the use of the expensive drugs that are advertised even though there may be less expensive alternatives available including non-drug approaches?

[17] Dozens of anti-Pharma books

Do you want your pharmacist to tell you that there are dozens of anti-Pharma books on the market and that if you really want to deeply understand pharmaceuticals, you should read as many of these books as you can?

[18] Black box warnings

Do you want your pharmacist to tell you that the FDA often adds black box warnings to the official prescribing information years after approving drugs? Do you want your pharmacist to explain that this indicates that the FDA doesn’t really understand the full extent of possible harm from the pharmaceuticals it approves at the time of approval

[19] Increases in life expectancy are not primarily due to drugs

Do you want your pharmacist to tell you that the primary reason for the increases in life expectancy in the last hundred years is public health factors like improved sanitation, improved housing, improved nutrition, cleaner drinking water, etc.? The primary reason for the increases in life expectancy is not pills as Pharma would like you to believe.

[20] Pharma has awesome power to control the narrative about health

Do you want your pharmacist to explain to you the awesome power of the pharmaceutical industry to drive the narrative about health toward pills and away from prevention?

[21] Temperature extremes during transport of pharmaceuticals

Do you want your pharmacist to tell you that temperature extremes in the summer and winter can adversely affect the potency of your medications as they are shipped to drug stores or as they sit in mailboxes in freezing or sweltering temperatures?

[22] Wait five years before taking a new drug?

Do you want your pharmacist to tell you that some experts believe that you should not take a new medication before it has been on the market for five years? This would allow time for significant adverse effects not seen during clinical trials to become evident.

[23] Me-too or copy-cat drugs

Do you want your pharmacist to tell you that very many of the drugs that the FDA approves are “me-too” or “copy-cat” drugs that are not a significant therapeutic advance in comparison to existing drugs?

[24] FDA has been captured by Pharma

Do you want your pharmacist to tell you that the FDA has been “captured” by the pharmaceutical industry? Regulatory capture is a situation in which a governmental regulatory agency has been captured by the industry it is supposed to regulate.

[25] “Safe and effective”

Do you want your pharmacist to tell you that the FDA’s assurance that all the drugs the agency approves are “safe and effective” is absurd? Do you want your pharmacist to tell you that the FDA’s definition of “safe and effective” is vastly different from the layman’s definition?

[26] Relative vs absolute risk reduction

Do you want your pharmacist to tell you that drug companies cite “relative risk reduction” rather than “absolute risk reduction” to make the drugs appear more effective?

[27] Surrogate endpoints

Do you want your pharmacist to tell you that drug companies cite “surrogate endpoints” or “surrogate markers” rather than “decrease in all-cause mortality”? Drug companies do this to make drugs appear to be more effective than they are.

[28] Number needed to treat (NNT)

Do you want your pharmacist to tell you that drug companies do not include “number needed to treat” (NNT) in drug commercials even though this is extremely important?

[29] Mechanistic and reductionist view of health

Do you want your pharmacist to tell you that Pharma has an extremely mechanistic and reductionist view of human health based on molecules, cells, and chemistry, rather than a view of health based on the whole person?

[30] Most pharmaceuticals are synthetic substances

Do you want your pharmacist to tell you that pharmaceuticals are mostly synthetic substances, manufactured in a factory, that have never before been seen during the long course of evolution?

I have an idealized view of pharmacists as strongly pro-consumer

I admit that I have an idealized view of pharmacists as a counterbalance to the hype and lies from Pharma. I have a view of pharmacists as strong consumer advocates whose goal is to help the public see through the false narrative promoted by the pharmaceutical industry.

Of course, many pharmacists don’t want to play that role. I contend that most pharmacists went to pharmacy school because they heard that pharmacists make a decent salary. That unfortunately includes me. I am not so naïve as to believe that most pharmacists see their role as educating the public about the risks and benefits of pills. The pharmaceutical industry, chain drug store corporate executives, and insurance companies want pharmacists to maintain a positive attitude toward pills.

The information you receive about pills is primarily from a deeply biased source

What we have in the USA today is a situation in which most of the information the public receives about pills comes from an industry with a powerful incentive to make people believe that those pills are safer and more effective than they really are and that pills are better than prevention. The biggest source of information that the public receives about health should not be an industry with a powerful incentive to grotesquely distort that information.

Only two countries, (USA and New Zealand) allow direct to consumer advertising of prescription drugs

Either we need to ban these advertisements or the FDA needs to mount a pro-consumer counteroffensive that is as massive as Pharma’s disinformation campaign. These advertisements won’t be banned because of the massive influence of Pharma lobbying Congress and the fact that the FDA has been captured by the pharmaceutical industry.

Culture Shock in Pharmacy School:

When I entered pharmacy school, I expected to learn that pharmaceuticals are akin to super potent vitamins that augment the miraculous healing powers of Mother Nature. I was surprised to learn that pharmaceuticals are, in fact, mostly potent synthetic chemicals which are foreign to human evolution that attack and overwhelm delicate biological and biochemical processes which have been fine-tuned over hundreds of thousands (or millions) of years.

I was surprised, disappointed, and disillusioned to learn that pharmaceuticals are at war with human biology. In my opinion, the pharmaceutical industry has profoundly mischaracterized what pharmaceuticals are. In contrast to foods, pharmaceuticals are largely an arsenal of weapons at war with human biology.

In Conclusion:

Should pharmacists just shut up and fill prescriptions? Or are you interested in pharmacists’ insights into the corrupt world of pills?

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.

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