Sunday, March 14, 2010

The Weekend is Almost Over

I wish I could change jobs, but I have no idea what I would do. I've come to the conclusion that I don't really like the profession of pharmacy or the health care profession in general. I feel like I'm doing more harm than good by promoting medication therapy to people. As I've said before, I don't take anything besides sudafed or Tylenol every once in a while. I don't believe medication is the secret to staying healthy for longer. I firmly believe that a healthy diet, good exercise, and an overall active lifestyle does more to help pretty much everything than drugs do.

Sure, medication has it's place. However, I just feel like in my pharmacy, most of the drugs we dispense are unwarranted. I mean, how can the most prescribed drug in the United States be Vicodin? Why do we have to keep more Percocet in stock than HCTZ? How come every child in the world now gets Ritalin, Adderal, Concerta, and now Vyvanse? Is it right to be handing out Lipitor to the man that's 100 pounds overweight, when if he just ate right, exercised, and lost weight, he'd decrease his risk for heart disease more than Lipitor ever could?

Everyone is looking for shortcuts to good health. Everyone wants to just take a pill and go right on doing what they were doing before. Hell, they're even doing research to see if they can make a pill mimic the effects of exercise on the body. We've reached the point where we even want our exercise to come in pill form!!

Furthermore, what happens if we just took all these drugs away? No more Lipitor. No more Actos. No more blood pressure medication. Basically no safety nets. You tell people, "look, you can live however you desire because this is a free country. However, if your poor eating habits and sedentary lifestyle end up causing you to develop heart disease or diabetes, you're going to have to live with it." No drugs to bail them out. If they don't live healthy, then they increase the chances of being sick, and once sick, there's nothing anyone can do for them.

Maybe if there were no drugs to fight these more or less preventable diseases, maybe people would take better care of themselves in the first place.

I think I'd love to be a personal trainer or a dietitian of some sort. I'd love to tell people how to work out in order to be as strong as they can be, and I'd love to teach people how to eat healthy. However, it's difficult making money in that kind of field, and sadly, I've grown accustomed to my 6-figure salary. I don't think I could afford an $80,000 per year pay cut in order to do the thing that I like the most and feel has the most worth. Therefore, I'll just keep chugging away at a job I don't particular like or believe in.

Maybe one day, I'll have the courage to just say "fuck it." I'll walk right out that pharmacy door and never look back. I wouldn't worry about money or plans for the future. I'd just go wherever my heart leads me. Maybe I'll only end up making minimum wage and struggling to make ends meet every month. At least then, a little part of me wouldn't die inside every time I go to work.


Anonymous said...

Not to mention that many of the side effects of drugs are worse than the actual symptoms of the "disease."
This is especially true with anti psychotic medications.
Tardive dyskinesia, which causes uncontrollable shaking all over the body is permanent in almost half of all cases. How can doctors live with themselves for prescribing this stuff? How are these drugs even legal?

Anonymous said...

How about you start saving now and when you have a sizable amount switch to part time and go back to school. When you finish you can work part time for both? One job that pays the bills and one that you enjoy? Or just do volunteer work.

Anonymous said...

I know exactly how you feel. Going into my 5th year of pharmacy school, I had enough. I am now well over 100 grand in debt and still not sure what I want to do, but am sure that pharmacy was not for me. Worked 4 years in retail pharmacy and a job I once loved I now despise. You have to do what makes you happy, otherwise you won't stay sane. Good luck.

Pharmacy Mike said...

Your example of antipsychotic meds is a little off the mark. Schizophrenia and other real psychological disorders often require these drugs just so the person can function in society. You can't exercise your way out of schizophrenia.

Yes, the side effects are bad, but often times the risk of adverse reactions is far outweighed by the benefits of the drugs.

Anonymous said...

Actually I've done extensive research on schizophrenia (which I know doesn't make me an expert or even close to it). Heck, I'm just a college student. However, I'm not just saying this stuff randomly. Drugs for schizophrenia don't act on any particular brain region. They basically emotionally blunt the person, so they have no idea what the hell is going on. In addition, many schizophrenics have had sexual and/or physical abuse in their childhood, which casts doubt on schizophrenia being an organic brain disease. In addition, many of these drugs actually shrink the brain. When research studies are being done on schizophrenia, they don't take into account what drugs do to the brain. Many scientists say schizophrenia is the cause of brain shrinkage, when in actuality, its the drugs. I can send you my research paper on the myth of schizophrenia. It's a fascinating topic.

PharmJam said...

I think the first comment is a good example of the level of understanding the public has when it comes to health states and treatment in general, a very remedial understanding. It is our job to do our best to educate them.

Pharmacy Mike said...

