As a pharmacist, was it immoral for me to dispense many drugs I felt were not “safe and effective”? This article explains my dilemma and the battle I waged with myself during my entire career working in chain drug stores.
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.
My Criticism of the FDA:
I recently wrote a commentary for The People’s Pharmacy which was titled “Pharmacist Dennis Miller Is Optimistic About Dr. Makary at the FDA.” In that commentary, I explained my criticism of the FDA and my hope that Dr. Marty Makary would help correct the many deficiencies I see in that agency. Dr. Makary is the physician whom President-elect Trump recently nominated to be head of FDA.
How Could Pharma Be Happy with Dr. Makary as Head of the FDA?
Dr. Makary is an interesting choice because he is a prominent critic of the medical establishment. I can’t see how the pharmaceutical industry could be happy with him because, for example, he has been outspoken about overmedication. In my opinion, Big Pharma absolutely wants Americans to be overmedicated. Overmedication is, in my opinion, a large part of Big Pharma’s business model.
A reader named Maureen says I was a hypocrite as a pharmacist:
As a result of my commentary, a reader named Maureen posted a comment suggesting that it was immoral for me to work my entire career as a pharmacist given the fact that I had serious questions about the safety and effectiveness of many of the drugs I dispensed.
Maureen apparently read my brief bio sketch which accompanies my articles. That bio sketch says that I worked for chain drug stores for my entire career. It also notes that I once managed the whole store years ago when the Revco chain (later sold to CVS) had pharmacist store managers. She claims I was a hypocrite.
I actually agree with her.
Here is the comment posted by Maureen on November 29, 2024:
Of course, I, like many readers of this article, support significant changes in the FDA.
Many readers also make decisions in their choice of employment to support our moral beliefs.
“Dennis Miller, R.Ph. is a retired chain store pharmacist.” We read that he also managed a chain store itself. If he believed all he’s written about pharma, then it’s not effective to speak out after working a system for so long that he declares damages his fellow human beings
Perhaps Many Pharmacists Feel That Much of What We Do Is Immoral:
It is possible that many pharmacists feel that what they do is immoral because they feel that many pharmaceuticals are not nearly as “safe and effective” as Pharma and the FDA claim. These pharmacists are perhaps disgusted that our medical system gives infinitely greater priority to pills than prevention. Perhaps they feel that most of the prescriptions filled in America’s pharmacies are to treat preventable diseases of modern civilization. Perhaps this leads to cognitive dissonance among many pharmacists.
Pharmacists, like workers in other sectors of our economy, have mortgage payments, car payments, daily living expenses, as well as the burden of saving for kids’ college education.
A Narrow Range of Acceptable Discourse in Chain Drug Stores:
During my career working at chain drug stores, I felt subtle yet powerful peer pressure from other pharmacists and from our corporate bosses to be positive about pills.
–Clearly corporate management at chain drug stores would not tolerate a pharmacist who uses his position in the chain drug store as a platform for promoting prevention and for educating the public about the controversies surrounding so many of the drugs we dispense.
–Clearly corporate management would not tolerate a pharmacist who spends his time teaching customers how they could be healthy so that they wouldn’t need so many (or any) pills.
–Clearly corporate management would not tolerate a pharmacist who encourages customers to read one or more of the dozens of books on the market that are very critical of the pharmaceutical industry and the FDA.
How I Rationalized Continuing to Work as a Pharmacist:
I told myself that since none of the pharmacists I knew or worked with seemed to be outwardly troubled by America’s pill circus, then who could blame me for “going with the flow” or for giving positive and supportive answers to customers about the safety and effectiveness of the drugs we were dispensing?
I gave positive answers even though I had serious concerns about many of these drugs myself and even though I had deep concerns that our medical system promotes pills far more aggressively than prevention. I felt that most of the prescriptions I filled were to treat preventable conditions.
After working three years as a pharmacist, I quit my job and took various near-minimum-wage unskilled jobs to avoid having to work as a pharmacist
Because I was extremely troubled by our medical system based on pills (rather than prevention), I quit my job just three years after I became a licensed pharmacist. I couldn’t take the contradictions any longer. I had saved up twenty thousand dollars during those three years. I spent the next five years away from pharmacy.
When my savings were nearly depleted, I took various unskilled jobs in North Carolina because I did not want to be a pharmacist anymore. I signed up with an employment agency that gave me various unskilled part-time jobs. For example:
–Even though I was a pharmacist, I took a low-paying job installing displays of Armstrong ceiling panels in hardware stores in eastern North Carolina.
–Even though I was a pharmacist, I took a low-paying job which involved driving a van that carried some kind of advanced or experimental IBM computer (I never learned the details) to various locations as far north as Philadelphia, Pennsylvania and as far south as Gulfport, Mississippi.
–Even though I was a pharmacist, I took a low-paying job as a laborer in a refinishing plant that reconditioned and repainted used computer keyboards.
–I rented a small house on a farm near Apex, North Carolina and helped my landlord harvest his tobacco crop during summers. He was also a handyman so I accompanied him on various plumbing and electrical jobs in the local area, in case he needed an extra pair of hands.
