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.
In my opinion, most pharmacists are largely uninterested in the following issues that I feel are critically important for an understanding of pharmaceuticals.
[1] The medicalization of common behaviors
Pharmacists don’t seem to be troubled by the medicalization of common behaviors. Pharmacists don’t seem to care that shyness is now labelled as “social anxiety disorder,” the winter blues is now “seasonal affective disorder,” excessive hand washing is now “obsessive compulsive disorder,” kids who are unruly or who do poorly in school are now labeled as suffering from “attention deficit hyperactivity disorder,” people who spend too much time shopping are said to have “compulsive shopping disorder,” people who are addicted to gambling are now said to suffer from “compulsive gambling disorder,” people who experience adverse health effects from working the overnight shift are said to suffer from “shift work sleep disorder,” road rage is now referred to as “intermittent explosive disorder,” dissatisfaction with the appearance of one’s body is referred to as “body dysmorphic disorder,” etc. Pharmacists don’t seem to care that the word “disorder” is appended to common behaviors to drag them into the medical domain.
[2] Increases in life expectancy are not primarily due to modern medicine
Pharmacists don’t seem to care that the primary reason for the increase in life expectancy in the last hundred years is due to public health factors like improved sanitation, improved housing, improved nutrition, cleaner drinking water, etc. Pharmacists seem to have completely accepted Pharma’s narrative that increases in life expectancy are primarily due to pills.
[3] Dozens of anti-Pharma books
Pharmacists don’t seem to care that there are dozens of books on Amazon.com that are critical of pills and the pharmaceutical industry. Pharmacists seem to be largely opposed to these books and are, in fact, often angered by them. A typical pharmacist comment might be something like, “Yeah, someone is trying to get rich by writing a book.”
[4] Pharma has awesome power to control the narrative about health
Pharmacists don’t seem to be troubled by the massive, awesome, remarkable, and scary ability of the pharmaceutical industry to direct the narrative about health toward pills and away from prevention. It’s one thing for Pharma to promote overmedication and medicalization and to exaggerate the benefits of pills and downplay the risks. It a more insidious thing to be able to completely change the narrative toward pills and away from prevention.
In my opinion, Pharma is very dishonest about the causes of many common medical conditions. For example: Pharma directs the narrative around cardiovascular disease toward statins rather than a change in diet and lifestyles. Pharma directs the narrative around type 2 diabetes and elevated blood pressure toward drugs rather than a change of diet and weight loss. Pharma directs the narrative around depression toward a highly suspect and theoretical brain chemical imbalance rather than an examination of one’s depressing life circumstances. Pharma directs the narrative around cancer toward cellular dysfunction and genetics rather than to the removal of toxic and carcinogenic substances that are so ubiquitous in modern society. To sell more pills, Pharma constructs a massive reality distortion field around the causes of many common conditions.
[5] Commonly prescribed drugs may cause cancer
Pharmacists don’t seem to care about the immensely important subject of tumors and cancers caused by commonly prescribed drugs. Pharmacists often say “Yeah. They give the rats massive amounts of the medication, so what do you expect?” Pharmacists don’t seem to be interested that these tumors or cancers often occur with doses that are not far from the human dose on a pound-for-pound basis.
[6] Black box warnings are often added years after FDA approves a drug
Pharmacists don’t seem to care that the addition of black box warnings to the official prescribing information indicates that FDA doesn’t really know the extent of potential harm from the drugs it approves. These black box warnings are often added months or years after the FDA has approved the drug.
[7] The full extent of adverse effects of drugs is unknown and probably unknowable
Pharmacists don’t seem to be concerned with the immensely important fact that it is impossible to know or predict all the biological and biochemical effects of pharmaceuticals at the molecular and cellular levels. Therefore the full extent of potential harm from pharmaceuticals is unknown and probably unknowable. Pharmaceuticals can cause subtle yet very significant damage to human biology and biochemistry that is not recognized before the drug is approved. These adverse effects may, in fact, never be recognized. For example, given the fact that cholesterol is ubiquitous in the human body and is essential for cell functioning and the production of hormones, how can anyone even begin to predict the full extent of effects of statins at the molecular and cellular levels?
