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Tag Archives: pharmacy
The holidays can increase the consumption of two drugs that we may use in a light to moderate fashion during the year, either at separate occasions or concurrently. One of these drugs is alcohol and the other is acetaminophen. Sometimes the consumption of alcohol results in adverse effects that require the use of the second drug, or perhaps the acetaminophen is just used regularly for any type of chronic or acute pain you may be experiencing.
The two main organs in our body that help to remove drugs are the liver and the kidneys. A series of chemical reactions occur where drugs are changed or “metabolized” to make them readily removed from the body, often through the intestines or the urinary tract. Without these organs, most drugs would quickly reach toxic levels, resulting in death. We are constantly bombarded with online offers to “boost” the detoxifying powers of both organs to improve health – a concept completely unproven and a certain red flag for someone looking to detox your money from your wallet.
It is common knowledge that alcohol is metabolized for removal from the body largely by the liver. Repeated over-consumption of alcohol, especially over the long term, can lead to liver disease. Acetaminophen is also heavily metabolized by the liver, and large doses of this drug, even in a single dose can have devastating effects on this organ. For the most part, in the average healthy individual, light to moderate intake of alcohol will not cause damage to the kidneys or the liver. The same holds true for acetaminophen in regular doses of 3000-4000 mg per day, even for extended periods of time. In fact we often see studies that seem to indicate that light consumption of alcohol can have some benefits. Keep in mind that this should never be a reason to start consuming alcohol in any amount when you never were before though as alcohol does have some adverse effects on the GI tract associated with it.
Recent evidence however has determined that the consumption of acceptable levels of both of these drugs at the same time can and has lead to serious kidney disease in otherwise healthy people. The effect was of greater probability in older adults (who often have reduced kidney function), males, blacks and Hispanics (over white patients), and those with conditions that can typically reduce kidney function like diabetes, high blood pressure and obesity. This news can come as a shock to those in the medical community who automatically look toward the liver as the weakest link in the metabolism chain for these two drugs. In fact I regularly tell patients to avoid acetaminophen in “hangover” situations as there have been documented cases of liver damage when the two have been taken together. It turns out, that life threatening kidney damage can occur even in the absence of liver disease when they are combined.
The recognized risk is that there is a two-fold increase in kidney dysfunction when these two drugs are combined even at acceptable doses. Keep in mind that many combination products in the over the counter section of the pharmacy contain acetaminophen, including cough and cold and sleep products. There is an increased danger when these medications are consumed and not reported to your pharmacist at the time you are purchasing them. You may be taking acetaminophen already in a prescription product that is combined with an over the counter medication containing the same ingredient. Some patients may also metabolize acetaminophen at a significantly slower rate than others, magnifying the problem. Changing your pain reliever to an anti-inflammatory (NSAID) like ibuprofen or ASA may be no better after alcohol consumption as the increase in inflammation in the lining of the GI tract can result in a serious GI bleed. Using codeine for pain relief is never recommended with alcohol on board.
The take away message here is if you are someone that is taking acetaminophen (or an NSAID or codeine) for pain, you are better off avoiding alcohol consumption even in light amounts. If you are someone with chronic or acute pain to the degree that one of these medications is needed, remember that the adverse effects can be quite sudden rather than gradual, and the use of lower dosages as recommended.
The front store of the pharmacy has traditionally been where the pharmacist and patient relationship grows to a level beyond where it would be with just prescription counseling alone. It affords to pharmacists a selection of products that empowers the lay public to take some sort control of their health in almost any way they choose. With certain selective issues (or perhaps a wider selection in their minds), they can bypass the waiting room of the physician, the poking and prodding, the embarrassing questions, the waiting at the pharmacy counter – all gone with just a wave of the hand from the OTC aisle to the pharmacist peering down to you from his or her stoop in the dispensary.
The general public questions this type of medical treatment very little, partially because of the level of trust that is consistently demonstrated towards pharmacists, or perhaps because most of what is available to choose from in this realm has been virtually unchanged in its ingredient list for decades. In fact I am willing to bet that if I were to walk through the aisles of my neighborhood pharmacy on the day I was born nearly 50 years ago, aside from a few struggles with brand names and a few recognized products that have been discontinued, the ingredient list on most items in the entire store would be much the same as my store today. This brings with it a level of trust in these products by the public, sometimes a false sense.