These were all part-time jobs paying close to minimum wage even though I was a pharmacist. I was so disillusioned with being a pharmacist that I was doing everything I could to keep from returning to the drug store.
Why I Returned to Pharmacy:
I was killing myself trying to make a living at those wages so, after five years, I returned to pharmacy, not because I had somehow reconciled my feelings about being a pharmacist, but because I needed to make enough money to survive.
I felt that if I could better understand the pharmaceutical industry, I could somehow reconcile my concerns.
During these five years that I was away from pharmacy, I spent a huge amount of time reading books and journal articles critical of the pharmaceutical industry and our medical system. This was before personal computers, so I spent a lot of time in the medical libraries at the University of North Carolina and Duke University, both of which were about ten miles from the small home I was renting.
I had hoped that if I could understand the pharmaceutical industry and our medical system more deeply, I would somehow be better able to deal with my disillusionment about being a pharmacist. I had also hoped to discover that I was not the only pharmacist who had deep questions about the safety and effectiveness of many drugs. I certainly did not meet any like-minded pharmacists during my first three years as a licensed pharmacist but I hoped to find articles written by any such pharmacists.
Ivan Illich’s Medical Nemesis Had a Major Influence on my Views:
This period was, as I said, before personal computers so I spent a huge amount of time using the Readers’ Guide to Periodical Literature. I was looking for every article I could find that discussed Ivan Illich and his landmark book Medical Nemesis: The Expropriation of Health (New York: Pantheon, 1976). I found dozens of articles discussing Illich and Medical Nemesis.
It was extremely gratifying to read in magazines and medical journals that there were many people who felt the same way I did about our medical system and its absurd obsession with pills and technology. Unfortunately, I did not know any pharmacists personally who were interested in reading Medical Nemesis or even hearing what it was about. Even today, pharmacists seem to be quite antagonistic toward books critical of pharmaceuticals.
I Tried to Interest a Pharmacist in Books Critical of the Pill Juggernaut:
Because I was killing myself trying to earn a living with low-paying jobs unrelated to pharmacy, I felt I had no alternative other than to return to work as a pharmacist.
One of the first pharmacists I worked with upon returning to the profession was someone who used to irritate and annoy me because she seemed to have absolute and unshakable confidence in the safety and effectiveness of the pills we dispensed.
I mentioned to her one day that I had been reading Ivan Illich’s Medical Nemesis and another well-known book at that time, Confessions of a Medical Heretic by Robert Mendelsohn, M.D. Mendelsohn was a pediatrician on the faculty at the University of Illinois who became a well-known critic of medicine and Pharma.
I asked this pharmacist whether she might be interested in reading these two books. She told me that she was going to accompany her husband on a short business trip in a few days and that she expected to be in a hotel alone for extended periods while her husband attended meetings. So she said she would look at the books at that time.
When she returned to work, I was very eager to hear what she felt about both books. I had hoped that the books would cause her to examine her rock-solid belief in the pills we dispensed, at least a little bit.
So I asked her if she had time to read the two books and what her reaction was. To my great dismay, she said yes, she had looked at the books, but her reaction seemed to be a huge dismissive yawn. The books seemed to have zero impact on her rosy outlook toward pharmaceuticals. She seemed to be bored by the entire subject. It was as if I were questioning her unassailable belief in her religion. So I never mentioned the subject to her again. Unfortunately, that pharmacist’s attitude seems to be typical of the vast majority of pharmacists I know.
Pharmacists Fear That Open Criticism of Pharmaceuticals Could Jeopardize Their Employment:
It is possible that many pharmacists have deep concerns about pharmaceuticals, but these pharmacists are afraid to vocalize those beliefs.
It is possible that there have always been many pharmacists who are disillusioned with America’s pill for every ill outlook, but these pharmacists are afraid to verbalize their concerns because of a fear of jeopardizing their employment.
I worked for chain drug stores for my entire career. Chain store pharmacists don’t want to get a reputation with our district supervisor for being critical of pharmaceuticals. Perhaps we realize that our bosses won’t hesitate to concoct some pretext to get rid of pharmacists who are seen as having questions about pharmaceuticals or who are much more interested in prevention than pills.
Major Ethical Dilemmas in Many Jobs:
What does any person do when he/she feels that very many of the jobs in a society are in some way immoral? My conclusion is that many people are quite willing to jettison their deep moral beliefs when faced with the prospect of not making enough money to survive. For example,
–What does an employee do when he/she works for a health insurance company and he/she is disgusted with the tactics used by his/her employer? The insurance industry is constantly trying to reject or deny claims, erect burdensome “out-of-network” provisions, require burdensome prior authorizations, invoke “pre-exiting condition” exclusions, increase co-pays, increase deductibles, etc. How can employees working for these insurance companies sleep at night?
–What does an employee do who works at a fast-food restaurant when he/she feels the food being sold there is not good for one’s health?
–What does an employee do when he/she works for a major food processing plant making processed foods that he/she feels are unhealthy?
