A Pharmacist’s Personal History:
From an early age, I wasn’t eager to take pills:
As a child and into my teen years, I was never happy or eager to take pills. At some primal level, it never made sense to me. I seemed to feel intuitively that health depends primarily on what one eats, one’s lifestyle, one’s weight, etc., not on what pills one takes.
I went to pharmacy school primarily because pharmacists were known to be paid well, not because of any great humanitarian impulse on my part. I decided to at least temporarily suspend my view of pills, give pills the benefit of the doubt, and enter pharmacy school with an open mind. Perhaps, given the prestige of health professionals and modern medicine in our society, pills are far more important to health than I perceived.
I was unable to fully understand the reasons why I was so unhappy in pharmacy school:
Even though I was unable to fully understand the reasons for my unhappiness during pharmacy school, I later realized that it was the very mechanistic and reductionist approach to health at the molecular and cellular levels that made me so uneasy. This approach in pharmacy school completely ignored the whole person and the wider society, culture, and environment. I did not realize it at that time but clearly this focus benefits Pharma, not people. Pharmacy school was about disease, not health. I never became comfortable with the pill-centric or pill-obsessed culture in pharmacy school.
Many drugs are essential and even lifesaving:
Let me state clearly that there are many drugs in the pharmacy that are essential and even lifesaving. That includes insulin, antibiotics, morphine and other opioids for pain, epinephrine for allergic reactions to things like bee stings and peanuts, antivirals for HIV and hepatitis-C, naloxone for opioid overdose, thyroid supplements for hypothyroidism, and others.
But the number of truly miraculous drugs is far less than you assume, and far less than Pharma marketing wants you to believe.
White coats: Look at me. I deserve respect because I’m a health professional:
I was in pharmacy school in the 1970s. The sight of all the pharmacy students, medical students, and dental students walking around in their white coats was quite impressive and somewhat intimidating. Surely all these students must be people of great empathy, integrity, and compassion engaged in the serious pursuit of knowledge that would allow them to slay human disease and end suffering. Surely my preconceived ideas were all wrong. Surely a health care system based so heavily on pills must be better than a health care system based on nutrition, exercise, lifestyles, losing weight, etc. Surely the public held health professionals and modern medicine in very high esteem for good reason.
We didn’t have a “white coat ceremony” at my pharmacy school, but that ritual has now become popular for many students in the health professions. Some of my classmates wore their white coats to all of our classes. I would have been shocked to see them in class not wearing their white coats. I suppose these classmates were extremely proud of their white coats.
I never wore my white coat to classes, except to the labs where it was required or expected. There always seemed to be something phony, pretentious, and egotistical about students wearing their white coats so much. What message were they trying to send? Perhaps it was: Look at me. I deserve respect because I’m a healthcare professional.
Pills Rather than Prevention:
In the back of my mind during my entire time in pharmacy school was this question that constantly nagged at me: Is human health really so dependent on pills? Are good nutrition, lifestyles, weight loss, exercise, etc. irrelevant to health? That seemed to be the underlying assumption when I was in pharmacy school because the curriculum focused almost exclusively on disease, not health.
I had a hard time believing that an emphasis on inorganic chemistry, organic chemistry, biochemistry, and medicinal chemistry were relevant unless a student planned to work in drug development. I felt then and still feel that such a heavy emphasis on chemistry in a pharmacists’ education is absurd.
I always felt that studying sociology, psychology, political science, and anthropology would be far more important for an understanding of the determinants of human health, in comparison to a heavy emphasis on chemistry. You may find this hard to believe but I don’t recall ever using my knowledge of chemistry while filling prescriptions during my entire career at chain drug stores.
In many ways, pharmacy school was a traumatic experience for me because I felt that I was the only student who harbored doubts about the obsession with pills in our medical system, and the lack of emphasis on prevention.
If I had stood up in pharmacy school and stated that I like prevention more than pills, I would have been viewed by most of my classmates and professors as disloyal, disruptive, not a team player, and not respectful of the profession of pharmacy.
To be completely honest, I don’t really know what my classmates felt about the importance of nutrition. That is because nutrition was rarely discussed in class or, from my recollection, in private conversations among students. All of my classmates seemed to be starry-eyed over chemical solutions for every medical problem.
