The People's Perspective on Medicine

Why Are So Many Pharmacists Disillusioned?

Top Ten Reasons Pharmacists Are Disillusioned and Why You Should Care by Dennis Miller, R.Ph.

Most pharmacists receive a nice paycheck, so any claim that they are disillusioned is unlikely to garner much sympathy. But understanding the reasons why pharmacists are disillusioned may help you to better comprehend the world of pills and, more importantly, help you avoid harm.

As a result of my commentaries in the popular pharmacists’ magazine Drug Topics over the last 18 years, I’ve received a huge number of e-mails from pharmacists saying that they’d leave the profession tomorrow if they could find-or were capable of doing-anything else that pays as well. Many pharmacists are not recommending that their children major in pharmacy in college.

Why are so many pharmacists disheartened?

1. Our health care system has so little to do with health.

Many pharmacists have sent me e-mails bemoaning the fact that our health care system has little obvious relationship to health. In my opinion, if you were to ask a large number of pharmacists what is the best way to improve the health of their customers, the vast majority would NOT say something like: increase access to drugs, expand the utilization of drugs, improve the prescribing of drugs, decrease the cost of drugs, expedite the approval of new drugs, spur the development of new drugs, etc. Instead, I believe the vast majority of pharmacists would say something like: If people would just eat better, lose weight and, in general, take better care of themselves, they wouldn’t need to take so many pills.

This e-mail is typical of many I’ve received from disillusioned pharmacists:

I 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 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.”

Many pharmacists are disillusioned feeling that what they do every day at work is not the best way to make people healthy. Many pharmacists believe that pills are not necessarily the best road to health, and that major changes in our customers’ diet and lifestyles would be more effective than pills. Consequently, spending our days slinging out prescriptions at warp speed is deeply unfulfilling and contrary to the reasons we became pharmacists.

Even though many (perhaps most) pharmacists would place non-drug measures at the top of their list of the most important things for people to do to improve their health, our medical system essentially gives only lip service to non-drug measures. This quick-fix pill-for-every-ill orientation of our heath care system is unrealistic but profitable. Disease prevention gets so little attention because there’s no money in prevention.

Take cancer, for example. Why does our health care system give priority to treating cancer rather than preventing it? 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.” Yet there is little attention to helping people change their diets or exposures before they are diagnosed with colorectal cancer or melanoma.

2. Pharmacy schools misrepresent the real world.

In my opinion, a big reason for pharmacists’ cynicism is the yawning gap between our expectations from pharmacy school and our subsequent experiences in the real world. Many pharmacists have told me that they’d like to initiate a class action lawsuit against this nation’s pharmacy schools for misrepresenting what this profession is like in the real world.

Pharmacy students are taught to be drug experts who advise the public about the proper use of medications. The problem is that, in the real world, the big chains are interested only in activities that are financially lucrative. Counseling customers on appropriate drug use is not reimbursed, so it is not valued. Many pharmacists feel that the only thing that the big chains care about is how fast they fill prescriptions. These employers view patient counseling about medications primarily as a drag on productivity.

The schools of pharmacy teach a mechanistic and reductionist view of health that removes Homo sapiens from any connection to the natural world. According to this model, health is directly proportional to the per capita consumption of pharmaceuticals. The infinite number of social, cultural, political, psychological, economic, environmental, nutritional/dietary and lifestyle factors in the causation of human disease are essentially ignored in favor of a remarkably narrow molecular and cellular focus.

3. Pharmacies are systematically understaffed.

Pharmacists are disillusioned because their employers have chosen a business model based on understaffing. Understaffing increases profitability by forcing everyone to work at maximum output, but this business model has many adverse consequences.

Understaffing means that pharmacists don’t have time to call physicians as often as we should to clarify questionable doses, inappropriate directions, poorly legible handwriting, and potential drug interactions. Understaffing means that pharmacists very often don’t have time to answer customers’ questions as thoroughly as we would like. Understaffing means that prescriptions are just a blur on an assembly line. The consequences are that there are far too many pharmacy mistakes and that too many patients/customers are poorly informed about the medications they take.