Back then many of these products were put there in the front store without a whole lot of randomized placebo controlled double blinded/crossover trials (RCT’s) that brought most of the prescription medications to market and back 50 years ago there was little debate as to their effectiveness. The pharmacist recommended it and you took it and it worked. That was that. The path that each product took to land on the shelves of your pharmacy each has a story and history of their own.
There is a growing concern that pharmacists are now selecting items for patients that have little backing scientifically. For example, one of these families of products, known as homeopathic, is one of them. Back 50 years ago you may have even spotted one of these in your neighborhood pharmacy. Now before I go any further I’ll end your guessing of my views of homeopathy: I don’t think it really does much of anything for anybody. For those of you still reading, because you’re in agreement of that last statement, just hold on a second. If we are slamming this mode of treatment because we feel the studies don’t back it or because there is nothing in the actual dosage form, that is fair enough. The supplement aisle is another category that brings about much criticism, and for the record, I have a different belief in this category (just not fanatical in like everyone should have all of them). But as “evidence based” practitioners, in all fairness we need to apply this to the entire store.
Applying our strong standard of evidence to everything else, we look with our magnifying glass at all other products: cough medicines, constipation relief, lice remedies, pain relief selections, antacids and reflux relief meds, skin creams, acne relief, teeth whitening (ok maybe not available in the 60’s), hemorrhoid relief, bug spray, lozenges, lip balm, and lots more. Can you quote or summarize the randomized controlled history for these categories? Perhaps can you find evidence against what you are recommending that product for? Acetaminophen for lower back pain? Cough syrup for someone with a common cold. You can check out a fuller explanation of these categories here .
So getting back to our original claim slammed against us: Why do we sell these items that obviously have some doubt as to their effectiveness? As a pharmacist I am always striving to supply what people want to use for their health as long as it does not harm their health in taking it. Secondly it should be effective. The order of these two is important. My community wanted organic food so that’s what I got in to sell at the pharmacy. Removed 12 feet of magazines and replaced it with organic, gluten free, non gmo. Does it harm them? No. Is it effective for what they are taking it for? Maybe. Maybe not. But it does not harm them.
When Cold FX was going through it’s court case on the claims it was making I voluntarily removed it from my shelves. When the case ruled in their favor I brought it back – much to the delight of my customers who had been asking for it for weeks and months. Is it safe – yes, and is it effective – who the hec knows. I push vaccines, but I also sell Muco Coccinum and stress that you cannot rely on that to prevent the flu or much of anything else. I sell probiotics but screen those with suppressed immune system who cannot safely take them. I ensure that it is used safely first and if it is effective for their gut health, immune health, skin health or mental health then so be it. I try to guide them with the studies I have available to me but first and foremost it must be used safely. That means the product won’t interact with their medication or medical condition or result in them omitting proper established treatment for their condition especially should it be serious or life threatening. No one should be curing cancer or treating their heart disease in this part of the store, but if they have a drug induced lowering of vitamin B12 then I’m their guy. If they are looking to prevent a cold they feel might be coming on with Zinc tablets then great (something I take).
The point of all this is most if not all of new drug research is targeted towards bringing new prescription medication to market, not OTC drugs. While it’s true that some prescription medication may trickle down to OTC status (and thankfully this should have RCT’s to back them up, which is great) not much groundbreaking in the OTC field happens for the most part. Recently I have seen a new product come out for varicose veins and one for vaginal dryness, but for the most part we are stuck with what we have out there, and it’s not an area where we test existing products on new indications, nor do we really go testing a lot of the current indications for existing products that they are sold for (perhaps with a few exceptions). Unfortunately the vitamin/supplement and herbal market is always pushing the boundaries of what science thinks will happen if you take pill A and what an RCT says. What this means is going forward we will be left with an aging pool of products, a number of which have questionable efficacy for the indication they are being sold for and a growing list of products that have the same backup. This pool may have some new additions here and there but the old standards stay around.
Complaining about a select group of these items such as homeopathy is noble, but is kind of two faced when we don’t slam other pharmacists that sell all the other products that have similar lack of actual evidence to back them up. Particularly when the pharmacist is following the law. Being a pharmacist is not being a doctor. We can now prescribe for minor ailments in my area, but the pharmacists today didn’t invent this front store they have available to them. A pharmacist’s recommendation may not always be the same as a doctor’s recommendation, or the same as another’s recommendation, but it should be as safe.