Is pharmacy a science, a business, a quasi-profession, a belief system, a vestige of snake oil?
I was troubled by these questions: Is pharmacy really a profession, or just a monotonous job masquerading as a profession? Are pharmacists scientists who welcome criticism of the pill-for-every-ill outlook? Or are pharmacists quasi-professionals because our income depends on maintaining an essentially positive attitude toward pills? Thus I felt like an outsider during my entire time in pharmacy school and, indeed, for my entire career working in chain drug stores.
Surely a job that places so much emphasis on productivity metrics (like speed in filling prescriptions) does not deserve to be called a profession. The main thing that the corporate bosses at the big drug store chains care about is how quickly prescriptions are filled and the payroll dollars utilized in the process.
Pharmacy is a rigid belief system based on many controversial assumptions
For example:
–Health is primarily dependent on pills
–Pills are better than prevention
–Elevated blood pressure, elevated cholesterol, and elevated blood sugar in type 2 diabetes are best addressed with pills rather than with diet, lifestyle changes, weight loss, exercise, etc.
–All mental problems are caused by chemical imbalances in the brain
–Obesity is a result of physiological malfunction rather than overeating
–Stomach acid is an error in human evolution that needs to be counteracted with antacids, acid suppressors, and proton pump inhibitors
–Fever is an error in human evolution that routinely needs to be counteracted with drugs like acetaminophen or ibuprofen even though fever is often Mother Nature’s method of fighting infection
–The decrease in estrogen level in women at the menopause is an error in human evolution that needs to be counteracted with estrogen supplementation
–Cholesterol is an inherently pathological substance that needs to be counteracted with statins. (In fact, cholesterol is critical for the proper functioning of every cell in the human body.)
Medical Nemesis and other books critical of Pharma and modern medicine:
In hopes of resolving my deep anxiety about my profession, I began reading all the medical and Pharma exposé books I could find. One day in 1976, I read a news story in my local newspaper that was somewhat unusual. It was about a new book titled Medical Nemesis: The Expropriation of Health by Ivan Illich (Pantheon Books).
Medical Nemesis was, at that time, pretty much over my head. I didn’t really know what Illich meant by terms such as “the expropriation of health,” “cultural iatrogenesis,” “clinical iatrogenesis,” and “social iatrogenesis.” Illich was a world-famous philosopher and social critic but I didn’t really understand a lot of what he was saying. I did, however, feel intuitively that the book was extremely important and that I needed to understand it completely if I wanted to understand pharmacy and modern medicine.
Richard Smith, the editor-in-chief of BMJ (formerly British Medical Journal) until 2004, wrote a commentary 25 years after Illich’s book was published in which he described the profound effect the book had on him. [Published in the UK by Marion Boyars under the title Limits to Medicine (1974). Published in the USA by Pantheon Books under the title Medical Nemesis (1976).] From the editorial:
R Smith, “Limits to medicine. Medical nemesis: the expropriation of health”
“The closest I ever came to a religious experience was listening to Ivan Illich. A charismatic and passionate man surrounded by the fossils of the academic hierarchy in Edinburgh, he argued that “the major threat to health in the world is modern medicine.” This was 1974. He convinced me, not least because I felt that what I saw on the wards of the Royal Infirmary of Edinburgh was more for the benefit of doctors than patients. I dropped out of medical school that day. Three days later I dropped back in again, unsure what else to do. Now I’m the editor of the BMJ, which is ironic. Having deserted medicine, I’ve become a pillar of the British medical establishment….”
I devoured both Medical Nemesis and Limits to Medicine, and now I’ve reread the latter—for the first time in 25 years. The power of the book is undiminished, and its prescience seems remarkable.
I bought a copy of Medical Nemesis and spent a year or two reading it over and over, wearing it out to such an extent that many pages became detached from the binding. I was determined to completely understand everything Illich was saying.
This was before personal computers so I went to a local library and searched The Readers Guide to Periodical Literature for every article that was written about Illich and Medical Nemesis. I found dozens. It was extremely gratifying for me to see that the issues that had bothered me so deeply throughout pharmacy school and into my career were finally being discussed openly, at least in some respected magazines, newspapers, and even medical journals.
