The Evolution of a Skeptic Pharmacist

Today’s post is a guest contribution from a Canadian pharmacist who is writing under the pseudonym Sara Russell:

For several years after graduating from pharmacy school, when I’d answer the question “What do you do for a living?”, it would be met with responses like “Good for you!”, “You must be so smart!” or simply “Wow!”.  After a decade-long absence from a role in direct patient-care, I returned to pharmacy.  I noticed that my response to that same question was met with much less enthusiasm, with some people even having trouble hiding their disappointment.  How did this happen?  When did being a pharmacist have less caché than saying you worked in a health-food store?

When I began my pharmacy career, so-called natural therapies were very much in the background.  I worked in a hospital oncology setting, and observed patients in the waiting room passing around the name of the latest herbal cancer cure.  This was before the internet age, so information was passed word-of-mouth, and evidence to support or refute these claims not easy to find.  If the oncologist found out, he would usually suggest they discontinue the remedy due to possible interference with their treatment protocol.  I don’t think very many complied with this request, and a few admitted to me that they simply would stop telling us.  Looking back, this was the genesis of my skepticism.  Not wanting them to keep this information from us, I made it my mission to investigate the claims of the various teas and capsules and report the findings back to them.  As a relatively new graduate, I embraced the possibility that there was a miracle cure out there and I hoped to be able to find information to confirm their hopes.  As I searched, time and time again I came up empty.  Strangely, some of the herbs had not even been associated with cancer treatment.  I came to realize that the message between patients became like the telephone game I had played so many times as a child.

Fast forward through a decade-long education in drug information, sales & marketing in the pharmaceutical industry, and I now embraced evidence-based medicine as a mantra of sorts.  One may think that the term “evidence-based medicine” and pharmaceutical industry don’t belong in the same sentence, but it was there that I learned the art of dissecting research and how to interpret results – a skill that I later realized was used more often to combat competitor’s claims than to support those my own company was boasting of.  I became the sales manager’s worst nightmare during training sessions, but my devotion to evidence actually served me well in my sales role as the physicians with whom I developed relationships trusted me.  Ultimately, I realized that I was not the right “fit” for a sales role, and my career in retail pharmacy was born.

After 15 years in other settings, I was ill-prepared for what I found on the shelves at my first retail job.  What was homeopathy again?  Didn’t we learn about that in History of Pharmacy 101?  Why is it back again?  What was Cold-fX, and why were so many people asking me for it?  If I were to be effective in my job I had to find these answers, so I took my drug information skills, and set to work.  I signed up for a basic homeopathy course offered by Boiron.  I laughed all the way to earning my certificate, which I decided not to print off for display in the pharmacy, as was recommended.  Searching less biased sources of information on homeopathy only deepened my feelings of incredulity.  The rep for Cold-fX had conveniently dropped off some published studies for me to read.  After reading them, I was not only underwhelmed, but wondered how so many other pharmacists could embrace it so enthusiastically.  Clearly, they must not have read the studies?  Mark Messier and Don Cherry knew better than I did though, so I quickly found out that few patients cared for my opinion.  The pharmacy owner encouraged me to adopt the mantra “What’s the harm?” and allow customers to try whatever they wanted as long as there were no obvious risks.  Still, I had this nagging feeling that to do so would be unethical, given that there was no real evidence to support their choices.

Then came the great flu pandemic.  Patients descended on us suffering obvious symptoms before the vaccine program rolled out and were looking to us for guidance and leadership.  Stories about vaccine dangers and conspiracies were swirling among family and friends and spread like another plague on Facebook.  Suddenly oscillococcinum was the most in-demand product in the pharmacy, and learning about it ultimately forced me to finally choose evidence over health freedom.  Indeed, I now saw its sale in pharmacies as not only unethical, but fraudulent.  A skeptic was born.

By pure luck, a pharmacist friend linked to this article on Facebook, which I shared with friends who had irrational fears about the vaccine.  Sadly, some responded with their own links to whale.to, Mercola and NaturalNews.  My fate was sealed, however, and I decided to make it my mission to educate the misinformed.  Daily visits to Science-Based Medicine soon lead me to the blog you’re reading, Respectful Insolence, and Skeptic North.  Understanding the difference between evidence-based medicine and science-based medicine completed my evolution.  Some friends began to poke fun at how closed-minded I had become.  They began embracing “all-natural” lifestyles, embracing acupuncture, and ridding their bodies of toxins with cleanses.  I began to realize that I was running up against a mountain when it came to debunking widely-held opinions, and decided to retreat into the valley to regroup.  I am not waving the white flag, however, as I am hoping that other health care professionals become more vocal:

Pharmacists, in particular, I call on you to scrutinize new products, dig into outrageous claims, and teach patients the difference between herbal and homeopathic products.  Don’t be afraid to comment on articles in our pharmacy publications that are lacking in evidence.  Nominate pharmacists for awards that thrive in business with practices such as Schill’s Remedy’s Rx as opposed to those that profit from the Suzanne Somers method of health. Pharmacy students – form skeptical student groups and question evidence presented to you as facts in lectures.  Send people to this website to read the many excellent posts written by Scott.