Most Pharmacists rely on the foundation that their “evidence-based” mantra is being followed. A simple Google search shows us that:
“Alternative medicine is any practice that is put forward as having the healing effects of medicine, but does not originate from evidence gathered using the scientific method, is not part of biomedicine, or is contradicted by scientific evidence or established science.”
Just in case you were wondering, Google defines biomedicine as “a branch of medical science that applies biological and other natural-science principles to clinical practice. The branch especially applies to biology and physiology”.
This last one is important as we shall see, because it opens the window for recommendations to be made even in the absence of placebo controlled randomized trials (but yet remain outside of the realm of alternative medicine). It allows biochemistry and physiology and biology to guide recommendations to patients, even though direct studies on humans measuring an effect compared to placebo are lacking. For example, if you are thirsty, drink water or you will eventually die. There really are no such studies to prove this but we believe it anyway. Fair enough. Let’s agree on this for a minute or two as we look at our “go to” recommendations we do every day in the pharmacy.
In 2012 the International Journal of Pharmacy Practice published a research paper that looked into the effect of evidence-based training on Pharmacists everyday recommendations. It found that Pharmacists did not routinely utilize evidence-based resources when making decisions about OTC medicines and some felt uncomfortable discussing the evidence-base for OTC products with patients. (1)
In fact most pharmacists go by three things when making OTC recommendations, what they were taught in school (since most OTC ingredients don’t really change all that much from year to year or decade to decade), what they learn through continuing education and what they see works in their patients over time (also known as clinical experience). This is why I gave up recommending OTC teeth whitening products. I do however recommend specialized toothpastes for sensitive teeth even though I have never read one independent RCT on either subject – because I routinely hear results from many customers. (2)(3)
These are simple recommendations that on the surface seemed to be a great idea. Not that the success of OTC teeth whitening grew into an urban myth to me but it really didn’t seem right to recommend something I had no scientific proof to back me up and make a profit on it plus lacked the positive feedback from my customers. Perhaps that is alternative therapy?
It’s part of every retail pharmacist’s day, stepping out from behind the dispensary counter and making recommendations that draws from the vast pool of for the most part, unchanging static list of ingredients in the front store. I draw a fair share of comments that claim some recommendations I make are “alternative” or “complimentary”, sometimes referred to as CAM therapies. The definition of this term seems to change with whomever makes up the argument. Some arguments against CAM are certainly legitimate, and some include categories that show some effectiveness but are not mainstream. Some involve treatment, cure or prevention of Health Canada Schedule A disorders, which include many conditions that we try to help daily – we just can’t advertise the products as such. They include obesity, hypertension, diabetes, acute anxiety and others. Either way, there are some regular recommendations made by Pharmacists daily that said Pharmacist assumes is proven to work based on mainstream suggestions, but are you making recommendations based on the same science that backs up the prescriptions you hand out daily. Furthermore, if these therapies do not meet these same evidence based standards, are they automatically shuffled into the CAM category or is there another category they might be moved into? Perhaps urban myths make mainstream otc pharmaceutical suggestions. Lets look at what the current literature says about common therapies. Are there any studies at all that back up what you are suggesting to your customer as fact? If there are studies, do they have the power to the same? If not, what is your rationale for making these recommendations and at what point do we call the recommendations as alternative or not evidence based. In fact, pharmacists do not always rely on the definition of evidence based in making an OTC recommendation.
Turning to the Cochrane Data Base, there are a few reviews for common OTC cough medications. In reviewing 29 trials involving 4835 people (adults and children – studies were current up to March 2014), the Cochrane Library stated “ We found no good evidence for or against the effectiveness of OTC medications in acute cough”. In a 2006 statement, the American College of Chest Physicians stated that its recommendation for cough due to cold was to treat with an antihistamine/decongestant combination. (4)(5) Also, the findings of using codeine or antihistamines for cough showed neither was superior to placebo. A study in the Archives of Pediatrics and Adolescent Medicine found that in Parent reported cough response to buckwheat honey, a DM cough syrup flavored with honey and a placebo, the honey alone treatment was superior to the DM syrup or the placebo in children. (6)(7) Popular cough syrups that use pine needle oil and Canadian Balsam in a capsicum tincture are popular in all pharmacies but lacking evidence.