4. Pharmacy mistakes are common.

Pharmacy mistakes are shockingly common in chain drug stores today. This will continue until the costs of settlements for harm caused by pharmacy mistakes exceeds the cost of adequate staffing in the pharmacy.

At this point, it seems that big chains have made the cold calculation that it is more profitable to have pharmacists sling out prescriptions at lightning speed and compensate customers who discover they have been harmed by pharmacy mistakes than to provide adequate staffing so that prescriptions can be filled safely and double-checked as they should be.

The sad reality is that adequate staffing hurts the chains’ bottom line. It is more profitable to understaff pharmacies and require all employees (pharmacists and techs) to work at breakneck pace even though this inevitably contributes to mistakes.

5. State boards of pharmacy are unresponsive.

The widespread occurrence of pharmacy mistakes has been one of the hottest topics in pharmacy magazines for many years. Many pharmacists feel that state boards of pharmacy are failing miserably in their duty to protect the public safety. As one example, the state boards of pharmacy should mandate adequate drug store staffing so that prescriptions can be filled safely.

Pharmacists are disillusioned because the state boards of pharmacy seem to be intimidated by the immense legal and political clout of the mighty chain drug stores. The big pharmacy chains are not shy about lobbying state legislatures to override any regulation that state boards of pharmacy champion for adequate staffing levels.

Consequently, state boards of pharmacy pass the buck by claiming that staffing levels are an employer/employee issue that should be left to the private sector. In contrast, pharmacists feel passionately that staffing levels are a public safety issue that desperately needs board of pharmacy intervention.

6. Industrial production metrics are used to assess pharmacists’ performance.

Chain drug stores use industrial production metrics to evaluate pharmacists rather than metrics based on improvements in human health. The big chains use metrics such as how much time it takes to finish a prescription once it’s entered into the pharmacy computer, the number of prescriptions filled per hour, and the staffing levels utilized in the process.

Pharmacists would laugh at the assertion that the big chains actually care about the health of our customers. For example, the big chains do not have any metrics to evaluate pharmacists based on things like how often we call physicians to clarify potential problems with prescriptions.

7. Customers are impatient.

Pharmacy customers make things worse by judging their pharmacists based solely on how rapidly they fill prescriptions. Customers are very impatient and usually don’t seem to realize the importance of pharmacists phoning prescribers to clear up anything that is questionable. They may say things like: “I dropped off my prescriptions before going to the grocery store and expected them to be ready when I returned. I have ice cream sitting in my car. What’s the problem?”

Pharmacists would like customers to have enough insight to realize the importance of our checking with physicians about potential drug interactions, inappropriate or unclear directions, contraindications, drug allergies, unusually high or low doses, therapy duplication, etc. Unfortunately, the customers also fail to recognize the value of medication counseling. As a result, pharmacists and patients may never have the opportunity to develop a personal relationship and build trust.

8. Arrogant and unappreciative physicians complicate the pharmacists’ job.

Physicians are often ungrateful and rude when pharmacists make calls about prescription questions. Too many physicians seem to view our calls as nuisances, rather than as pharmacists’ efforts to protect customers and to prevent liability in the event that a customer suffers harm. Having to play telephone tag or wait on a return call that never comes can interfere with “productivity” as well as delay the delivery of a prescription to the customer.

9. The American Pharmacists Association has abdicated responsibility.

Many pharmacists have tremendous disdain for our leading professional organization, the American Pharmacists Association. Pharmacists are disgusted that APhA has never made issues like safe staffing levels and better working conditions (meal and bathroom breaks, etc.) a priority. APhA has been inexplicably and inexcusably missing in action in this critical fight.

10. The Food and Drug Administration has not exercised appropriate judgment.

Many pharmacists perceive the FDA as too willing to approve drugs that clearly don’t meet the layman’s definition of “safe and effective.” In addition, many pharmacists are disillusioned that the FDA allows direct-to-consumer drug advertising. They feel that these advertisements pressure physicians to prescribe medications that are often unnecessary. Only the USA and New Zealand allow direct-to-consumer advertising of prescription drugs.

Why Should You Care?

