This critical perspective is from retired pharmacist, Dennis Miller. There’s a huge amount of important information about drugs that pharmacists rarely discuss with customers. Chances are you feel your pharmacist is wonderful, kind, caring, and concerned about you as a person and your health. That may or may not be true, but my contention is that there is a wide range of important, pertinent, and insightful issues that pharmacists rarely, if ever, discuss with pharmacy customers. Find out what pharmacists don’t tell you.
Counseling Is Critical:
Counseling patients is a critical part of the pharmacist’s professional responsibility. It is what distinguishes them from clerks. Nonetheless, pharmacists’ counseling is usually a remarkably abbreviated interaction that typically barely scratches the surface of information that many customers would consider to be very important.
I am now retired, but I hate to admit that that description usually applied equally to me throughout my career in chain drug stores. I, too, was guilty of the fast-food model of drug information.
The Fast-Food Model of Drug Information:
In your brief interaction with your pharmacist, he/she may indeed give you useful information such as “This drug may cause you to be drowsy so don’t drive or operate dangerous machinery” or “Take this antibiotic until it’s all gone” or “Take this drug with food”, etc.
But what you may not know is that there’s a huge body of very important information that is rarely discussed between pharmacists and customers. From my perspective, it is actually more interesting what pharmacists don’t tell you than what they do tell you.
There’s massive controversy surrounding so many of the products in the pharmacy, yet the typical pharmacy customer gets no sense of that controversy in his/her brief and superficial interactions with pharmacists.
You could spend days on the Internet reading about many of the issues related to your drugs, but all you get at a drug store is usually one or two sentences from the pharmacist or a one-page leaflet. Understaffing and time constraints are important causes of this lack of full disclosure of pertinent information, but they are definitely not the only causes.
How Safe Is Your Medicine?
Many pharmacy customers feel that because the Food and Drug Administration approves a drug, it is worry-free, safe and effective. In fact, the FDA approves far too many drugs that should never be approved and that don’t meet the layman’s definition of “safe and effective.” Usually, pharmacists don’t tell you about any of these concerns.
The FDA, in effect, passes the buck to physicians and consumers to read and reflect on all the related precautions, adverse effects, contraindications, and drug interactions. The FDA shirks its responsibility to protect the public safety by simply mandating that drug companies disclose this information in the detailed official labeling which most people never see.
Even though you may appreciate detailed answers to your questions and detailed counseling by your pharmacist, other customers waiting in line behind you don’t like the bottleneck that you’re creating by monopolizing the pharmacist’s time. Speed of service and maintaining a positive attitude are two concepts that chain store pharmacists have internalized to protect their job security. Consequently, those factors greatly influence the length and depth of pharmacists’ interactions with customers.
Wide Range of Drug Information Disclosure in Different Scenarios:
- There is a wide range in the level of drug information disclosure in different scenarios. Here are some examples:
- When you pick up your medication at your drug store, your pharmacist’s counseling on a new prescription may be just one or two sentences. On the other hand, the leaflet that’s included with your prescription is usually about a full page in easy-to-read 10 to 12 point text.
- The drug information that’s on the backside of non-medical magazine advertisements for drugs is also typically a full page, but there is usually more information in those ads because the text size may be somewhat smaller.
- There is yet another level of disclosure of drug information in the final part of drug advertisements on TV in which the announcer breezes through a long list of (sometimes scary) possible side effects.
- Drug advertisements in medical and pharmacy journals can include up to 3 or 4 full pages of drug information in tiny text after the flashy first page in vivid color featuring happy people having fun on sunny days with the family pet.
- And then there is the most detailed publicly available source of drug information which is the official label. This can be 25 pages of text in an online PDF file.
The Level of Disclosure Varies Widely in Different Scenarios:
Why is a different level of disclosure allowed in different scenarios or situations? The lowest level of drug disclosure is possibly the pharmacist’s in-person verbal counseling, typically 1 or 2 sentences. Contrast that with, say, the 25 pages of text in an online PDF version of the official labeling.
Which level of disclosure is appropriate: 1 or 2 sentences from a pharmacist, a one-page printed leaflet from a pharmacist, a one-page summary on the back of advertisements in non-medical magazines, or a 25-page online PDF? Who has the right to decide which level of disclosure you deserve?
When pharmacists mention only one or two common side effects of a drug you’re taking, is that a disservice? Do pharmacists have a right to unilaterally decide that mentioning serious but uncommon side effects will scare you and cause you to be fearful of taking a prescribed medication?
How much information about adverse effects, precautions, contraindications, and drug interactions is the public entitled to? Is too little information a disservice to the public because it avoids full disclosure? Does too much information scare people?
