Pharmacists’ views toward the drugs they dispense span the entire spectrum from highly supportive to highly critical. Pharmacists’ views are certainly not monolithic. But, as a former pharmacist, I believe it is fair to make some generalizations about pharmacists’ views in this regard. [Dennis Miller, RPh, wrote this article and worries that some pharmacists have become cheerleaders for drugs.]
Employers vs. Employees:
It certainly makes pharmacists’ lives easier to have a positive and supportive attitude toward the drugs they dispense. If you divide pharmacists into two categories: 1) those who are employers and 2) those who are employees, it is reasonable to assume that employee pharmacists don’t want to anger their employer by being critical of the drugs they dispense.
I worked my entire career for chain drug stores. My supervisors definitely would not have allowed me to continue my employment if I developed a reputation for being critical of many of the products of the pharmaceutical industry.
Oversupply of Pharmacists:
With the rapid uncontrolled growth of private (for profit) pharmacy schools and the resultant flooding of the market with an oversupply of pharmacists, employers are much less likely to tolerate a pharmacist who sees himself as a watchdog who is critical of many of Big Pharma’s products.
Businessman or Consumer Watchdog?
Of course, pharmacists who own the drug store in which they work are free to say whatever they think about the drugs they dispense. However, in my experience, pharmacists who own the store in which they work are more likely to have the perspective of a businessman or businesswoman than a consumer watchdog. The viability of their business (the drug store) seems to take priority over a consumer watchdog role.
Detailed Discussions with Customers Slow Down the Prescription Flow:
When customers ask us about drug safety and effectiveness, it is absolutely easier for pharmacists to have a supportive attitude. Whenever we express some criticism toward a drug that a physician has prescribed, the customer rightly wants us to explain our reasons. This definitely slows down the prescription flow and causes other customers to become impatient and angry. Customers expect their pharmacist to explain things in detail, but these same customers are not eager to wait patiently while other customers ahead of them receive similarly detailed explanations.
Pharmacists do not want customers to tell their physician that the pharmacist criticized a drug that doctor prescribed. We don’t enjoy calls from angry physicians.
Dangerous and Oppressive Production Metrics:
Pharmacists working at chain drug stores are heavily burdened by oppressive and dangerous metrics which measure how quickly prescriptions are filled. A reputation for being a slow pharmacist is certainly not how chain pharmacists want their supervisor to see them.
Engaging in detailed discussions with customers about drug safety and effectiveness is extremely time-consuming. This conflicts with the heavy emphasis placed by chain corporate management on pharmacists’ speed in filling prescriptions.
Corporate Management’s Immoral Business Model Based on Understaffing:
Chain corporate management seems to have made the cold calculation that it is more profitable for pharmacists to fill prescriptions at lightning speed and then compensate any customers harmed by the inevitable pharmacy mistakes. Chain pharmacists’ most common complaint is that their employer has chosen an immoral business model based on understaffing. Understaffing increases profits because it forces all employees to work their entire shift at maximum speed. The result is an epidemic of pharmacy mistakes and inadequate time for pharmacists to answer customers’ questions with the detail that these questions deserve.
Thus prescription flow is expedited by short, positive, reassuring answers from pharmacists when customers ask us about drug safety. Being a cheerleader for drugs speeds up the prescription flow, whereas being a consumer watchdog who expresses skepticism about some drugs slows down that flow.
Conflict Within the Pharmacist’s Psyche:
Pharmacists who harbor doubts about many of the drugs they dispense are likely to suffer a conflict deep within their psyche as they battle 1) their need to be supportive towards the drugs they dispense and 2) their awareness that the benefit-to-risk ratio with many drugs is controversial.
For example, I suspect that many pharmacists are uncomfortable when customers ask us about muscle pain and weakness from statins, or serious tendon damage from fluoroquinolone antibiotics, or the growing list of troubling side effects from proton pump inhibitors, or whether generic drugs manufactured in countries like India and China are as good as brand name drugs.
Pharmacists are well aware of news stories in the mass media about the outrageous prices for prescription drugs. Consider, for example, the tens or hundreds of thousands of dollars for anti-cancer drugs that are still under patent.