The fact that pharmacists are disillusioned is a symptom of our sick health care system. The big chain drug stores have chosen understaffing as a profitable business model. Why should you care? Because understaffing absolutely increases the frequency of pharmacy mistakes. Many pharmacy mistakes have little impact on your health. On the other hand, some pharmacy mistakes are deadly.

Pharmacists are disillusioned because Big Pharma lobbies Congress to pressure the Food and Drug Administration to expedite drug approvals. Easing up on approval standards can result in drugs that are unsafe, barely effective, or even counterproductive.

Drugs are heavily advertised on television with the goal to convince you to ask your physician whether “Drug X” is right for you. Too often these wonder drugs are little more than copycats of existing drugs. An older drug or a non-drug approach might actually be superior, but how would you know?

Pharmacists are disillusioned because our health care system gives only lip service to the prevention of disease. Many believe that lifestyle changes and a diet of whole (unprocessed) foods can very often be a better approach than pills. Instead, however, business pressures conspire to promote drug use instead.

This is why I believe that the underlying reasons for pharmacists’ disillusionment have a very real and direct impact on your health and safety.

About the Author:

The author, Dennis Miller, is a retired chain store pharmacist living in Delray Beach, Florida. He welcomes feedback at dmiller1952@aol.com. You can also post a comment below.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Government run health care is not a perfect answer, but this isn’t utopia. It is the best system on earth right now because it eliminates the greed factor by eliminating big business. There should not be a profit in healthcare. Insurance companies should not be involved. Drs should be salaried government employees. Drug companies would not be allowed to advertise publicly.
Visit a not poor country that has National Health care and see for your self how much better care those citizens receive. Our hospitals have become shameful conglomerates, gobbling each other up along with every private medical practice in town. Big business totally controls health care; FDA; University medical schools,; drugs.; and the worst,Our
Congressmen!! I worked 47 years in Health care. So glad I retired 12 years ago before it became unbearable.

as a retired doctor, I agree totally with this essay. “A pill for every ill” I have spoken many times. A quick fix. No effort on patient’s part. An industry driven by profits. The medical-industrial complex makes the military-industrial complex look like small potatoes. Congressmen beholden to wealthy men and corporations for the millions needed for elections. A “moneyocracy”. Not much chance they will stand up to their donors to make needed corrections. Sad.

I agree wholeheartedly with this article. I have changed drug stores several times because the pharmacist seemed unconcerned about the prescriptions I was given. Also, I have seen things like my name spelled wrong and yellow stickers with info that was unreadable because of poor printing or smudged print. At my present pharmacy, I had to tell them about 6 times to stop putting my meds in hard to open bottles because I can’t open them. A lot of doctors are mere pill pushers and seem to have a goal of giving you as many pills as you can tolerate. By all appearances it isn’t about your health and certainly not about how you feel.

Thank you for an eye-opening article. Many of the commenters stated situations that I had guessed at. I, too, believe that it is not in the best interests of the health care industry for people to be well because that would reduce the profit. Consequently, I have sought alternative health care, gotten off of pharmaceutical medications, and improved my health. Was my allopathic doctor happy that I wan’t taking any prescription medicaitons? No. She wanted to prescribe something for me even before she examined me. She happily showed me that she didn’t even have to write a prescription because now she could send it to the pharmacy through her computer. That meant I wouldn’t have time to look up the side effects (some of which include “death”) before I got the prescription filled. That scared me so I haven’t been back to that doctor in over two years. I no longer trust allopathic doctors. I am sorry that the helpful pharmacists of the past are just that – part of the past.

Absolutely true. All of the comments I’ve read so far are right on. I’m 70 now, and on Medicare. I have complained to everyone I can in the medical health industry (Doctors, nurses, surgeons, Blue Shield 65 Plus (HMO), Scripps San Diego, blah, blah, blah. All they want to do is push drugs and surgeries that are not necessary. They should do a cartoon showing the entire medical corporate industry parroting, “We’ve got a pill for that!” It’s just insane greed.
The only one that I still trust are most pharmacists. Even then, it’s usually about the drug interactions concerns I may have.
Life style changes and organic, homegrown foods, minimal processing, cook it yourself, get off every drug you have been prescribed as soon as you can and stay away from teaching hospitals

Pharmacists are not the only disillusioned healthcare workers, most are! Inadequate staffing is the root of most mistakes made against patients, as is the lack of practical face-to-face human experience for care givers. The public is not aware of the type of education required from any provider, and it is nearly impossible to tell one from another. More years in college does not make a better bedside RN. Pharmacists could be an excellent resource for patients if they were allowed to practice as many were taught. We the public also need to be more responsible for our own heath status- quit being so lazy, there is no pill that cures everything!

