Does APhA Really Represent Pharmacists?

Tonight I was playing with my son with the TV on in the background when a commercial splashed across the screen. Immediately I stopped what I was doing and watched, jaw slightly agape, at what was on the screen.

What was it you may ask? Take a look for yourself:


Beautiful is it not? Even more so when you go to the actual YouTube page and read the purpose of the advertisement. It truly is great to see a professional organization be assertive and stand up for their profession. Clearly the AMA will not sit idly by and wait for change to come to them.

Bravo for that.

Now wouldn't it be great if APhA did the same? Between the health professional organization trifecta of the AMA, APhA and ADA, the APhA is often the silent partner. Whereas the AMA and ADA are very active outside of their practitioners and have a very broad public awareness, few outside of our immediate profession even know what APhA is.

It's one of the topics I have pushed several times on this site in the past and will continue to do so until someone actually listens. Recently I discussed the distressing notion that a business oriented enterprise is, in effect, leading our profession to change for their own selfish reasons.

It is something which has even been brought up in publications like the Wall Street Journal. Interesting how those even within the profession see the massive amount of benefit of the idea I laid out, yet APhA does not seem interested in actually following through with it.

It is this which is the most distressing aspect of pharmacy as a whole. In school and by APhA we are repeatedly told about the "future" of pharmacy, but in reality there does not appear to be a realistic path towards this future. Progress by APhA can be measured by the speed of a sloth, and we run the risk of being bypassed by other health care profession as the system evolves.

For instance let's look over the Strategic Issues on the AMA website which describes who they are and what they are fighting for. It is rather all encompassing while being concise and plotting for the future, wouldn't you agree? It's something even the lay person could read and instantly understand what AMA, and physicians as a whole, stand for.

Now let's look over what APhA has listed as their Advocacy Issues. One of the first things you notice is a lack of an adequate summary to the overall goal of the organization. Line by line and link by link they list specific issues, but there is no connection between the issues and what they mean for pharmacy. The AMA does a spectacular job of presenting their main goals and then diving into the specifics. Here, the APhA merely presents the specifics without any cross-linking to form a cohesive idea. In the end, the problem lies not so much with the issues themselves, but more with how they are presented.

Clearly the AMA's website is focused towards both their providers and their patients whereas APhA's website is tailored to its providers. There is already a disconnect of perception between pharmacists and their patients, and this does nothing but further that divide. If anything, the APhA website continues to make it's self inaccessible to the patients they so often tout as the focus of their work.

Why is this? Why is it the organization, which is financed partially through the dues of pharmacists, seems to ignore this crucial ingredient to the long term success of the profession? Why is it that pharmacists across the country feel like they have no voice?

There was no immediate response to the disparaging remarks by the CEO of Medco from APhA. For those unfamiliar with the situation, this link provides a good summary. How is it that our so-called voice of the profession remains eerily silent while one of the most powerful individuals in health care obtusely insults our profession?

What are those dues good for then? Several times it has been reaffirmed that the APhA can only reflect the views of those members who participate, and pay, through their membership. Granted I see the logic in this, by why is membership required to represent pharmacists as a whole? Why is it that none of the 70+ pharmacists I have worked with over the last ten years are active with APhA? Why is it that rarely do you find a community pharmacist, who just happen to make up the largest constituents of the profession, that considers the APhA worthwhile?

Because they have no faith in it. APhA is viewed as a lion with no teeth and no roar. Why devote time to something which is ultimately fruitless? As pharmacists are pushed around year after year with little light at the end of the tunnel, of course they become disillusioned. Who wouldn't?

So why doesn't APhA throw up a hail mary and start to regain the trust of the pharmacists it represents? Why doesn't APhA consider educating patients on who they are to overcome the biggest obstacle the profession faces, a lack of understanding of who and what a pharmacist is. Why doesn't APhA maintain a daily, strong active voice for the profession which can readily respond to comments from individuals such as David Snow?

Why doesn't APhA model itself after the AMA and actually represent the profession?

Give me a reason to want to be a member of APhA. Give me a reason to want to be extraordinary proactive within the profession. Give me a reason to stand up for what pharmacy stands for. Give me a reason to have faith in APhA.

Is that too much to ask?

Will You Remember Me?

Every day we cheat death. It is not something we readily acknowledge despite its prevalence.

We choose to eat a low fat salad for lunch. We choose to drive just a little slower on the freeway after a scare.We choose to go for that three mile run when all we want is to drink a beer on the couch.

Jusitifying it as a desire for "healthy living" we go about our lives without acknowledging that what we are really doing is avoiding the inevitable for just a little while longer. Each person has a differing reason for following such a winding, and often difficult, path.

Many years ago I realized I didn't want to just live my life as a mindless drone in a dead-end job. I did not want to be the person who merely went through the motions of bringing home a check, driving the kids to soccer practice and then hit repeat every day. I wanted to do something different, something unique, something... special.