Narcotics for pain
Marketing by drug companies has been quite successful in the widespread use of narcotics today. In fact when various types of pain are treated with opioids, NSAIDS, and acetaminophen, narcotics’ recommendations often fall at the bottom. Dental pain, while often treated with narcotics, has been shown by the Cochrane Database to be treated more effectively with combination ibuprofen and acetaminophen and back pain has also been shown to have more favorable outcomes when treated with non-opioid medications. (8) Historically pharmacists police OTC meds, sometimes blind while trying to keep patients restricted to a days supply. This is now going to be easier with the dawn of the Drug Information System (DIS) in Nova Scotia, giving more real time data than the triplicate prescription monitoring system. Logging in OTC codeine products allows pharmacists to see in real time the profile of the patient at other pharmacies that are also on the system.
It is becoming more and more clear that opioids are to be the exception rather than the rule when it comes to most pain relief. Terminal conditions involving pain are a clear indication for opioids. The numbers needed to treat are typically higher in the opioids compared to the non-opioid medications and in acute pain to chronic pain conditions the opioids are not preferred unless absolutely necessary. Jumping to OTC codeine has not proven to be the answer with most patients based on science.
Next to cough and cold, and analgesics, acid suppressing agents are a main staple in a pharmacist’s OTC toolbox. Three main categories are antacids, H2-blockers and PPI’s, all available OTC. Most pharmacists may be under the impression that when these are given, they help neutralize acid in the stomach in their own way and relieve reflux symptoms, and that’s that. It turns out these three medications have differing effects that must be kept in mind to help the patient. Antacids have a role in neutralizing acid in the esophagus transiently but do not significantly affect the pH in the stomach. As a result it has been found that in cases of chronic heartburn, repeated administration of antacids commonly result in erosive esophagitis. For this reason it is important to recommend them only in cases of GERD that is temporary or intermittent in nature and to realize that ulcer healing will be minimal. With the H2 blockers, there is a tolerance that can develop rather quickly with these medications that unfortunately is not dose dependent and there is also a secondary analgesic effect on the tissue of the esophagus. (9)
The key in OTC recommendations is recognizing the strengths and the limitations of each of these medications. Simply giving an antacid for a patient with “heartburn” without knowing the exact details of frequency goes against the indication for that suggestion. Monographs for these medications state a six week course and should not be used long-term for acid suppressing agents. It is important to not continue to give antacids too frequently in order to prevent further damage to the esophagus. In fact there is no evidence to support long-term treatment with H2 blockers or PPI’s.
While it was something pharmacists had suspected for years, it has now been shown in clinical trials that the effectiveness of the pediculicide known as permethrin has dropped from 99% in 1996 to 25% in 2009. In 2010 this effectiveness was estimated to be 18% as opposed to 46% for isopropyl myristate, which is now a popular alternative for head lice. This is a case of staying on top of current literature. (10) Although something may have been proven to work before, it may not have the same effectiveness now and is continued to be used assuming older data is still appropriate.
One of the most commonly recommended laxatives for both occasional and chronic constipation as well as narcotic induced constipation is senna. There are no well designed randomized placebo controlled trials for senna and for the most part I think most pharmacists are unaware of this and go by clinical results in making this recommendation. Also no known studies comparing stand alone efficacy of docusate over placebo exist. Fiber, fluids and exercise show surprisingly little results unless the patient is deficient in any of them. (11)
One of the common arguments against alternative therapy is not so much a lack of studies, but a lack of what is considered quality studies by the one against alternative therapies. Sometimes it is what the majority of us do that removes something from alternative. While there are no lack of studies on nicotine replacement therapy OTC in smoking cessation there are many limitations to many of the studies (12). This is a common argument against treatments that are considered alternative. At some point however we need to treat somehow and we see clinical results, based on science (RCT or biology) and we use this to guide our recommendations safely.