Because the treatment of cancer is a gold mine, Big Pharma does not want you to know that 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.”
In my opinion, too many pharmacists have accepted Pharma’s claim that big profits are necessary to fund medical research (even though that research is too often geared to producing me-too or copycat drugs rather than true innovations). Many pharmacists do not know or care that the USA has the highest prescription prices in the world.
Pharmacists Are Attracted to a Nice Paycheck More Than a Consumer Watchdog Role:
Many pharmacists went to pharmacy school because they had heard that pharmacists receive a nice paycheck. In my experience, students do not go to pharmacy school with visions of becoming a strong consumer watchdog who protects the public from unsafe, ineffective or outrageously overpriced pharmaceuticals, or from overprescribing, overmedication and unnecessary prescribing.
Prescription Drug Advertisements on TV Are a Circus:
Pharmacists are certainly aware of the circus which is the advertising of prescription drugs on television. Many pharmacists view these advertisements as an insult to our intelligence and feel that these advertisements cause people to ask their physicians to prescribe drugs that may be unnecessary, inappropriate for the condition being treated, or for which there may be cheaper alternatives that would work as well or better.
The FDA Does a Poor Job Protecting the Public Safety:
Some pharmacists are well-aware of the fact that the pharmaceutical industry routinely exaggerates the benefits of drugs and downplays their risks. And many pharmacists feel that the Food and Drug Administration is doing a very poor job in protecting the public from unsafe and ineffective drugs.
For example, where were the FDA and the Drug Enforcement Administration (DEA) when the narcotic OxyContin was massively marketed as being less addictive than was widely perceived. The company that owns OxyContin seemed to be quite willing to downplay the extremely addictive potential of this drug in order to increase sales into the billions of dollars.
Price Gouging for Drugs with Few Competitors:
Some pharmacists feel that the pharmaceutical industry is deeply immoral. For example, drug companies like to identify products that are made by very few companies (sometimes because manufacturing such drugs is complex), and then jack up the price of those drugs to astronomical levels.
Outrageous Price Increases for Life-Saving Drug for Bee Stings, Peanut Allergies, etc.
Due to its manufacturing complexity, for many years only one company made epinephrine auto-injection. This is a drug that people self-inject for potentially life-threatening allergic reactions to things like bee stings, peanuts, etc. The sole manufacturer of this drug decided to exploit its exclusive market position by raising the price through the roof.
Sky-High Price Increases for Insulin:
A similar situation exists with insulin. Insulin is a life-saving drug. People with type 1 diabetes would die without insulin. Due to its manufacturing complexity, there are only three insulin manufacturers serving the U.S. market: Eli Lilly, Novo Nordisk, and Sanofi. In my opinion these companies exploited their market position by raising the price of this life-saving drug to outrageous levels.
Is Big Pharma a Benevolent Enterprise–or as Ruthless as Any Other Industry?
In my opinion if you view the pharmaceutical industry as a benevolent enterprise that works tirelessly for the health of the public, you are sorely mistaken. The drug industry is just as ruthlessly obsessed with profits as any other industry. In my opinion, companies that engage in extreme price-gouging for life-saving drugs which have few competitors are the definition of unscrupulous and perhaps even evil.
Pharma’s Endless Deceptions:
Pharmacists are aware of the endless games that the pharmaceutical industry plays through deceptive drug advertising, through developing me-too drugs, through being slow to report adverse drug effects to the Food and Drug Administration, through pushing pills rather than prevention, through scaring people to take pills rather than motivating them to change their diet and lifestyle in an effort to decrease the number of pills they need.
In my opinion, the biggest criticisms of the drug industry are that it exaggerates the benefits and downplays the risks of pharmaceuticals, that it grossly overcharges for its products, and that it does not emphasize that most of the prescriptions pharmacists fill are for preventable diseases of modern civilization. This includes extremely common conditions such as elevated blood pressure, elevated cholesterol and elevated blood sugar (in type 2 diabetes). Can anyone seriously deny that prevention is better than pills?
Even though pharmacists are aware of the games that Big Pharma plays to get people to take more pills and in order to increase the price of those pills, and even though these pharmacists often seem to tell themselves that the morals of Big Pharma are highly questionable, some pharmacists nevertheless seem to believe that the drug companies invariably produce safe, effective and necessary drugs.