To the pharmacist I say , “Welcome to my world!” I’m a retired nursing professor and went from absolutely loving all my patient contact in the 70’s to hating it by the time I left patient care years later. I loved patient care and hated health care systems. Time was spent getting prior authorizations and paperwork almost to the exclusion of patient care.

Our healthcare system has been hijacked by big business and politics. I, for one, have always respected pharmacists far more than physicians, with good reason. And, the truth be told, I’m sure that physicians have also been overworked and bullied into submission to the conglomerates that control our health care systems in the world. There is good reason why the quality of healthcare in our country has declined so much. My personal take is that this will continue to be the problem until such time as there is political will to nationalize our healthcare system and take profit out of the equation.

a very sad state of affairs. I think the suggestion for pharmacists to unionize is a great solution, but in our current political environment, highly unlikely.

My son graduated from UNC School of Pharmacy in 2006. Fortunately for him, he realized that retail pharmacy wasn’t for him. He completed a 2-year fellowship in neonatal pharmacy. Now an expert in his field, he loves his job and frequently presents at conferences across the country. There’s more to pharmacy than retail, but one has to be willing to delay gratification and accept a small salary while doing an additional residency/fellowship.

An acquaintance of mine is a Pharmacist working for a big chain. He is considering retiring in part due to the new requirement that the Pharmacists also give vaccinations. He doesn’t feel that he has the time to devote to giving an injection and then observing that person to make sure there are no adverse reactions. They are supposed to be doing this in addition to filling a large number of prescriptions quickly. He believes that this is a recipe for disaster.

Pharmacists are a god send…..Took a RX to Publix Pharmacy for CIPRO. As my son and I waited the pharmacist said “she cannot fill it as it is contrary to my husbands other meds”. She called the ER MD who prescribed the medicine (after I had given the MD a list of my husband meds) and his reply was, “fill it anyway”. The pharmacist REFUSED to fill it and told us to call/see our MD the next day, Monday.
We thought this pharmacist went above and beyond for our protection. That’s what I call a GOOD, RESPONSIBLE and CARING PHARMACIST!!!

Before we leap to criticize some person in the line at the pharmacy who is overweight and assume that their problem would be resolved with lifestyle and dietary changes, let’s keep in mind that some very necessary drugs, such as anti-psychotics, can cause weight gain. Lifestyle and dietary changes will not cure schizophrenia.

Thank you for this conversation … I think pharmacists are a very underused source of information on medications for the patient. Such a waste, and drug stores are to blame.

thank you for this. i wish more people in the “health” business would speak out and that our governments would take more interest in these issues.

Thank you for this well thought out message. I fully understand your concerns.

Dennis McKinley

Well said! I learned a long time ago to take my health into my own hands – educating myself, putting myself on an elimination diet to solve my GI problems, using The People’s Pharmacy info to help me get off Prilosec, and finally becoming a vegan and getting off all medications. But I am a retired science teacher with an interest in health topics. So many people think we have a great health system and totally trust their doctors and all the ads on TV. We need the media to expose the truth and the government to stop caving into the lobbyists and truly represent the people.

This is something that I have begun to realize after my cancer diagnosis nearly a year ago.

I read a lot and realized that a whole food plant based diet (no animal products at all) is the best medicine. Perhaps some pharmacists enter the profession because of the pay, but I think many young people entering pharmacy may be doing so out of a desire to have a professional career helping people. I understand the disillusion they later experience, but isn’t it a natural outcome for an ethical person who gets involved in our profit driven medical system. Very sad.

