People have been living on earth for about 250,000 years. For the past 5,000 healers have been trying to heal the sick. For all but the past 200, they haven’t been very good at it.
– Dr. Paul Offit
Twenty years is a long time in medicine. I celebrated my 20th pharmacy class reunion last weekend. Of course reunions are time to reflect back to our early years as pharmacists. Lots has changed. Much of the therapeutics I was taught is now obsolete. In 1993, HIV was a death sentence and there were only three, largely ineffective drugs available. Thanks to new drugs, HIV can now be managed like a chronic disease, and some of my colleagues have HIV-focused pharmacy practices. The same dramatic changes have occurred in fields like cancer and transplant medicine. And in some cases, the cause of disease has become more clear – my old textbooks make no mention of Helicobacter pylori as a cause of ulcers.
The practice of pharmacy has changed, too. On the positive side, pharmacists are working in new settings where they can focus on medication management, and not just dispensing prescriptions. Regulators are granting pharmacists the ability to take on new roles, and pharmacists are being compensated for more than simply “count, pour, lick and stick.” From that perspective, it’s a promising time to be a pharmacist. But there’s a much more disturbing side to the profession that’s emerging, too. Community (retail) pharmacy practice is under pricing and competitive pressure, and smaller pharmacies are being subsumed into big retailers where the pharmacy department is buried in the back – a loss leader to bring in patients, but hardly with a health-care focus. And most disturbingly, I see a move within retail pharmacy practice to leverage its professional credibility to sell all types of modern-day snake oil, ranging from detox kits and “cleanses” to dubious “food intolerance” testing. Homeopathic remedies (an elaborate placebo system of sugar pills) are increasingly found on pharmacy shelves, alongside real medicine. And don’t forget the enormous wall of vitamins that seems to get larger and larger. Yes, complementary and alternative medicine is booming, and pharmacy wants its share. Pharmacy regulators turn a blind eye. What do my pharmacy colleagues tell me? They’ll tell me it’s customer demand, and that they don’t recommend the quackery. To me, I see this trend as damaging the credibility of pharmacists in the eyes of the public and of other health professionals. (more…)