[8] Direct-to-consumer advertising of prescription drugs is allowed in only two countries
Pharmacists don’t seem to be troubled by the fact that only the USA and New Zealand allow direct-to-consumer advertising of prescription drugs. The rest of the world presumably feels that these advertisements encourage overmedication and the use of the expensive advertised drugs even though there may be less expensive alternatives available including non-drug approaches,
[9] The modern world is making us sick
Pharmacists don’t seem to be concerned that the modern world is making us sick. This includes the standard American diet consisting very heavily of processed foods. It also includes the synthetic chemicals that are ubiquitous in our air, water, homes, and workplaces. It includes common household cleaners, flame retardants, fabric protectors, paint thinners, oven cleaners, toilet bowl cleaners, food dyes, pesticides, sodium nitrate, high fructose corn syrup, sodium benzoate, monosodium glutamate, etc. It includes toxic chemicals that outgas from furniture and carpets. A prime example is formaldehyde which is ubiquitous in many household products even though it is a suspected carcinogen.
As regards the standard American diet, the powers that be in the medical establishment downplay the role of the modern grocery store and processed foods in the epidemics of elevated blood pressure, elevated cholesterol, heart disease, stroke, kidney stones, type 2 diabetes, obesity, colon cancer (and other cancers), dental caries (cavities), etc. Our medical system is corrupt because it gives priority to treatment rather than prevention.
[10] Weight-loss drugs have a poor track record of safety
Pharmacists don’t seem to care that weight-loss drugs have a poor record of safety over the last several decades. The pattern seems to be: Intense hype followed by a slow recognition of the adverse effects and then a drastic decrease in the prescribing of those pills. I predict that will be what happens with the current world-wide obsession with Ozempic/Wegovy.
[11] Many drugs demonstrate only marginal benefits
Pharmacists don’t seem to care that many classes of drugs have great difficulty demonstrating significant benefit. That includes drugs for depression, psychosis, Alzheimer’s disease, and osteoporosis.
[12] The human brain is far more complex than Pharma’s crude drugs
Pharmacists don’t seem to care that the human brain is the most complex thing in the universe and that the level of understanding of the human brain is still very rudimentary. The drug companies march into the unknown with a tsunami of pills affecting the brain despite such ignorance.
[13] Up to 90 percent of cancers are preventable
Pharmacists don’t seem to care that The Merck Manual says that up to 90 percent of cancers are preventable. Pharmacists don’t seem to see how absurd it is to treat cancer with remarkably toxic chemotherapy rather than focus on removing the synthetic chemicals that are so ubiquitous in modern society. Pharmacists don’t seem to be willing to acknowledge that cancer is Big Business, an immensely profitable approach to what is, in fact, a largely preventable condition.
[14] Stomach acid is not an error in evolution
Pharmacists don’t seem to care about Pharma’s massive assault on stomach acid with antacids, acid suppressors, and proton pump inhibitors. Pharmacists don’t seem to care that Pharma has portrayed stomach acid as an error in human evolution. In fact, stomach acid is essential for life, essential for digesting food and for killing noxious organisms in that food.
[15] Menopause is not an error in evolution
Pharmacists seem to have been quite hesitant or resistant to accepting the harm caused by HRT (hormone replacement therapy) including cardiovascular disease and uterine cancer. Pharmacists seem to be resistant to the common-sense conclusion that if Mother Nature determined that estrogen production is very significantly decreased with the menopause, then that is what hundreds of thousands of years of evolution have determined to be optimal for females.
[16] Cholesterol is not an error in evolution
Pharmacists seem to be resistant to accepting the fact that cholesterol is not an error in human evolution that needs to be attacked with drugs like statins. Cholesterol is essential for the functioning of cells and in the body’s production of many substances such as hormones.
[17] Fever is not an error in evolution
Pharmacists seem to be resistant to accepting that fever should not be routinely treated and that fever is very often a protective mechanism to fight infection.