I moved to Durham, North Carolina, so that I could be near two very good medical libraries, those at Duke University in Durham and the University of North Carolina at Chapel Hill.
A few of the other books that helped me begin to climb out of the black hole that I felt I was in as a pharmacist included: The End of Medicine by Rick Carlson (John Wiley & Sons, 1975), Confessions of a Medical Heretic by Robert Mendelsohn, M.D. (Contemporary Books, 1979), and The Politics of Cancer by Samuel Epstein, M.D. (Sierra Club Books, 1979).
One of the two people who Illich thanked most prominently in the acknowledgements section of Medical Nemesis was John McKnight at Northwestern University in Evanston, Illinois, near Chicago. I felt that I needed to speak with someone in person who was intimately familiar with Illich and Medical Nemesis. So I drove all the way from North Carolina to Evanston and met with Prof. McKnight. It was extremely fulfilling to speak with someone who understood the issues that had concerned me so deeply throughout pharmacy school and into my career as a pharmacist.
Pharmacy professors are not comfortable discussing these issues:
I did not attend pharmacy school at the University of North Carolina at Chapel Hill, but I stopped in there one day to see whether I could find a pharmacy professor with whom I could engage in a discussion regarding some of the issues discussed by Illich in Medical Nemesis. I spoke with one professor there but was quickly given a cold shoulder. He showed absolutely no desire to discuss these issues and, in fact, indicated that he was irritated at my request to do so. So I gave up and left. I felt very unwelcome trying to discuss the issues discussed by Illich in Medical Nemesis.
I called one of my favorite professors from the pharmacy school where I graduated. Even though he was friendly, I could tell that he, too, was very uncomfortable discussing these issues that were so immensely important to me. So it was a short conversation.
Pharmacists don’t seem to be interested in a critique of pharmacy or Pharma:
For several years I worked for the drug chain Revco (later sold to CVS) in Durham, North Carolina. The other pharmacist with whom I worked at that store seemed to have complete faith in all the pills we dispensed. She seemed to have no doubts about the pharmaceutical industry or America’s love affair with pills. Her supreme self-confidence with her tidy view of pharmaceuticals used to grate on me. She seemed to be completely oblivious to criticism of Pharma. She seemed to not care about dietary and lifestyle approaches to health or to understand their importance. She seemed to be completely unconcerned about the issue of the safety and effectiveness of pharmaceuticals.
One day I told her that I had been reading two fascinating books critical of pharmaceuticals and modern medicine. I asked her whether she would be interested in seeing them. She agreed somewhat reluctantly. So I loaned her my copies of Medical Nemesis and Confessions of a Medical Heretic. She told me that she was going to be accompanying her husband on a business trip in a few days and she said she would probably be in their hotel room alone for long stretches. She said she would probably have time to look at the books then.
I eagerly awaited her return to the store, hoping that her reading the books would be a eureka moment. But sadly it was not. As soon as she came back to work, I asked her whether she had read any of the two books and what was her reaction. In a very bored and dismissive tone, she said that, yes, she had looked at the books, but she didn’t find them interesting. And that was it. The books had no effect on her supreme confidence in the legitimacy of the pill-for-every-ill outlook that was typical of the pharmacists I worked with.
It is actually possible that more pharmacists agree with criticism of pharmaceuticals than I realize. That’s because pharmacists don’t feel comfortable discussing this topic openly. Pharmacists fear being labeled as troublemakers by our colleagues or being disloyal to the profession. A pharmacist stating that he/she has serious problems with the pill-for-every-ill outlook of modern medicine is as unwelcome, I suspect, as someone stating that he/she is an atheist among a congregation of true believers. Many critics of modern medicine do, indeed, claim that modern medicine resembles a religion or rigid belief system in many ways.
Diseases of Modern Civilization:
The next book I came across that had a major impact on me was Western Diseases: Their Dietary Prevention and Reversibility by Denis Burkitt M.D. and Norman Temple, Ph.D. (Humana Press, 1994). This book compared and discussed the incidences of diseases around the world and found that the process of westernization was accompanied by a typical disease burden that included colorectal cancer, breast cancer, prostate cancer, lung cancer, endometrial cancer, ovarian cancer, high blood pressure, type 2 diabetes, heart disease, atherosclerosis, gout, kidney stones, osteoporosis, deep vein thrombosis, dental caries, obesity, constipation, hemorrhoids, appendicitis, diverticular disease, pulmonary embolism, gallstones, ulcerative colitis, and others. (see “Diseases currently recognized as Western,” pages 24-25).