What Pharmacists Don’t Tell You Might Scare You:
Is anything wrong with scaring people if it prompts them to make major changes in their diet and lifestyle?
Unfortunately fear is one of the few things that prompt people to make significant changes in their diet and lifestyle. It is my fear of refined sugar, refined flour and a general fear of processed foods that caused me to drastically change my diet.
Because most of the prescriptions pharmacists fill are to treat preventable diseases of modern civilization, wouldn’t mentioning a few possible serious adverse effects be wise? It could be the impetus for people to make big changes in their diet and lifestyle. Then it would not be necessary for our customers to take so many medications which have many potential adverse effects of widely varying levels of severity.
Do pharmacists have a right to not inform you about serious and possibly deadly side effects?
Who gave pharmacists the authority to decide what level of disclosure is appropriate for each customer? Just because very serious adverse effects may not be common does not mean that the patient/customer does not have a right to that information. You may be one of the people who experiences that uncommon yet serious adverse effect.
Pharmacists have the right to unilaterally determine how much drug information you need or deserve.
The act of pharmacist counseling is a very interesting phenomenon because your pharmacist is given the right to determine how much information to disclose and whether to avoiding mentioning of the most serious possible adverse effects. This is a quite remarkable state of affairs where potentially scary information is simply not disclosed.
Why Pharmaceuticals Are Different from Most Products in the Marketplace:
Pharmaceuticals are unlike almost any other product for the layman in the marketplace (except perhaps pesticides and, to a lesser extent, tobacco and alcohol) because these products (pharmaceuticals) can be associated with significant risks. There’s a reason why these drugs in the pharmacy require a prescription. The reason is that there can be serious risks associated with these drugs.
Busy physicians do not have the time to sift through all this information about warnings, precautions, etc. In addition, physicians assume that if a drug has been approved by the FDA, it is fundamentally safe to prescribe it.
How much drug information do people want or need?
There is tremendous debate in medical and pharmacy circles regarding how much drug information people want or need, and whether in-person verbal counseling about medications is as good as, better than, or worse than written information.
My preference is for detailed information that’s printed or available online. My perspective is: the more information, the better. However, many health professionals say that the more people read about prescription drugs, the less likely they are to want to take the prescribed medication. Maybe that’s why there is so much that pharmacists don’t tell you.
That coincides with what I witnessed in the drug store. A not uncommon scenario is that a customer tells the pharmacist that he/she (the customer) looked up a drug prescribed by his/her physician and that consequently the customer is not sure he/she wants to take that drug.
I’m now retired but, in my experience, when people looked up their drug in the Physicians’ Desk Reference (according to Wikipedia, 2017 was the last hardcover edition of the PDR) or, more recently, when they access the official labeling online (search Google with a drug name and official labeling), nearly everyone is less enthusiastic about taking the medication.
The Public Is Deeply Distrustful of Big Pharma:
Pharmacists dispense the products of an industry (Big Pharma) that the public deeply distrusts. This is an industry that portrays potent and potentially dangerous pharmaceuticals in a carnival atmosphere on TV while ignoring the huge controversies surrounding their products.
These advertisements ignore any discussion of our corrupt medical system in which the fox guards the henhouse. This is what’s known as “regulatory capture.” Pharmacists increasingly play the role of legitimizing Big Pharma’s products which are, in fact, quite often clouded by very serious concerns such as FDA’s becoming a captive of the drug industry, Big Pharma’s immense clout over the US Congress, and Pharma’s corrupt influence over drug research.
The military-industrial complex doesn’t want to prevent war because war is immensely profitable. Similarly, the medical-industrial complex doesn’t want to prevent disease because there’s much more money in treating disease than in preventing it.
Usually, pharmacists’ in-store verbal counseling ignores any discussion of the fact that Pharma is well on its way to polluting the scientific basis of modern medicine. This counseling ignores any discussion of Pharma’s success beyond its wildest dreams in controlling the narrative about health in which pills are promoted as more important than prevention. Pharma’s self-serving narrative implies that Homo sapiens is no more than a collection of chemicals which means that chemical solutions (pharmaceuticals) should be used for everything.
To what extent are pharmacists willing accomplices of Pharma’s corrupt practices? And to what extent are they unwitting dupes of Pharma? Have pharmacists been willingly led down the garden path by a nice paycheck? Should pharmacists be shouting from the rooftops that there are many drugs we dispense every day that we’d never take ourselves or recommend for a close friend or family member?
Dennis Miller, R.Ph. is the author of The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.