[18] Preventable diseases of modern civilization
Pharmacists don’t seem to care that most of the prescriptions we fill are to treat preventable diseases of modern civilization. Pharmacists don’t seem to care about this immensely important subject which is also referred to as diseases of modernity, diseases of advanced societies, diseases of affluence, diseases of industrialization, Western diseases, and lifestyle diseases. This is the framework that informs my understanding of human illness and of modern medicine’s grossly inappropriate approach to addressing it. Pharmacists don’t seem to care that as societies adopt a Western diet and lifestyle, those societies develop the same conditions that exist in Western societies. An inescapable fact is that there’s no money in the prevention of these diseases of modern civilization whereas the utilization of pills is very lucrative financially for health professionals, Pharma, hospitals, insurance companies, etc.
Most lists of preventable diseases of modern civilization include common conditions like the following: heart disease, stroke, hypertension, deep vein thrombosis, pulmonary embolism, obesity, kidney stones, osteoporosis, elevated cholesterol, type 2 diabetes, gout, colon cancer, rectal cancer, breast cancer, prostate cancer, lung cancer, endometrial cancer, ovarian cancer, dental caries (cavities), varicose veins, gallstones, constipation, appendicitis, diverticular disease, hemorrhoids, Crohn’s disease, celiac disease, pernicious anemia, ulcerative colitis, rheumatoid arthritis, multiple sclerosis, etc. (See Western Diseases: Their Dietary Prevention and Reversibility, edited by Norman J. Temple, Ph.D. and Denis P. Burkitt, M.D., New Jersey: Humana Press, 1994, pp. 24-5)
[19] Volunteers in clinical trials are not representative of the real world
Pharmacists don’t seem to care that volunteers in clinical trials are typically younger and healthier than the people (often senior citizens) who will take the drugs in the real world. Younger and healthier people can withstand adverse effects of drugs better than older people. Older people are more likely to have decreased liver and kidney function which slow the metabolism and elimination of drugs from the body. Pharmacists don’t seem to care that controlled trials are sliced and diced to deliver results favorable to the drug company.
[20] Relative vs. absolute risk reduction
Pharmacists don’t seem to care that drug companies cite “relative risk reduction” much more frequently in advertisements than the far more meaningful “absolute risk reduction.” This makes pills appear to be a lot more effective than they are.
[21] Generic drugs
Pharmacists don’t seem to be troubled by the fact that FDA doesn’t have adequate staff to inspect drug manufacturing facilities around the world. Inadequate staffing for inspections understandably casts doubt on the quality of generic drugs.
[22] FDA has been co-opted by Big Pharma
Pharmacists don’t seem to care that the FDA has been co-opted by the pharmaceutical industry. This is known as “regulatory capture” wherein a governmental agency has been co-opted by the industry it is supposed to regulate.
[23] Modern medicine is absurdly mechanistic and reductionist
Pharmacists don’t seem to care that modern medicine is extremely mechanistic and reductionist and that it focuses on molecules and cells rather than on the whole person.
[24] Pharmaceuticals are mostly synthetic substances never before seen during evolution
Pharmacists don’t seem to care that pharmaceuticals are mostly synthetic chemicals, manufactured in a factory, that have never before been seen during the long course of human evolution.
[25] Pharma’s obsession with molecules, cells, and chemistry
Pharmacists don’t seem to care that Pharma wants you to believe that the key to human health is the study of molecules, cells, and chemistry, rather than diet and lifestyles.
[26] Number needed to treat
Pharmacists don’t seem to care that FDA doesn’t require the inclusion of the very important “number needed to treat” (NNT) in drug advertising,
[27] “Safe and effective”
Pharmacists don’t seem to care that the FDA’s definition of “safe and effective” is far different from the layman’s definition
[28] Surrogate endpoints
Pharmacists don’t seem to care that FDA allows the use of “surrogate endpoints” or “surrogate markers” rather than “decreases in all-cause mortality” to make drugs appear more effective than they really are
[29] Placebo effect
Pharmacists don’t seem to care that the placebo effect accounts for the majority of the benefit that people receive from many pills and that the placebo effect represents a continuation of a hocus-pocus component in modern medicine that was prevalent in the Wild West
[30] Modern day versions of snake oil?
