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. The opinions he expresses are his own.
In my opinion, a huge number of pharmacists—perhaps a majority—do not believe that what we do every day is the best path to health. In private conversations, pharmacists will often admit that loading people up with pills is not the best way to make them healthy.
If People Would Just Take Better Care of their Bodies:
Pharmacists often make comments to technicians after filling six or eight or ten prescriptions for the same person: If he (or she) would just take better care of himself, lose weight, exercise, eat better, give up smoking, avoid alcohol, etc., he wouldn’t need nearly so many (or any) pills.
I remember one pharmacist, after filling a prescription for an antidepressant, mentioned to the other staff in the pharmacy department (out of earshot of customers):
“This customer has some problem in her life that pills won’t solve. She needs to examine the reason she’s depressed rather than look for pills to solve her problem.”
I remember I felt instant sympatico with this pharmacist for being what I consider to be honest and forthright even though he clearly would never consider saying that to the customer. The customer would likely be insulted and infuriated by such a comment from a pharmacist. Another example: Mentioning to an obese customer the need to lose weight is a huge minefield that most pharmacists avoid at all costs.
Pharmacists May Not Reveal Their True Opinions to Customers:
Pharmacists sometimes reveal their true feelings about pills only to close friends or family, like when we go out to dinner at a restaurant and the setting is somewhat intimate. In such quiet settings, the sharing of secrets can sometimes strengthen the bond we share with people we know well.
In my experience, pharmacists are usually much more positive about pharmaceuticals in our conversations with our customers in comparison to our conversations with close friends and family.
In my opinion, pharmacists will not admit their doubts about pharmaceuticals openly for two main reasons:
1) With an oversupply of pharmacists in many areas, we don’t want to get a reputation with our district supervisor as a pharmacist who is critical of pharmaceuticals. Our district supervisor could concoct some pretext to ease us out of our job.
2) It is taxing on our psyche (cognitive dissonance) to have to admit to ourselves that, after investing so much time and money in school and in the subsequent years filling an endless river of prescriptions, we are spending our entire career engaged in an activity that (largely but not entirely) is not the best way to make people healthy.
Go with the Flow and Don’t Make Waves:
By mindlessly filling a relentless torrent of prescriptions, we are doing what our alma mater, our professional associations, our spouse, our parents, state boards of pharmacy, Big Pharma, Big Insurance, Big Chain Drug, etc. want us to do. But we are not spending our days doing what many pharmacists feel we should be doing: teaching people how to be healthy so that they won’t need so many pills.
Of course, that should be the responsibility of physicians—not pharmacists. But physicians face many of the same pressures to go with the flow that pharmacists face. Our medical system is based on a fast-food-like model of herding patients/customers. Teaching people how to be healthy and to prevent disease simply takes too much time. Insurance companies reimburse pharmacists for filling prescriptions, not for teaching people how to avoid needing so many pills.
Why Don’t Insurance Companies Push Prevention More Vigorously?
You’d think that insurance companies would favor getting people off pills, but that’s certainly not what I experienced. (Insurance companies are primarily concerned with getting people off expensive brand name drugs and switching them to cheap generics.) Perhaps if people concluded that preventing diseases to get off pills were an admirable goal, those people might also conclude that insurance coverage for prescription drugs is less necessary, a scary thought to Big Insurance.
The Profit Motive Prioritizes Treatment Rather than Prevention:
We need to remove the profit motive from our medical system by adopting national health care like most other advanced nations. Prevention would at least theoretically be given much more emphasis under national health insurance. According to Robert Lustig in his book Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine (New York: HarperCollins, 2021, p. 19), our medical system is 97.5 percent treatment and 2.5 percent prevention.
Academics and clinicians nationwide stand by both Modern Medicine and our healthcare system. They feel that investing in areas and “personalized medicine” technologies that “cure” people diagnosed with cancer, cardiovascular diseases, or neurological diseases will ultimately yield better long-term results than focusing on public health measures. This conclusion is wrong, both at the individual and societal levels, and shows at best the misconception of what the real problems are, and at worst a perverse desire of various stakeholders to maintain the status quo at the expense of both lives and dollars. We spend 97.5 percent of our healthcare budget on individual treatment, and only 2.5 percent on prevention.
Are Health Care Workers Really “Professionals”?
A definition of a professional is one who places the well-being of his/her clients above his/her own financial interests. With that definition, I think that very few health care workers could accurately describe themselves as professionals. Pharmacists, for example, spend their days doing something (filling prescriptions) that very many of us feel is not the best way to make people healthy.
Thus we may be truthful as regards what’s openly expected of us, but we are not truthful if our goal is to do what’s in the best interests of our customers. If we feel that a pile of pills is not the best thing for our customers, and we do not inform our customers of our concerns, are we truly professionals? We collect a nice paycheck for an activity that very many of us feel is not the best path to health.
Most of the prescriptions that pharmacists fill are to treat preventable diseases of modern civilization. If pharmacists are aware of that basic fact, are we being honest with ourselves and truthful to the definition of a professional if we are not doing what is in the patient’s best interest (teaching them to be healthy so they won’t need so many pills)? Our medical system pushes pills because that’s a much more financially lucrative activity than promoting disease prevention.