While we may not know everything about the schizophrenic brain, we do know a good deal. We know that schizophrenia is a result of excessive dopamine. We know that if we give patients dopamine antagonists, we can alleviate a lot of the symptoms of schizophrenia.

As far as blunting a person's emotions... schizophrenia actually does that itself. A blunted affect is one of the negative symptoms of schizophrenia. First generation antipsychotics (haloperidol, chlorpromazine ,etc.) only treated the positive symptoms (i.e. paranoia, delusions). However, they didn't touch the negative symptoms. The newer antipsychotics (Geodon, Risperdal, Zyprexa, etc.) treat both positive and negative symptoms.

As I said, these drugs do have a lot of side effects. However, the newer generation drugs cause movement disorders (dyskinesias, dystonia, tardive dyskinesia) less often than the first generation antipsychotics.

I have a customer who is a shining example of how antipsychotic meds can benefit someone. He's schizophrenic, and he used to be bat shit insane. I mean, he used to be loud, rude, and just had the look of a crazy person all the time. As a last resort, he was put on Clozapine, and the transformation is unbelievable. He's now the most normal person you'll ever meet. He's well-dressed, well-mannered, and very friendly. He's just a totally different person. Clozapine has given him back control of his life.

That's not to say that these drugs aren't often used incorrectly. However, there certainly are many legitimate uses for them.

zin said...

I'm not saying that antipsyotic drugs don't have their place. I'm just bringing up the horrible side effects. The whole problem really is the concept of schizophrenia itself. For example, there is no agreed upon definition. You essentially have a mix of positive and negative symptoms all bunched under one name. People can have 15 different symptoms and still be diagnosed as schizophrenic.
Scientists are studying different groups of people, which essentially makes all research meaningless if there's no common defintion.
Even Bleuler, who came up with the term schizophrenia,
admitted that it is probably a group of different disorders and not a single disease.
The dopamine hypothesis of schizophrenia has not been proven. Besides many antipsycotic drugs actually increase dopamine activity. So if schizophrenia is caused by increased dopamine activity, how are drugs that increase dopamine activity helping?

I don't pretend to know what's going on in the brain when it comes to these drugs, and you know far more about how these drugs work on the brain. However, there is a huge problem with the whole concept of schizophrenia.

While some schizophrenics do have brain damage, studies suggest the majority of schizophrenics been abused in their past. It's been shown that sexual/physical abuse can change brain structure. This means that even if
schizophrenics do have brain damage, labelling it as schizophrenia is
pretty pointless, when it could be from the trauma of sexual abuse.

I didn't mean to get into this discussion, but you seem to be pretty open-minded.
If you are the least bit interested, I would love to send you my research essay on schizophrenia that I did for my Abnormal Psychology class.


Anonymous said...

I agree. We just had our third patient die this year from an overdose on prescription meds and it's only March. All relatively young people too (26-35 age range). It's so sad and such a growing problem

Pharmacy Mike said...

I guess my overall point is that regardless of how the disease originates, the drugs help.

My post was about drugs being used as a short cut to better health. People could exercise or eat healthy, but instead we'd rather eat like crap, sit on the couch all day, and take Lipitor.

You can't exercise your way out of a psychological disorder though regardless of how the disorder came about. You can lose 100 pounds and better control blood sugar levels. You can't lose weight and help paranoid delusions. Many of these people aren't mentally well enough to function in the world. These drugs help them.

I'm not arguing with you or even disagreeing with you. Honestly, psychiatry is one of my weaker areas. I just think the example doesn't quite fit into what I was talking about in my post.

Anonymous said...

Have you ever read your PDR and been amused that every time you read something about type 2 diabetes, it always lists diet and exercise FIRST and then medication?

I also love how these people ALWAYS come through the drive-thru!

Anonymous said...

I am an MD. If I don't give that guy Lipitor or some other lipid lowering agent and if he has a heart attack (forget the fact that he is lazy, smoking and fat)then I'M SUED because I did'nt stop him form having the heart attack! Like that's all it takes! Now if I document that I counseled him on all of these lifestyle changes to make and I give him Lipitor and he still has a heart attack, then I'm covered!

Pharmacy Mike said...

I'm not pointing fingers at MDs saying they prescribe too much. I was just talking about societal views in general. We believe the answer for every ailment is in some kind of pill. Instead of taking responsibility for our own lifestyles, we want scientists to develop drugs that allow us to live however we want and still be healthy.

You do bring up another interesting point... How much of medicine is governed by the fear of being sued? It's seems like the most commonly uttered phrase by physicians and pharmacists is "you have to cover your own ass." We have to do everything we possibly can, even to the point where it's beyond reasonable to do so, just to cover ourselves in case something goes wrong and we get sued.