Pharmacists are often categorized as “retail” (chain and independent) pharmacists and “hospital” pharmacists. In my opinion, many retail pharmacists seem to have the mentality of a small-town grocer. Such pharmacists seem to view the products on pharmacy shelves as no more controversial than the products at a car parts store, a hardware store, or a farmers market. In my opinion, pharmacists don’t seem to realize how controversial pills and the pharmaceutical industry are.
People should keep in mind that pharmacy has a long and embarrassing history of promoting snake oils, salves, potions, tonics, elixirs, etc. of very dubious value. Has the snake oil component of pharmacy disappeared? Or are many of the products on pharmacy shelves today simply modern-day versions of snake oil? The veneer of science has increased but perhaps human gullibility has remained constan
[31] Products applied to the skin often enter the systemic circulation
Pharmacists don’t seem to care that products which are applied to the skin or hair often end up being absorbed through the skin and into the systemic circulation with unknown adverse effects.
[32] USA ranks poorly on many health metrics
Pharmacists don’t seem to care that the USA ranks very poorly on many markers of population health despite spending the most per capita on pharmaceuticals. Pharma wants you to have a molecular and cellular focus on individuals rather than a population focus. Pharma wants you to focus on pharmacology rather than on global health statistics which are quite embarrassing to the USA. Pharma wants you to believe that human health is directly proportional to the per capita consumption of pills.
[33] Why is the term “polypharmacy” used instead of “overmedication”?
Pharmacists don’t seem to care that our medical system uses the very peculiar word “polypharmacy” rather than be more honest and direct by referring to it as “overmedication.” “Polypharmacy” is an intentionally obtuse word meant to divert attention to the massive problem of overmedication as a result of Pharma flooding the market with pills.
Pharma is selling a state of mind
Given the fact that marketing, not science, is what drives the pill business today, the public needs to realize that Pharma views pharmaceuticals as a blank canvas upon which any reality can be constructed. For very many conditions, Pharma is selling a state of mind rather than a science-based remedy. That’s why the placebo effect plays such a huge role in the effectiveness of so many of the products in drug stores.
Are pharmacists unthinking automatons?
I will be excoriated by other pharmacists for writing this article. Pharmacists will say that I am describing them as unthinking automatons or robots who don’t care about criticisms of pharmaceuticals. I hope that some pharmacists will post comments saying something like “I do indeed care deeply about these issues.” I am not claiming that such pharmacists don’t exist. I’m just saying that I haven’t met any pharmacist in person who openly verbalized his/her concerns about pharmaceuticals and the pharmaceutical industry.
I am sure that there are pharmacists who do care about evaluating the safety and effectiveness of pharmaceuticals. I just haven’t met them in person. Perhaps they’re just too fearful of being labeled as anti-drug or anti-pharmacy. I’ve never worked in a hospital pharmacy so I am unable to comment on the attitudes of hospital pharmacists. I worked for chain drug stores for my entire career and am now retired.
Our job is to move pills
The business aspects of pharmacy are paramount (as opposed to the scientific aspects of pharmacy) for retail pharmacists. Pharmacists working for the huge drug store chains learn very quickly that we are paid to move pills, not to educate the public about the risks and benefits of those pills. Pharmacists learn very quickly that their corporate bosses will not tolerate a pharmacist who spends his time promoting prevention rather than being supportive of pills.
The powerful socialization process in pharmacy schools and at chain drug stores
The public doesn’t seem to realize how powerful peer pressure is on pharmacists to promote a favorable view of pills. The public has no idea of the socialization process in pharmacy schools and in chain drug stores that causes pharmacists to internalize the norms and ideologies of a medical system based on pills rather than prevention. Pharmacy school promotes the evaluation of, for example, Drug A versus Drug B, but pharmacy school does not, in my experience, promote a discussion of the relative value of pills in comparison to disease prevention via dietary and lifestyle changes.
In my opinion, most pharmacists don’t seem to care that prevention is better than pills. Pharmacists seem to be resistant to accepting the fact that Homo sapiens is part of the natural world and is dependent on the natural world for sustenance. We have been force-fed a belief in better living through chemistry and pharmacology.
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.