Many Drugs Are Essential and Even Life-saving:
Of course, there are many drugs in the pharmacy that are very important, essential, and even life-saving. That includes insulin and antibiotics. It also includes thyroid hormone for people who are hypothyroid. It includes epinephrine for people who have allergies to things like bee stings and peanuts. It includes opioid-type pain pills for moderate to severe pain. It includes naloxone for treatment of opioid overdose. It includes anti-virals which have turned HIV into a manageable condition. And there are other critical drugs.
Email I’ve Received from Skeptical Pharmacists:
For several years, I wrote commentaries for the popular pharmacy magazine Drug Topics. I often discussed issues like overmedication. I included my e-mail address with each commentary in case pharmacists cared to contact me and share their experiences. I’ve included several of those e-mails below.
Pharmacists would often state in their e-mails that I should not show or forward their e-mail to anyone else or, if I did, I should remove their name and any other identifying information. I would occasionally get e-mails and then a few hours later, I would receive a second e-mail from the same pharmacist saying something like, “I forgot to mention it but please don’t show my e-mail to anyone. Please respond so that I will know you will not share it with anyone else.”
Skeptical Pharmacist #1:
My colleagues and I have a general aversion to medications unless absolutely needed, because we know the potential side effects of these medications. It’s always a risk vs reward situation.
Skeptical Pharmacist #2:
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. We hear all the time about how the USA has the best healthcare in the world, yet now it is coming to light that we really, really DON’T, given the miserable conditions many of us live in, when healthcare costs eat up most of our assets as we age, and the end is nowhere in sight.
Skeptical Pharmacist #3:
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.
Skeptical Pharmacist #4:
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.
Skeptical Pharmacist #5:
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!
Skeptical Pharmacist #6:
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.
Skeptical Pharmacist #7:
I was privileged to work at one time for the Air Force and then for the VA, and I respect the philosophy of those organizations. Funny thing – when the facility is assuming most of the cost of the treatment (as is in most federal pharmacies), suddenly prevention of disease states becomes extremely important to the system. I witnessed the processes in place to emphasize education of the patient and encouragement of the patient to exercise more control over his/her own outcomes when possible. Of course, meds were dispensed (and lots of them), but when the focus was on behavioral management when possible, it was gratifying to see many patients take that control and make significant improvements with fewer medications. Also polypharmacy [overmedication] was more easily addressed when the pharmacist had an overview of most of the patient’s medications. No doubt in my mind that as long as the numbers (how fast and how many scripts filled) have such importance, the money will be winning out.
Skeptical Pharmacist #8:
[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.
Skeptical Pharmacist #9:
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. Maybe the new kids coming up, if they will pay attention, can change things. But first, they have to see the problem.
Skeptical Pharmacist #10:
I have not been reading much of the pharmacy magazines the past few years, due to their pro drug biases, and lack of evidence-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.
Skeptical Pharmacist #11:
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.
Skeptical Pharmacist #12:
I would love to spend time counseling all my patients on lifestyle changes. Preventative medicine is the best type and the most cost-effective. Unfortunately until pharmacists are recognized federally as healthcare providers, we cannot bill for these type of services. If we can’t bill for these services, we cannot generate revenue. Our current revenue comes from pills, so to remain employed, that is what we must do.
Skeptical Pharmacist #13:
I have always tried to live a healthy lifestyle, yet without sacrificing on things I enjoy. My motto is quality over quantity when it comes to eating. I do not smoke, drink moderately, and am still at the same weight of 100 pounds that I was when I was 22 years old.
I agree with many, if not all of the points you bring up. I too, am a pharmacist for the past 25 years, and I feel our western society is overmedicated and relies too much on prescription medicines as a solution. I really felt this way more than ever when I recently had a “western disease” of heartburn and GERD and was diagnosed with esophagitis and gastritis by endoscopy. I was prescribed Prilosec, and after 2 weeks, had very little relief and was switched to Nexium and was told to take it for 3 months to help “heal”. I was unhappy to think that I would have to take something long term like that, and after 8 weeks total of being on a PPI [proton pump inhibitor], I decided to research other options and thoroughly examine my lifestyle to see if there was anything that I myself was doing to contribute to the gastritis.
I also reached out to my older sister-in-law who lives in India to ask what methods they utilize there.
After all my research, and knowing that PPI’s do not really solve the underlying problem, I abandoned the Nexium and started multiple non-pharmacological therapies and made a few lifestyle changes. The first week after stopping the Nexium was the hardest, as the heartburn came back pretty severe. But I anticipated that, after the “channels were blocked for so long,” that opening the floodgates again would perhaps trigger a major blowout. However after a week symptoms subsided and I continued all the other measures. It wasn’t easy, but now I’m physically much better and psychologically better knowing that I am not taking a daily maintenance pill.
But I was lucky because I had the desire, drive and time to help myself. Others may not be inclined to do so.