Years ago I worked as a tech for two pharmacies –in NJ and FL. It amazes me that doctors “look down on” pharmacists. Very often we’d get calls from doctors asking the pharmacists what drug they’d recommend. Pharmacists have great respect for doctors and bend over backwards to please them, even when doctors make major mistakes writing Rx’s. Most pharmacists are super-intelligent. They can give excellent advice. One even saved my life when a doctor made a mistake with my Rx.

This article has been an eye opener I have noticed the hectic pace that pharmacist are expected
to work under.

My brother graduated from Temple University School of Pharmacy and spent two more years getting his MS in biological chemistry. He loved helping people more than being in the lab and developed many respected and happy relationships with his customers at a small town pharmacy in Connecticut in the mid-60’s and ’70’s.

As the chain stores gobbled up the independent pharmacies, he struggled with what was best for financial security for raising his family and keeping his head above water. Eventually, he left the consultation counter at the small town independent drug store and took a job stocking the inventory at new chain stores and he knew something was gone forever. But he invested in stock with his new employer, now corporate.

He died rich, but not happy, with the exception of travel and fishing and family and social friendships during his retirement years. He was a brilliant, funny, kind man.

I am sure he would not have chosen pharmacy all over again for satisfying life work. It pretty much took the stuffings out of him as it was practiced in corporate settings.

A foot note is that when he was a teenager, he got a delivery job with our local independent drug store and the two pharmacist brothers there took an interest in guiding him to go to pharmacy school and talking to my parents about his clear abilities in chemistry and in getting along with people.

Thanks for this opportunity to pay tribute to my brother, who died of leukemia over two years ago. And thanks for this honest assessment of the drug industry and its impact on peoples lives, both pharmacists and those they wish to help.

You left out a critical point…..Pharmacists are not unionized. We need to stop being such a passive profession and get assertive. We should form associations (state level pharmacy associations are nonexistent) and march against the poor treatment of Pharmacists across board…… in hospitals too.

We should demand to be treated like the highly educated professionals we are. In my observation most of us are so passive and only care about that meager (yes I said meager) pay check we get from our employers. Where I live a pharmacist $100,000 salary is considered mid level income. We should demand reimbursement for all drug interventions we do, counseling, etc etc

I would like to thank LEM in Florida for his wonderful story about a time when we as patients could trust the doctors and the pharmacists. Now it is so different and we do need to think about our profit driven medical system including how much pressure is put on pharmacists. Also, his brother sounds like a remarkable person.

As a member of the public I would like to know what the best tactics for us, the great masses out there, are. What can we do to push needed change?
Catherine’s comment suggests practical individual action, good. But surely there’s more. letter campaign to big chains? Boycott one if it’s worse than the others (improbable)? What?

Thank you Peoples Pharmacy for another excellent article.

People need to realize that pharmacists can, and do, make mistakes. Be certain you know the name of the medicine your physician prescribes and the reason why.

I do not currently take any medicine–except for a medicated polish I brush on my toenails. However, in the past, I was once prescribed medicine for high cholesterol which I never had. I immediately saw a new physician and lab tests confirmed that my cholesterol levels were excellent without medication.

We have to educate ourselves about our medical histories. Physicians also make mistakes. We can help pharmacists and physicians to help us, as patients, by being informed consumers of medicine and medical care in general.–Rachel

This assessment is absolutely correct. I left pharmacy practice in 2006 after 30 years in retail. I make less than half of what I made 11 years ago, but am far happier now. I absolutely do not miss retail practice. It’s a meat grinder and is bad for a person’s physical and mental health. I have come to the point that I question the benefits of pharmaceuticals. While no doubt many may be beneficial when used correctly, many have equally detrimental side effects.

This is one of the main reasons I get your newsletter. That’s a fantastic article, although discouraging at the same time. I, too, believe we are way over medicated, and seeing the line of people waiting for their various drugs, who obviously aren’t taking care of themselves in the first place, is discouraging.

I’ve been amazed at how easily some doctors prescribe medications, especially for depression! I’ve had two doctors from internal medicine (now called “adult” medicine at our clinic) prescribe antidepressants to me without blinking an eye. The side effects were horrible, so I quit taking them right away, even though I was encouraged to continue.

It’s too bad customers don’t have a better awareness of the purpose of a pharmacist. And it’s too bad that doctors aren’t more willing to work with them.