As many people aren’t equipped to interpret science-y information, sometimes I adopt the “fight propaganda with propaganda” routine, and send people to the CBC website to watch a few excellent episodes of Marketplace debunking homeopathy, Cold FX and food labels that appeal to the naturalistic fallacy.  While I don’t chase people down who put Stodal into their carts, for those customers that ask for my help, I do provide a quick lesson in homeopathy or in the case of a product like Cold-fX, show them the bottom line on the evidence.  In the majority of cases, people feel misled by the hype and walk away $10-$20 richer.  Plus, given that many hold the impression that pharmacists only want to sell products, they realize that I can be trusted for honest advice.  One customer, a highly-educated well-to-do prominent local woman to whom I’d just explained homeopathy declared “That is something I’d be totally into!”

So I realize I can’t win everyone over, but I can try – one customer at a time.

Next up …. Skepticism in a small town, and why I retreated into the valley – again.

Photo via Flickr user ell brown under a CC licence.

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9 thoughts on “The Evolution of a Skeptic Pharmacist

  1. Your story is my story, only I’m not a pharmacist, just a long time skeptic who learned basic science, thank goodness, in college–not that that has stopped many of my peers from wandering off the cliff of woo.

  2. Stacy Jardine says:

    I’ll keep this short because I could sing your praises for days! Because of this blog (and others linked to it) I’ve developed the same practice strategy as you – don’t chase em down but answer truthfully. Only one time (and recently) a lady flat out accused me of working for Big Pharma. I DIDN’T EVEN RECOMMEND PILLS! I was trying to explain why you don’t want to change your blood pH. Sigh. Keep up the fight…one person at a time.

  3. loudsnorer says:

    Thank you for sharing! Excellent points.I think this is the critical thinking skill/attitude that we pharmacists should have. I would add that the same attitude should be applied to all health products, whether it’s homeopathic, “natural”, Western, Eastern, traditional, unconventional,…

    Personally, I consider all products as “placebo” unless proven otherwise. Unfortunately, many drugs do not have strong evidence that demonstrates clinically meaningful benefits. But at least we should acknowledge it and be open about it, rather than making claims…

    Your first paragraph is thought-provoking.

  4. Thanks for fighting the good fight. I know how hard it is to see your friends rely on evidence-free health care treatments and consider you closed-minded for not doing so. This blog and Science-based Medicine have helped me a lot as far as being informed and able to argue my case.

  5. CatWill says:

    I am humbled by your reference to our dispensary in your blog. Thank you, I look forward to reading more.
    Catherine Schill B.ScPhm

    • Sara says:

      I recently read the article in Drugstore Pharmacy. It seems you’re practising the kind of pharmacy we all dreamed of when we graduated! I wanted to link to the article but it wouldn’t work due to the login requirements.

  6. I’m so happy to have read this article! Got here via Science-Based Medicine blog looking up the IgG testing my usual pharmacy has started flogging, and really wanting to vote with my dollars and go somewhere woo-free, or at least reduced-woo. Would the Remedy’s in Edmonton be a good place to try? Are you allowed to name names and make recommendations? I would love it if you could. Thanks for any advice you can give!

  7. Incision says:

    Well done to the author, spot on – I followed the same route you did and cannot agree with you more on the state of the business. I have long shared your view of the pharmacy profession (Also a pharmacist myself) and reached the same conclusion that ethics goes out the window when total sales come into play.

    We also had a homeopathy section in shop and my response to people asking for it was always along the line of “But you know it doesn’t actually work, don’t you?” And if they asked why not (Usually with eyebrows raised…) I gave them something to think about of what homeopathy and the placebo effect was about.

    Unfortunately these people are so far gone in their beliefs and scepticism of “Big Pharma” that a quick discussion would not enlighten them. What really scared me was how many pharmacists are going along with it either through ignorance about evidence-based medicine or by wilful ignorance of what they are selling to the public, the business is rotten at the core.

    The problem is that the homeopathy and naturopathy fields are very poorly regulated (If at all), and that just about anyone with a kitchen and a garden can put something on the market and border on making a claim. People not trained in science should be protected by the government from companies making unfounded claims in the media (Don’t even get me started on the media…), but how can this be done if the governments themselves are biased or ignorant about science? Love the blog, keep it up!

    ((By the way, anyone else bothered by the advert on this page by “world class psychic Norah”?))

  8. Ann Ominous says:

    I know a pharmacist who responds to the statement “But its natural” with “So is horse shit…would you eat that??”

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