–What does a lawyer do who feels that our legal system is corrupt because it is stacked in favor of rich and powerful people? Does he/she become a public interest lawyer suing big corporations?
All of these people need to make a living. Should they choose a lifestyle fitting a monk in order to protest their disgust with the system? Should they keep quiet and continue to exploit their fellow human beings to earn a living wage? Should they become activists for reform of the industry they work in?
Staffing Levels Are a Greater Concern for Chain Store Pharmacists Than the Safety and Effectiveness of the Pills We Dispense:
For many chain store pharmacists, dangerously understaffed pharmacies are a far greater immediate concern than the safety and effectiveness of the drugs we dispense.
Our dangerous working conditions include drive-thru windows, which are the worst thing that ever happened to pharmacy. Drive-thru windows cause customers to think that the process of filling prescriptions is no different from the process of filling hamburger orders at McDonalds, Burger King, and Wendy’s. Speed is extremely important at chain drug stores and fast food restaurants.
Productivity metrics are the constant oppressor of chain store pharmacists. Our bosses are obsessed with metrics such as the time it takes to fill prescriptions and the level of staffing (payroll dollars) utilized in the process.
Given the fact that our district supervisors are evaluated by sales metrics similar to those used to evaluate the pharmacists they supervise, you can be sure that these bosses make it clear to pharmacists that these metrics are what determine whether we will remain employed by that chain. The corporate executives at chain drug stores are interested in profits, not the health of the public or the altruistic goals of some pharmacists. The corporate executives do not feel that it is the pharmacist’s job to educate the public about pharmaceuticals.
I agree with film maker Michael Moore as regards our unethical healthcare system>
In discussing the recent shooting of the UnitedHealthcare CEO Brian Thompson, film maker Michael Moore is quoted in the Miami Herald (via msn.com)
Moore added that “yes, I condemn murder, and that’s why I condemn America’s broken, vile, rapacious, bloodthirsty, unethical, immoral health care industry and I condemn every one of the CEOs who are in charge of it and I condemn every politician who takes their money and keeps this system going instead of tearing it up, ripping it apart, and throwing it all away.”
Moore concluded, “Throw this entire system in the trash, dismantle this immoral business that profits off the lives of human beings and monetizes our deaths, that murders us or leaves us to die, destroy it all, and instead, in its place, give us all the same health care that every other civilized country on Earth has: Universal, free, compassionate, and full of life.”
Grace Hall, “Hollywood’s Michael Moore Refuses to Condemn Anger Toward Health Insurance Industry,” Miami Herald via msn.com
How Can Health Professionals Work in “America’s broken, vile, rapacious, bloodthirsty, unethical, immoral health care industry”?
According to Marcia Angell, M.D., formerly the editor-in-chief at The New England Journal of Medicine (The Truth About the Drug Companies, New York: Random House, 2004):
“[The pharmaceutical industry] over the past two decades has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the U.S. Congress, the FDA, academic medical centers, and the medical profession itself.”
Modern-day Versions of Snake Oil?
In my opinion, most pharmacists don’t seem to know or care that pharmacy today is an enterprise driven primarily by marketing, not science. The pharmaceutical industry has succeeded spectacularly in creating its own reality to encourage the acceptance of pills for everything. This is a massive reality distortion field which has bamboozled the public and, in too many cases, health professionals as well.
Only two countries (USA and New Zealand) allow direct-to-consumer advertising of prescription drugs. In my opinion, this indicates what an outlier and anomaly this country is as regards prescription drugs. In my opinion, the USA today is still the Wild West with regard to prescription drugs.
Today’s marketing is much more sophisticated than the frontier snake oil salesman from a hundred years ago hawking his high-alcohol content potions from the back of a wagon. But there are serious questions about the safety and effectiveness of many of the products sold in drug stores today.
Final Words:
Drug side effects are the Achilles heel of pharmacy. Pharmacists fear that the public will realize that most pharmaceuticals are not natural substances and that they, therefore, come with long lists of potential side effects, some of which can be quite serious. Thus very many pharmacists are on the defensive about the pills they dispense but don’t tell customers about their own serious concerns.
In my opinion, our medical system is fundamentally corrupt because it promotes the idea that synthetic chemicals known as pharmaceuticals are a better approach to health than prevention via diet, lifestyles, avoiding processed foods, avoiding the synthetic chemicals that are ubiquitous in modern society, etc.
People probably assume that our medical system is obsessed with pills because there’s no alternative. In fact, there’s a very real alternative: prevention. But there’s no money in prevention so we’re flooded with pills. As a pharmacist, I can state that prevention is nowhere near the top priority in my profession for the same reason: There’s no money in prevention.
As regards the reader of my People’s Pharmacy article who said I was a hypocrite for working as a pharmacist, even though I have serious concerns about many of the drugs I dispensed, my response to her is that she is correct. But I placed my need to survive above my deep disillusionment with being a pharmacist.
I am trying to make amends for the hypocrisy that my career represents by writing articles and books that I hope will, in some small way, help transform the pharmaceutical industry and our very corrupt health care system.
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.
