The Wonders Of Modern Medicine

Well, you usu­al­ly don’t hear any­thing about phar­ma­cists in the news. We have heard a lot over the last week or so, and it has­n’t been all that favor­able.

I’ve been debat­ing on writ­ing this blog arti­cle for 10 months now. I did­n’t want to offend any friends with it, since I have a num­ber who are phar­ma­cists, many who are con­ser­v­a­tives, still more who are Chris­tians. How­ev­er, I don’t think they’ll be offend­ed at all if they’ll just read what I have to say.

Phar­ma­cists are like engi­neers in at least one way: when they make the news, it is almost nev­er a good thing. Last Spring, a num­ber of phar­ma­cists made nation­al head­lines when they refused to fill pre­scrip­tions for The Morn­ing After Pill, which isn’t so much a sin­gle pill as a short reg­i­ment of pills. Brand named Plan‑B, made by Barr Phar­ma­ceu­ti­cals, went against these pro­fes­sion­als’ reli­gious beliefs and so they stat­ed that they could not in good con­science sell it. The facts have seemed to me hard to pin down on exact­ly what hap­pened in any one case, but I have found some records 1. Par­tic­u­lar­ly, to what lev­el were these women denied hav­ing the pre­scrip­tions filled? Some report­ed that two women were sim­ply told to come back at anoth­er time and con­sult a dif­fer­ent phar­ma­cist who would be com­fort­able dis­pens­ing the med­ica­tion. How­ev­er, oth­er women stat­ed that a phar­ma­cist had tak­en their pre­scrip­tion, refused to fill it or even give it back so they could go else­where. Fur­ther yet, some stat­ed that they were giv­en lec­tures by phar­ma­cists on abor­tion and reli­gion.

In response, the gov­er­nor of Illi­nois signed into law a rule requir­ing phar­ma­cists to fill these pre­scrip­tions with­out delay. Five phar­ma­cists from Wal­greens were sus­pend­ed or fired, along with at least one from Tar­get. Sev­er­al more states are con­sid­er­ing a vari­ety of laws, from requir­ing pre­scrip­tions to be filled to pro­vid­ing rights of con­science for phar­ma­cists and oth­er health care work­ers. The phar­ma­cists from Wal­greens are suing in Illi­nois, claim­ing they were fired in vio­la­tion of the state’s health­care work­er’s rights act for not agree­ing to uphold the new with­out delay law. More recent­ly, the Mass­a­chu­setts state Board of Phar­ma­cy required Wal-Mart to begin stock­ing and sell­ing Plan‑B to com­ply with the state’s law for stock­ing all com­mon­ly pre­scribed med­ica­tions.

Allow me to attempt to out­lay some of the dan­gers of both sides of this argu­ment. First, as a licensed pro­fes­sion­al, telling a phar­ma­cists to just ‘shut up and do your job’ has severe dan­gers entailed. They don’t sell paper­clips back behind that counter. Pre­scrip­tion med­ica­tions are often dan­ger­ous or even life threat­en­ing if not tak­en prop­er­ly. The phar­ma­cist serves as a safe­ty guard between the physi­cian (who typ­i­cal­ly only has one course in med­ica­tions and the pam­phlets the drug reps leave behind) and the patient. The num­ber of calls made by the phar­ma­cist to a doc­tor or nurse alone regard­ing mis-pre­scribed drugs is enough to mer­it their role. They do much more, but let’s be clear: they have a license for a rea­son. They are trained health care pro­fes­sion­als whose judg­ment helps patients’ lives. Telling license pro­fes­sion­als to shut up and do their job results in tragedies, and when tech­ni­cal­ly igno­rant law­mak­ers step in to force that men­tal­i­ty, the pub­lic is receiv­ing a dis­ser­vice. Par­tic­u­lar­ly in the case of phar­ma­cists, telling them to just fill what­ev­er comes across the counter is a recipe for forged pre­scrip­tions, doc­tor shop­ping, and drug abuse.

Now, on the oth­er side, becom­ing a licensed pro­fes­sion­al requires one to make cer­tain promis­es to the pub­lic, for it is they in the end who have grant­ed us the license to prac­tice. Through a proxy of a state-board of pro­fes­sion­als appoint­ed by an elect­ed gov­ern­ment, we answer to the pub­lic. Not indi­vid­u­al­ly, but by con­sen­sus. Fur­ther, we do not have the author­i­ty to think that any one of our judg­ments so vast­ly out­weighs those of the rest of our field that we can sim­ply ignore any rule or code. Also, we must not be activists for some cause that is whol­ly sep­a­rate from our work when per­form­ing those duties. We are not robots, and all have our own morals. How­ev­er, morals must nev­er be con­fused with pro­fes­sion­al ethics2. Again, in the case of phar­ma­cists, they must refrain from forc­ing their views upon patients. It is not their pro­fes­sion­al role to judge and enforce laws which aren’t asso­ci­at­ed with their license.

If a phar­ma­cist is uncom­fort­able from fill­ing a pre­scrip­tion, for what­ev­er rea­son, this should be made clear to employ­ers and patients in advance (yes, even post­ing signs to that effect). When a patient does present such a pre­scrip­tion to the phar­ma­cist, then it is their duty to give them the oppor­tu­ni­ty to have it filled by anoth­er staff mem­ber or a phar­ma­cy in the imme­di­ate area. Bar­ring that pos­si­bil­i­ty (think rur­al areas), the phar­ma­cist should fill the pre­scrip­tion. This is essen­tial­ly what the Illi­nois law requires and is what the APhA states [pdf] is it’s pol­i­cy on the mat­ter. The notion of being able to deny health-care ser­vices to some­one a pro­fes­sion­al does not feel com­fort­able pro­vid­ing for is a dan­ger­ous con­cept. I can assure you, some­one out there does­n’t want to help you because of some­thing you are or have done. None of us will be ben­e­fit­ed by allow­ing that to hap­pen (for­tu­nate­ly, the vast major­i­ty of health care work­ers under­stand that their oaths does not allow for moral judg­ments of oth­ers).

Last­ly, and more to the point of this case of Plan‑B. I real­ly think that the phar­ma­cists in ques­tions should famil­iar­ize them­selves more with the sci­ence of how the drug works. In laymen’s terms, the drug can­not work if if a woman is already preg­nant. All it does is pre­vent the egg from being released or the sperm from fer­til­iz­ing the egg (it is just a strong dose of birth con­trol, after all, not RU-486). It is no more an abor­ti­fi­ciant than a con­dom is, or for that mat­ter, the fact that you’re read­ing this and not hav­ing sex is (blog read­ing is a very effi­cient form of birth con­trol). If life begins at con­cep­tion, as many main­tain, then this sim­ply can­not be abort­ing life. Life by that def­i­n­i­tion has not yet hap­pened. Phar­ma­cists are health care pro­fes­sion­als, and it seems a dis­grace­ful mark on the few that don’t wish to be both­ered with under­stand­ing biol­o­gy that might con­flict with knee-jerk judg­ment.

My final point: shut up and be a pro­fes­sion­al. It’s a high stan­dard, but it is what you are trained for.

Am I com­plete­ly off the mark here? Is every­one offend­ed at this point? I hope not, but say so below. This is your place for dis­cus­sion as much as it is mine.

  1. Lazy web, go do my bid­ding: feel free to com­ment on any one case or as a whole as you find them. []
  2. The rea­son why those are dif­fer­ent fills vol­umes and I’m not going to go into it now. []