All these reasons are why I wish I could get out of the health care profession.

zin said...

You're right, I did get off topic with schizophrenia and antipsychotic side effects. But, it related to the post in that consumers want a quick fix to their ailment, yet many forget of the horrible side effects that are often just as bad as the actual disease.
I think it's important to know about these horrible side effects even of the newer generations of these drugs.


Anonymous said...

Amen brother.

rinter said...

Mike, I understand your feelings. Maybe you can save up a good nest egg and become a personal trainer in the future? (not sure what training entails and how much capital you need to start your business) I was sad that you felt so burnt out, because I enjoyed your pharmacy blog so much! (about the patient care dealie, my local doctor's office actually has a pharmacotherapeutics specialist in their staff who counsels on diabetics) Could that be something you can look at? Though not sure what residencies are out there (plus competitive). Good luck to whatever you do, but please keep up the blog

Rinter said...

About the ideas of Western medicine, believe me, overseas, they are not obsessed with pills and would rather do natural lifestyle steps, i.e. eating more fruits/vegetables. However, I would say the mental health field is by far better here than overseas which the mentall ill are often shlepped onto the streets.

Jessica S said...

Sorry but I have to disagree. Without medications many people would die and be in terrible pain. I know there are some medicines that people just can't live without. I have a younger sister that has to take Concerta everyday or else it is impossible for her to concentrate. My dad tried to wean her off of it a couple of years ago and it ended up hurting her even worse. It really bothers me when people say that ADHD isn't something serious and it's just an excuse for bad parenting. Have you thought about patients who were born with diabetes? Or the patients who got a limb amputated? Without proper pain medications they would go into shock and die. Granted it is true that diet and exercise could probably help the patients who are overweight and lazy. But what about the other patients who are average but just sick? Without the right medications who knows where they would be now.

no pcat pharmacy schools said...

a professor related a pharmacist as a single cog in a huge corporate machine. I have read and heard about so many unhappy retail pharmacists. Taking that paycut from the get go might pay off in the end.

The Redheaded Pharmacist said...

Everyone wants that magic bullet that will cure all their problems simply by popping a pill into your mouth daily. The problem is that drug doesn't exist. But that doesn't keep companies from trying. I know of not one, not two, but three companies working on a medication for gambling as we speak. There are trials right now for alcoholism medications and more weight loss drugs. And there is even an investigational study being done to try and come up with a pill that will mimic the benefits of exercise! An exercise pill, really? I'm guessing that last one will never make it to market but I could always be wrong. The problem is that it is so much easier to take a pill than to make the effort to improve your life by hard work and effort. Why exercise when you can take Alli right? Sadly, it isn't that simple.

Anonymous said...

Pharmacy Mike,

I enjoyed reading your post. I am a registered dietitian, thinking about going back to school for pharmacy :)
I've enjoyed my career in nutrition for personal reasons (helped me run a marathon, stay thin, give advice to friends and family). But, unfortunately I can't make a living promoting a healthy lifestyle. And to be frank, I am sure I get as frustrated (if not more) with my clients as you do with yours. Most people would rather take a pill, than change their lifestyle (sadly).

Anonymous said...

I completely agree with you and your assessment of the state of medicine currently, and frankly, the state of American culture that demands an "easy fix" to all problems. I think you can do this as a pharmacist, its not easy. Find a way to involve yourself and market Disease State Management Programs. Think about a BP or Diabetes (e.g. the diabetes prevention program trial) where you help control a patient's disease process using non-pharmacologic means. That is a huge selling point if you can tell patients you are working to get them off of medication. Just an idea!

I think there is also a huge need for socially responsible pharmacists to get involved in public policy. Food labeling, school meals, regulation of tobacco, unhealthy foods (e.g. mcdonalds) etc.

Anonymous said...

become a PA there would be one less cant write rx's md to worry about

AnotherRxTech said...

These exact feelings are what have led me to drop out of pharmacy school shortly after starting. I was a tech first, thought I'd found what I wanted to be when I "grew up," but the more I've learned, the more I realized that I didn't want to be a part of what was going on around me. I already feel as if I'm complicit in a fraud on most of our patients, and I don't even have the authority to counsel yet. I can't imagine how I'd feel after 20 years of dispensing drugs like Celebrex, Lipitor, and Lexapro (and the crappy 'blockbuster' drugs that replace those after the patents expire).

Like commenters about have said, there certainly are some drugs that, when prescribed and used properly, do change people's lives and/or enable to them to live them more fully. Bad the sad truth is, most of the prescriptions we sell don't fall into either of those categories. And the even sadder truth is that the industry isn't going to change anytime soon.