It is one of the reasons I chose pharmacy. Hell, it is one of the reasons this site exists.

I have few selfish desires in my daily life. I put the vast majority of free energy towards my wife and son because... well they deserve it. For many years my main daily goal has been to make people happy. For my wife it may be a simple massage at the end of a long day, for family and friends it is my intentionally hilarious comments on Facebook or Twitter.

Ultimately though I begin wonder if I will be remembered.

I have always wanted to do something truly great, something that makes people step back and be amazed. I always said one of my goal's in pharmacy was to change the world in some way before my time was done. How I will accomplish this remains a mystery, yet a part of me feels that this particular time will come.

Yet a small part of this desire was born in spite. Far too many times in my life, especially my "school yard" days, I was dismissed or told I would not amount to much. Since that time I have always been driven to not only prove them wrong, but to make them feel humble in their judgements.

As the years have worn on and I have continued on this process, my ultimate desires have become more  personal. Today I would be very content just knowing my son, wife and family were proud of me. Everything else is secondary to this point.

And yet, there is still that desire to attain greatness... the ability to look back on my life many decades from now and smile knowing that I am going to leave this world a better place.

I guess the ultimate question is... Will you remember me?

Voodoo Pharmacy

This is, hands down, the oddest spam comment I have ever had on this site. And yet, after a stressful day at work it oddly starts to make sense...

I am melinda,from what I can read. It has been sad news and scam to everyone about Voodoo casters or so. But to me they are so real cause one worked for me not quite two weeks. I traveled down to where his shrine his and we both did the ritual and sacrifice. and now me and my ex are living very ok now.I don't know about you but Voodoo is real;love marriage,finance, job promotion ,lottery Voodoo,poker voodoo,golf Voodoo,Law & Court case Spells,money voodoo,weigh loss voodoo,diabetic voodoo,hypertensive voodoo,high cholesterol voodoo,Trouble in marriage,it's all he does. I used my money to purchase everything he used he never collected a dime from. He told me I can repay him anytime with anything from my heart. Now I don't know how to do that. If you can help or you need his help write him on (nativedoctor101@live.com) Thank you.

Wait, Is That Walgreen's Leading The Way?

Past writings have been evident in showing that I greatly disagree with how Walgreen's conducts their business in the profession. With firsthand experience, it is quite obvious that patient care is not necessarily their primary focus. Clearly I am not alone in this feeling as it is often perpetuated by vast number of other individuals within the profession.

Then how is it that, at this very moment, the pharmacy organization that is finally standing up for, what can best be termed, the unalienable rights of pharmacy is Walgreen's?

Who is challenging one of the largest PBMs in this country and their ridiculous reimbursement rates?

Who is seeking to educate the public as to what a pharmacist truly does in the retail setting?

It's not APhA. It's not the various pharmacy schools around the country. It's Walgreen's of all people.

Actually it speaks volumes that an organization who's ultimate goal is really to increase their revenue is taking this stand rather than the professional organization that is supposed to represent us.  Walgreen's is not attempting to be the torch bearer for the profession, they is just a byproduct to increase their own market share.

There is some irony in that due to Walgreen's inherent greed, they are inadvertently pushing forward a movement that could actually change the profession. The spat with Express Scripts will invariably continue to grow more ugly as they both stare each other down like two bullies on a playground. It's about damn time someone stared them down though... even if it is another bully.

Walgreen's has also been focusing on an advertising campaign regarding their ten point checklist for patient's safety. It may seem trivial to us, but when you consider many people believe a pharmacist merely puts pills in a bottle, this may help to show that we are actually a dispensary of knowledge.

I have been saying for a long time that the profession needs to step up and show the public what it is we are doing. Not only to better facilitate understanding of the profession, but to reveal how much more integrated we can be in the health care system. We can't do it on our own, that has become blatantly obvious, so why do we not have our patients become involved?

And Walgreen's is attempting to accomplish it in their own battles. It really is perplexing as it is intriguing and if the outcome is successful it may prove to be a blueprint for future change.

Who would have thought that Walgreen's would be the first one to take the first step on a national scale? Wonder if APhA is even paying attention...

Health Literacy and Increasing Patient's Decision Making

Health literacy has been a buzz word in health care for several years now. It is an obvious idea when one thinks about it, but may not be overly apparent. Often we take our intrinsic knowledge for granted, and do not consider that a patient may not have basic reading skills yet alone basic science knowledge.

Because of this in class we talk about open ended questions, talk-back guidelines and reading level of materials. All very valid points, but they all underline a common theme. There is way too much unfiltered information out there for patients now.

Think about it, with the internet and sites like Google, the average patient has ready access to nearly the same medical material that health professionals have. This post does not even consider the large amount of misinformation present. I'm more concerned with the sheer amount of correct and pertinent information related to a patient's health.