Having said all this, the point is from our experience most over the counter meds really do work for their intended uses. If we required iron clad prescription drug quality studies to flip through on all of our front shop recommendations, we may very well cut the front store medicine section in half, not to mention the prescription medications that are prescribed off label. Certainly a lot of the cosmetic anti-aging and skin cream products would fall away. We also must remember that although we counsel based on past results with patients, we still make recommendations based on our education. Being against alternative medicine, whatever your own definition, may mean supplements, nutraceuticals, hormone therapy or herbal products to you. Maybe you consider selling vitamins as alternative. Some bad examples of irresponsible alternative therapy have painted all therapies with the same brush, and some reported side effects and hospitalizations of patients using alternative therapies fail to mention hospitalizations of patients on conventional medicine. As pharmacists, we value what is considered modern medicine but it’s not all that is out there that works. We must be considered the drug expert in all therapies, whether they are proven and safe to completely unproven and unsafe and everything in between in order to make an informed recommendation. Perhaps “evidence based” is a point we try to achieve but never completely reach until we change our definition of what it is. Based on how we defined alternative medication at the start of this article, perhaps alternative therapies are not as uncommon in pharmacies as is claimed by those that are against them.
1) Lezley-Anne Hanna and Carmel Hughes; The influence of evidence-based medicine training on decision-making in relation to over-the-counter medicines: a qualitative study; International Journal of Pharmacy Practice Volume 20, Issue 6, pages 358–366, December 2012
3) Ilze Maldupa, Anda Brinkmane, Inga Rendeniece, Anna Mihailova ;Evidence based toothpaste classification, according to certain characteristics of their chemical composition ; Stomatologija, Baltic Dental and Maxillofacial Journal, 14:12-22, 2012
4) Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD001831.
5) Smith SM, Schroeder K, Fahey T. Over-the-counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev. 2008;(1)
6) Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents Arch Pediatr Adolesc Med. 2007 Dec;161(12):1140-6.
7) An De Sutter. There is no good evidence for the effectiveness of commonly used over-the-counter medicine to alleviate acute cough ; Evid Based Med 2015;20:98 doi:10.1136/ebmed-2014-110156 Systematic review
8) Dr Donald Treater M.D. Evidence for the Efficacy of Pain Medications. National Safety Council (NSC.org)
9) McRorie, J. W., Gibb, R. D. and Miner, P. B. (2014), Evidence-based treatment of frequent heartburn: The benefits and limitations of over-the-counter medications. American Assoc Nurse Prac, 26: 330–339
10) Sanofi-Pasteur , Evidence Based Management of Head Lice 2014
* (Sanofi-Pasteur is a manufacturer of ivermectin lotion)
11) Lawrence Leung, MBBChir, FRACGP, FRCGP, Taylor Riutta, MD, Jyoti Kotecha, MPA, MRSC, and Walter Rosser MD, MRCGP, FCFP Chronic Constipation: An Evidence-Based Review . Journal of the American board of family medicine July-August 2011 Vol. 24 No. 4 pp 436-451
12) Nicotine Replacement Therapy for Smoking Cessation or Reduction: A Review of the Clinical Evidence [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Jan 16. SUMMARY OF EVIDENCE.
-There are people out there for whatever reason, are not looking for you to make them happy or to make you happy.
-Being reactive in a discussion with a dissatisfied customer is much worse than taking a minute and putting yourself in their position.
-There are treatments that you see working clinically that you may or may not have been taught in pharmacy school or afterwards that may bring negative attention to you by strongly opinionated individuals. All health professionals are biased towards personal clinical experience. Your main goal is to keep patients safe and help them improve their health with their best interest in mind. (Haters gonna hate).
-There is virtually no workplace in the world that is exempt from workplace politics.
-Managing staff is like parenting: if both of you can’t separate the job from friendship, then both fall apart.
-As long as humans are involved, mistakes will happen. Showing that you have learned from the mistake going forward is the best response.
-If you are looking to make money off of filling prescriptions through third party reimbursement, remember they control your income so you need to come up with other ways to make money. Don’t be embarrassed to admit that you are trying to make a profit because that’s what keeps you in your neighborhood operating as a business making them healthier. If someone claims you are profiting off of sick people, that’s fair, but you are really profiting in making them healthier.
-Pharmacy is a dynamic business and you will need to be just as dynamic to be profitable. Many things are out of your control with your profit margin and this forces your profession to change to keep alive. Don’t be afraid to branch out within your scope of practice. Just don’t be a carpenter that tries electrical. This means providing services and products you didn’t before and actually charging for things that everyone takes for granted as being free.