In my opinion, an industry that engages in endless games, deceptions and lies to increase drug use and profits cannot be assumed to be marketing safe and effective drugs. If a pharmacist views the marketing as suspect, he/she should also consider the likely prospect that many of the drugs are also suspect.
Pharmacy Magazines Fear Angering Advertisers with Articles Critical of Drugs:
In my opinion, one of the biggest influences on pharmacists’ views toward pharmaceuticals is the largest circulation pharmacy magazines like Drug Topics, Pharmacy Times and US Pharmacist. From my experience in reading these magazines for decades, readers are far more likely to find articles critical of drugs in non-medical publications like The New York Times, Wall Street Journal, and BusinessWeek and on TV with Sixty Minutes.
I don’t know whether pharmacists realize the extent to which the content of pharmacy magazines is tailored to avoid alienating advertisers. By far the largest category of advertisers in the major pharmacy magazines is the pharmaceutical industry. Clearly the major pharmacy magazines do not want to be viewed as critical of drugs because that would absolutely discourage the pharmaceutical companies from advertising in those magazines.
I believe that pharmacists have become cheerleaders for drugs in significant part because the overwhelming theme in pharmacy magazines is that pharmaceuticals are great, and that the risk vs benefit assessment falls squarely in the category of beneficial. A pharmacist who reads the major pharmacy magazines sees far more articles stating, for example, that Drug X is beneficial in the treatment of Disease Y―that is, in comparison to articles describing the drawbacks and adverse effects associated with Drug X.
I suspect that the public is surprised that a pharmacist would state that The New York Times, Wall Street Journal, BusinessWeek and Sixty Minutes are far more likely to publish stories critical of pharmaceuticals in comparison to the major pharmacy magazines. I believe that if the major pharmacy magazines had a comparable willingness to publish stories critical of pharmaceuticals, pharmacists’ attitudes toward the drugs we dispense would be significantly less positive or at least more balanced.
Because the major pharmacy magazines are usually distributed for free to pharmacists, these pharmacy magazines are far more dependent on advertising revenue than publications that charge for subscriptions or access to their website.
Have Pharmacists Swallowed Pharma’s Kool Aid?
In my opinion, it takes a heavy toll on the pharmacist’s psyche to acknowledge that many of the products we dispense come from an industry that is highly suspect if not largely corrupt. To decrease this psychological conflict and to please our employers, pharmacists willingly dispense drugs they often would not take themselves, while simultaneously remaining silent about their personal doubts about drug safety and effectiveness.
Thus, too many pharmacists have decided to become cheerleaders for the drugs they dispense. Too many pharmacists seem to have swallowed the Kool-Aid in order to perform their job. Even though many drugs that pharmacists dispense are effective and even life-saving, too many other drugs are far from that. You probably won’t hear that from your pharmacist.
A Postscript to Dennis Miller’s Article:
Dennis is a retired pharmacist. He wrote the above article a few years ago. We just received this message from a reader. It reinforces his warning that too many pharmacists have become cheerleaders for drugs:
Q. My husband takes several prescription medicines for his health issues. He also has type 2 diabetes, controlled with diet.
Yesterday our pharmacist called and suggested he take a cholesterol-lowering medication to help prevent heart problems. She even offered to call his primary care physician to speak about it.
He told her he had been on statins previously but discontinued them several years ago because of side effects. That ended the conversation.
Are you familiar with this type of phone call? It left me wondering if she were a conscientious pharmacist or an employee marketing drugs. I’d appreciate your thoughts since this has never happened before.
A. Guidelines push physicians to prescribe statins to virtually every man over the age of 63. They are also supposed to prescribe statins to people with type 2 diabetes, even though such drugs may raise blood sugar.
Health care organizations are encouraging pharmacists to contact patients directly (Pharmacy, Feb. 2022).
That might explain the call. We think it is a sad commentary on the profession, though.
We welcome pharmacist feedback. Do you feel some of your colleagues have become cheerleaders for drugs? Do you think that is a positive or negative trend? Please share your comments below.