Seeing that these very common diseases are, in fact, preventable reinforced my feeling that a medical system based on treatment (rather than prevention) is absurd and corrupt. This book (and others that have followed) have the effect on me of making a mockery of much of the work that health professionals do.
See the following additional sources for a discussion of diseases of modern societies:
1. S. Boyd Eaton, M.D., Marjorie Shostak, and Melvin Konner, M.D., Ph.D., The Paleolithic Prescription, New York: Harper & Row, 1988.
2. Tessa M. Pollard, Western Diseases: An Evolutionary Perspective, Cambridge University Press, 2008
3. Daniel E. Lieberman, The Story of the Human Body: Evolution, Health, and Disease, New York: Pantheon Books, 2013
4. Noel T. Boaz, Evolving Health: The Origins of Illness and How the Modern World Is Making Us Sick, New York: John Wiley & Sons, 2002
5. Wenda R. Trevathan, E. O. Smith, and James J. McKenna, Evolutionary Medicine and Health, New York: Oxford University Press, 2008
6. Wikipedia: Diseases of affluence
7. Wikipedia: Lifestyle disease
Gary Taubes discusses diseases of modern civilization in his book Why We Get Fat (New York: Anchor Books), 2011, p. 168:
“…isolated populations that go from eating their traditional diets to incorporating the kinds of foods that we eat daily in modern Westernized societies. Public-health experts call this a “nutrition transition,” and it’s invariably accompanied by a disease transition as well–the appearance of a collection of chronic diseases that are known as Western diseases for just this reason. These diseases include obesity, diabetes, heart disease, hypertension and stroke, cancer, Alzheimer’s disease, and other dementias, cavities, periodontal disease, appendicitis, ulcers, diverticulitis, gallstones, hemorrhoids, varicose veins, and constipation. These diseases and conditions are common in societies that eat Western diets and live modern lifestyles, and they are uncommon, if not nonexistent, in societies that don’t. And when those traditional societies take up Western diets and lifestyles–through either trade or emigration (voluntary or forced, as in the slave trade)–these diseases will appear shortly after.”
Most of the prescriptions pharmacists fill are to treat preventable diseases of modern civilization. If these diseases are preventable, why is our medical system only interested in treating them? Most health professionals don’t seem to be troubled by that fundamental criticism of modern medicine.
Vestiges of Snake Oil in Modern Drug Stores:
How much of the drug store is modern-day snake oil and marketing run amok? Has pharmacy completely transcended its snake oil past, or has it evolved or morphed into a highly sophisticated and out-of-control marketing machine built on the exploitation of human gullibility? The use of long scientific-sounding words has certainly increased but human gullibility has perhaps remained the same as it was during the days of the frontier snake oil salesman.
Some people love pills. Others have a strong aversion:
It struck me that the general public (and possibly pharmacists as well) can be divided into two categories: 1) those who seem to have a predisposition for liking pills, who feel that pills are the best road to health and are, in fact, an entirely reasonable solution for everything and 2) those who have an aversion to taking pills, who are fundamentally skeptical of the pill-for-every-ill outlook, and who feel that dietary and lifestyle approaches are far more logical, safer, less expensive, and often more effective.
In Conclusion:
Can you imagine our medical system being based on prevention rather than pills? Probably not because that would be immediately dismissed and ridiculed as socialism. Our medical system is about the monetization of the maladaptation of Homo sapiens in modern society. Profits are far more important than human health.
I entered pharmacy school with a basic disinclination to believe all the hype about pills and modern medicine. To maintain my sanity, I embarked on a lifelong journey to learn about the arguments for and against pills. I began my journey nagged by doubt and skepticism. I’m now retired in a state of major disillusionment after having dispensed a gargantuan number of pills in my career, while feeling that a medical system based on prevention would be far more rational.
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.