-You may not be able to eat, drink or go to the bathroom when needed.
-Be aware of the difference between what you think is permissible income-wise with the government and what is really permissible. The former is irrelevant.
-Donating to your community may seem expensive but it helps to keep your business strong by keeping your community strong.
-You are the expert on medications, the doctor is the expert on medicine.
-Delegating authority is one of your strongest assets in success.
-No one pharmacist can be the number one go to on every subject, but you can be on one or two subjects. This is what will set you apart and make your business both interesting and profitable.
-There is a huge difference between a leader and a boss.
-The customer is not always right but they should walk away thinking so.
Who is it that really makes the final call on what your treatment is for any of your medical conditions? Most would say their doctor. As a pharmacist however I see something different. It is common to see a patient come to the dispensary counter after their physician has already phoned to see if a first choice drug is covered. Maybe I call the Doctor after I see the prescription and tell them the patient’s plan doesn’t pay for that choice. I see people go without therapy that used to be covered but isn’t anymore. OTC meds are often considered for the most part as “off the radar” for these plans, as if OTC means something useless or not Doctor or Pharmacist recommended. It is often frustrating for medical professionals to feel like their hands are tied and that they are being told what to write for. Newer and more expensive medications that may have obvious benefit over older drugs may be left out in the cold for lengthy waits until a plan decides to cover them. As well, unrealistic hoops may be required to be jumped through before an effective one is covered. It is not uncommon for refills to be made for an unused and ineffective drug that is not taken for weeks or months to show a plan that a drug is being “tried” in order to get the next one approved. Meanwhile the patient suffers needlessly until the more effective one is paid for by the plan. Slow prior approval processes can become mired down in a way that has patients waiting needlessly for letters from physicians, OT’s, and other specialists.
Unbeknownst to the rest of the world is the strangle hold these plans have on pharmacies. While it is true that pharmacies fill more prescriptions when patients have third party plans, it becomes a profit based on volume that puts big chain pharmacies that avoid smaller communities at an advantage and smaller more community minded independents out. Gone are the days when pharmacies had some say in their dispensing fee, now a four letter word to the public but the main way dispensaries make money. Pharmacies used to be and should be able to run based on their pharmacy sales but not so much any more. dispensing fees don’t cover the cost of filling a prescription for most pharmacies. For the first time we are now seeing a decrease in dispensing fees. It has become a take it or leave it contract.
Small communities that have relied on the donations of these strong businesses have seen this drop off or eliminate altogether, reducing spinoff benefits. Keep in mind that small independent pharmacies have a more timely and positive response to the types of charity requests seen daily. Preferred provider contracts give lower prescription prices at specific chains, something that used to be illegal. The drop in pharmacy revenue causes front store prices to climb and customers find themselves paying for services that they assumed should be for free, like tax receipts, refill extensions, med reviews, calling the doctor and consultations – things that we are accustomed to getting gratis.
So, physicians are somewhat dictated to, pharmacies are told their price for what they are selling and who is it that controls your health? Of course there are benefits. Most wouldn’t afford the healthcare they have without their plan and that plan is a business that deserves to have some control over its own costs. It should not be a dictatorship that slowly undermines our entire healthcare model.
The Value of a local Independent Pharmacy
It’s difficult to find anything for free these days. I see bills for such things as faxing to a local number, photocopying, corking fee to open wine bottles at a function, cutting up a cake, supplying year end receipts, filling out health insurance forms, consultations, supplying information, It is also difficult to have a donation request responded to without a waiting period for most people.
So what does a pharmacy do differently? (especially a small town or independent pharmacy). Well we give volumes of donations to local causes after weekly and sometimes daily requests. Quite often we give you your year end tax receipts free, call your doctor for free, fax your form to your drug plan (after we have filled it out for you), talk to you on the phone for 10-15 minutes at a time or sit down for even longer about your health concerns for free. In my area I am the only pharmacy and often a temporary charge medications if a patient doesn’t have the money, I do public speaking for free for anyone who asks. I do glucose and cholesterol tests for free, make deliveries daily to our nursing home and supply free INR tests to their residents as needed, and OTC counselling off and on all day long. Most people assume many of these things are done readily for free by their local pharmacy. Other services eek their way out as well, like a 45 minute grocery store tour to help people eat better http://www.stonespharmasave.com
While it is true that pharmacies charge a dispensing fee for filling a prescription, it is that one fee that fuels most of these other daily contributions and tasks. Keep in mind that some pharmacies charge for some of these services and some do not. As well, lots of businesses do stuff for free. Should I be charging for all of these services? Some would say yes. The local independent pharmacy that sticks out its neck and serves the small community that bigger name pharmacies don’t go is invaluable to the community in more ways than just a place to fill prescriptions.