Think about it, what if you had immediate access to, say, the building plans of your workplace.  The next day you come in and talk to the owner telling them you think this wall should be moved back another five feet or so to give us more room. In looking at the plans, you say it doesn't appear to be doing anything other than partitioning the floor space.

You know what would happen? The owner would laugh his ass off and walk away as you unknowingly want to move a load bearing structure.

Yet this is what we are forced to deal with in health care each day. Patients log on to WebMD or watch Dr. Phil, are presented with information that they do not have the neccessary background to fully understand. They then take this information, come to us and decide to make decisions about their health care without considering our own expertise.

At best it is ludicrous. At worst it is deadly.

I know, I know, you are all screaming. "But a patient has a right to know this information and participate in the management of their health!" And this is true... to a point.

Consider when the negative press about Avandia came to light. One particular patient of ours immediately stopped taking to the medication due to fear of "heart problems." Never mind the fact that the liklihood of this problem was not all that great, we cry wolf far too much in protocols now but that's another discussion, she did not want to die from a heart attack.

The pharmacist looked her straight in the eye and said, "Well you can possibly die from a heart attack or for sure die from diabetes. Your call."

Good for him.

As much as we do not wish to think of our profession in this way, pharmacy is really the management of poisons for positive health purposes. There are side effect whether we like them or not almost solely for this reason.

Many people simply do not understand this part. Life is full of risks, you speed on the freeway to make an appointment or start smoking to look cool with your friends. But when a drug can benefit a patient, but they don't want to take it due to a minor chance of a severe reaction that's okay?


Solutions to this problem can be insanely simple. For instance, when we hand out drug monographs, or when they are posted online, side effects are often listed under categories like 'common' or 'severe'. Dizziness is often listed in the same breath as heart palpitations... but does that mean that the probablity of both are equal? Actually, how often do these side effects occur?

As pharmacists, we know these answers. Patients do not.

So why not add odds of occurrences to all side effect listing? Or perhaps list them in the order of occurrence? I'm sure a few more patients will panic by seeing the exact numbers, but I'm sure many more will have their minds put at ease when they see how rare these 'common' side effects are.

A simple change like that mitigates one of the problems with health literacy and compliance. We have made information a little more digestible and give them a stronger base to make a decision about their health.

We talk about white space and reading level, but not how to relate the information to patients. Honestly, that should be the primary goal of health literacy. It doesn't matter if the material is at a fifth grade level if there is no way for the patient to relate the information in order to make a decision.

And that's ultimately what this is all about, making sure the patient is properly informed so they can make decisions about them selves. We cannot rid the world of WebMD or Oprah, as much as we may want to try, but we can certainly organize the information we give out in a better manner.

Seems simple enough, right?

The 'Nevers'

Fewer singular words are more difficult to comprehend than the word never. We live our daily lives looking towards the future and under the assumption that we can do whatever we set our minds to.

There is no 'never' in this mindset.

We teach our children that they can grow up to be a world famous scientist or the president or a star football player. As we enter young adulthood, we are told we can be the next great business person or a well respected health professional.

There's always more in life to attain and time appears to be limitless.

But the truth is, the older you get the more 'nevers' become apparent.

For instance, I will never be an astronaut. Surely this was a fantasy in the most literal sense, but I am now officially beyond the most basic requirements. Even if I were to set every ounce of energy towards attaining this goal, I can no longer attain it.

As the number of 'nevers' increases over the years some choose to ignore them while others choose to embrace them.

Namely because when you start thinking about the 'nevers' a wave of sadness floods over one's self. We do not like the term because never is ultimately connected with one of our most feared words... death.

For instance, I will never talk to my good friend again. Never again will we meet up yearly in my hometown for a local event, drink beers on the deck of my home and laugh at those who doubted us in high school. It's a difficult and bitter pill to swallow, and it is intrinsically laced with the word 'never.

I will never recapture the sheer amount of unbridled fun of the first year in college. There were minimal stresses in life and when all of your friends live on the same wing of your dorm you ultimately form daily unforgettable experiences. Today, we're lucky if we can all gather but one time a year.

Not all 'nevers' are negative in nature.

Never again will I not know what it's like to be a father. Who knew someone so small could brighten even the darkest days?

Never again will I have to worried about being loved in the last few years I have found more people who care for me than in all previous years combined. For someone who has found the deepest of depths of despair, it is reassuring to know this fact.

These are 'nevers' that I can live with. And they make the less enjoyable 'nevers' a bit more barable.

So on days like today, remember what we may never be able to change the past. We may never be able to change how we feel. We may never be able to get over our own personal pain.

But that's okay. It makes us stronger, more resilient and ultimately a better person.

And in the end, that is what truly matters.