I believe this can and should change in the future. Just like Michelle Obama’s “Let’s Move” campaign to get kids exercising, and Michael Bloomberg’s push to limit soft drink sizes, people will slowly listen and catch on. I see more and more younger people than ever before who are now interested in healthier eating.
Maybe there needs to be some sort of “decrease your number of pills” campaign!! Getting a pill-taking country like the USA on board will be difficult but it could happen.
There have to be a lot more people out there who also think like you and me. The food industry has done a lot of work getting people to understand the downside of processed foods and the public is slowly starting to listen.
People like us have to work to get the public to understand the downside of chronic prescription medicines and let them know that alternatives are out there and that we are willing to help.
I am still a practicing pharmacist; however I am willing to dispense less pills and offer more to help the public help themselves. Maybe I’m the minority, but persistence can pay off.
Skeptical Pharmacist #14:
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.
The same idea applies to people on antidepressants and anti-anxiety medications. I recall a woman who came to the pharmacy for her antidepressant medications. She was the most morbid, negative person I ever met. Once again, I felt like going over to her and saying, “You know, if you changed your attitude and outlook on life, you would not need to be taking all of these medications.” She would also have saved a lot of money and avoided all of those side effects caused by the medications.
Skeptical Pharmacist #15:
There are too many temptations in this world and people readily jump in without thought of the consequences. The key to health is healthy living and prevention. Unfortunately because the current state of the insurance industry people are taking advantage of the quick fix scheme that these same insurance companies, PBM’s included, have perpetuated.
Skeptical Pharmacist #16:
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 “pharmaco-avoidance” [avoidance of drugs] if given the chance to get to know the patient to be frank enough to offer lifestyle change advice, for instance.
Skeptical Pharmacist #17:
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.
The prescribers who, as we know, don’t have the time to connect the dots or don’t know how to interpret tests (e.g. thyroid) or know what nutrition and lifestyle changes to suggest will appreciate our efforts. So, when we think of Medication Therapy Management, instead of looking for compliance issues, adverse drug reactions, drug interactions, etc. we should, first and foremost, be thinking of how to titrate a patient off unnecessary medications, suggest lifestyle changes, advise on dietary interventions, and suggest OTC supplements (vitamins / nutrition / herbs / minerals) after we connect the dots. My 2 cents.
Skeptical Pharmacist #18:
I’ve been a practicing pharmacist now for 57 years and I am no longer shocked. The thing with hypertension and diabetes is that no matter how many times you tell them or how much guidance you provide them, they simply will not follow a balanced or safe diet. I work in a hospital, and the same people keep coming back in with elevated blood sugars. We have a diabetic counselor who works very diligently with these patients, even helping them get reduced or free insulin, and they just will not take care of themselves. We also have free cooking classes and free counseling sessions for anyone in the community who wishes to take advantage of our programs. Few do so.
Skeptical Pharmacist #19:
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.
Skeptical Pharmacist #20:
I just wanted you to know that I enjoyed reading your article, “10 Shocking Things I’ve Learned As a Pharmacist.” I wholeheartedly agree with all your points! I graduated from XXXXX in 1997 and do hospital work in XXXXX. I guess the same B.S. applies throughout the medical field and all over our fine nation. I also believe good nutrition and daily exercise with a little good old fashioned fresh air could probably cure much of what ails us and eliminate the need for many of the pharmaceuticals polluting our bodies and waterways at present. Keep writing. I think more people need to understand.
Skeptical Pharmacist #21:
I had a family approach me at the pharmacy counter. All of them were obese from father to child (which drives me crazy). Their question of which diet pill would work best for them was answered with my standard: “The over-the-counter stuff is just caffeine. It’s not worth buying.”
I was thinking: “Give me your grocery cart and I’ll help you. But you won’t like me very much!” [It was] full of junk food, no vegetables.
My irritation with work is that I’m still spending too much time with prescriptions that I shouldn’t have to, instead of doing MTM [medication therapy management] or other things that will increase health. If people knew how to eat better and move more, then there would be less hypertension, diabetes, etc.
Skeptical Pharmacist #22:
I am a pharmacist who has been with XXXXX for 17 1/2 years and was laid off in June due to my store closing (as a result of the then-pending merger with XXXXX). I saved an article you wrote in the May edition of Drug Topics titled “Pharmacy Schools Should Focus on Health Rather Than Pills.”
For many years, I have had a strong interest in natural products and supplements. The more I learned about them, increasingly I preferred them to the often-toxic medications.
Conversely, the more familiar I became with medications, the less I preferred them to natural often safer (and many times equally or more effective) alternatives, including healthy lifestyle choices.
I would be interested to know if you have any suggestions as to a career path I might pursue. I would like to be involved in holistic health care in some regard, but am not sure where I would fit in. I have contacted a couple of local wellness centers which do acupuncture, massage, and/or the like but there does not seem to be a role for a pharmacist. I would consider non-pharmacy jobs. I have been disinclined to go back to school for alternate training, but am slightly more open to the prospect now. Of course, it would be nice to find something where I could earn a decent living as well, but right now my priority is just to find something. I would appreciate any feedback you could offer.
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.