There seems to be no bigger a disconnect than the opinions between the camps that are either for or against organic food. Virtually anything one reads on the topic sets its tone early on the purpose of the article so as to give you have a pretty good idea of what side they will be taking. There is always a sort of subjective vibe you get based on the author or the early wording. I often refer to science as a puzzle that needs all of the pieces included to get a full picture of what it is trying to tell us. A key piece to the puzzle that we often don’t have available to us is time. While it is true that fruit flies have given us the luxury of accelerated generations in a usable period of time in scientific discovery, in the field of GMO products, time is the one variable we need (and don’t have) in order to make a full discovery of how this new food affects humans. I am the first to agree that we are not getting slammed in the face with blatantly obvious effects of GMO foods, but we cannot hide the fact that studies to date are not completely one sided in declaring these foods safe yet. “Safe”: meaning long-term health effects.
So, to sum up, the pro GMO side says no evidence against so they are safe and/or they are safe because studies show no harm is caused (the null hypothesis pushes through), and the con GMO side says there is evidence suggesting harm and/or there hasn’t been enough time to determine an effect medically so we should err on the side of caution (much like the way we were told to eat back in the late 70’s and early 80’s regarding carbs and fat which has been shown to cause more than a generation of obese North Americans). The same species of beings reading the same studies can lead to different results, or maybe some read what they want and promote certain conclusions.
As there is always something new around the corner in science to cause quarrels because we find the need to have an answer immediately, enter e-cigarettes. If there ever was something out there that seemed like a bad idea from the start this could be it. But let’s look at the science before we jump to any conclusions. I recently read an article by Joanna Cohen, the director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg Schools of Public Health. She is and has been quite involved with tobacco policy research for quite some time. Even she cannot come to a conclusion based on the available science that e-cigarettes are good or bad. Despite the fact that nicotine, carcinogens and chemicals considered toxic to humans are found in these devices and the vapor, we still must wait on science to tell us whether there is harm or not; and until we find out how to teach fruit flies to use these devices, we are left testing slow breeding human beings and looking for the development (short and long term) of adverse medical effects. In fact we are already seeing a ban on use of these products sometimes in areas where traditional cigarettes are banned. Seems fair enough when you try to use logic before a scientific study (which seems like an oxymoron) given what little we know about e-cigarettes. In fact I almost hit the floor when visiting a pharmacy in the US when an employee was actually using an e-cigarette at work in the aisle! After all where does all of that material go when it is vaped into the air? Outer space? More likely it goes into someone else’s lungs eventually. Isn’t this how the widespread acceptance of tobacco smoking developed into last century?
So to sum up, the pro e-cigarette side says no evidence against so they are safe and/or they are safe because studies show no harm is caused (the null hypothesis pushes through), and the con-e-cigarette side says there is evidence suggesting harm based on what is in the vapor and/or there hasn’t been enough time to determine an effect (much like the way we were told to back in the late 40’s’s and early 50’s regarding smoking tobacco which has been shown to cause more than a generation of lung cancer stricken North Americans). The same species of beings reading the same studies can lead to different results, or maybe some read what they want and promote certain conclusions.
Does that last paragraph sound familiar? It should since it is almost word for word the same as the second paragraph written here.
So then why are you normal and logical when you think e-cigarettes should be restricted in whom they are sold and marketed to and where they are used as well as how your national health watchdog regulates them; however, you are a quack, fear monger and a charlatan when you even suggest a conclusion about GMO foods by using the same analytical thinking? While I am not suggesting the health effects, if any, are even remotely linked between these two things, the logic of how we argue for or against them and openly ridicule each other on our stances follows a different set of standards between them.
Countries that label GMO food as such and yet ban the use of e-cigarettes in enclosed spaces in truth are likely following the same thought process for both decisions.