When it comes to healthcare, we really have a problem with helping individuals take care of themselves as a first defense. I just turned 65, and I’m amazed at how people let themselves go. They stopped exercising and eat way too much junk food. Recently I talked to a young man (early 40s?) who was having stomach problems and thinks he’s allergic to onions. He drinks an average of 8 glasses of milk a day AND a lot of diet Mountain Dew. My guess is that’s what’s causing his problem, but he’s not even willing to change his diet. And WHY should my insurance premiums keep rising to support this kind of self-destructive behavior?

Pharmacists are now just hired guns for the multiple-store-owning-chains or mail order. When I obtained my degree 50 years ago I had no idea I would be working on an assembly line.

In my first job I knew all our patients and they knew me by name. I made trips to the store after hours and delivered medicines to their homes.

The question now is not how much you helped a customer but rather how many Rxs were filled or rather rubber stamped after being filled by a tech. Does one even know “their” pharmacist much less calling him after hours.

Fortunately I left the retail pharmacy business and spent the next 30 + years working in industry. Would I study pharmacy again? No.

Interesting & revealing article. Many of the pharmacists concerns are strikingly similar to those of teachers who discover that the way things work in school systems and what they are prepared for in teacher ed programs are very different

This is a real eye opener. I realize Peoples Pharmacy has gone out on a limb to publish this. Bravo. The entire healthcare system is out of control. We all understand the problems but solutions are complicated.

I have very rarely needed medications. When I did, knowing that the bottle came with a list of potential unintended effects, I just thanked the pharmacist and paid. If I again need any medication from a pharmacy, I will try to make the pharmacist feel a little better by asking him or her if he/she has any advice and recommendation; of course, having chosen a time when the pharmacy does not have a line of waiting customers. Asking a pharmacist for advice before going to a doctor also seems more fulfilling of the pharmacist’s ideals; but are they allowed to give advice before a doctor’s visit?

It’s a little naive for pharmacists to think they’re going to change the world. This society of our’s is off the rails regarding eating right, etc. and no pharmacist is going to come out from behind the case and consult about living healthier life styles. Just look around.
Why would the ‘disillusioned’ not investigate this profession prior to majoring in pharmacy?? It’s a hard job and the old thought of “owning my own store” is even a tougher job.

I have worked in health care for over 45 years and have seen the tremendous change from human service to profiteering. I did not even imagine such a change when I chose my career and I too would not recommend this to my children.

As Lewis Black explained last week on the Daily Show our country (referring to our medical/industrial/governmental complex) decided to turn poor health into a gold mine. None of them truly want to prevent illness; that would put them out of business.

Medical screening centers are mostly just another profit center. No, a pharmacist is not able to teach healthy life style but they can certainly observe and write about the problem, along with many others.

As a health educator, I have found it very hard to help people find and afford healthy foods in a world of processed food industries, toxic agriculture, industrial polluters, government agencies on the take, who are worse profiteers than the medical industry. This is our major social problem that we all need to look at. Criticizing one person who writes about his experience is not helpful. RN, MS

Bravo! Is there a solution?

I was a pharmacist, graduated in 1981 after the required 5 years of school. Truth of the matter is, the college education I received was the best pharmacy experience I had, especially my internship working at a well run, well staffed independent drug store.

Ten years after graduating the profession had changed much more than I ever expected. Computers came into use, allowing quicker processing, and therefore higher workloads. In addition, Third Party Payers went from 30% at that independent, to over 90% when I left the profession in 2006.

I became a glorified insurance agent, fixing all sorts of prescription coverage issues for customers. In addition, although the state I worked in mandated counseling on all prescriptions, including refills, there was no practical way to accomplish that. All the research in the world would not have made any difference.

These conditions have evolved over time, and have been brought about by insurance and chain drugstores. Insurance has insulated pharmaceutical manufacturers from the pricing pressures competition would allow, so they charge outrageous amounts for their products.

I am a psychologist who has served many consumers in group homes. What I have seen is the consistent prescription of psychoactive medications in inappropriate combinations that place consumers at risk for significant reactions. I am guessing that pharmacists see this often. They know who is responsible, but cannot do a darn thing about it.

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