BIG FOOD AND BIG PHARMACY……….a marriage made in hell.

It is now widely accepted that the biggest healthcare crisis facing counties like Canada today is obesity and the sequelae diseases which obesity spawns like diabetes, heart disease, orthopedic issues etc.   This phenomenon is recent in terms of human history going back perhaps 60 years.   Although there are several reasons for this serious outcome, it is also widely held that lack of adequate exercise and poor diet are significant cause factors.

Children rarely go out to play anymore.  Physical education is no longer a subject taught at school.  Parents believe that unsupervised play is dangerous and endangers child safety while potential child abduction is much less likely than evidence actually indicates.  Video games and watching television have become the major sources of entertainment for children who then become obese adolescents, and eventually obese adults.  TV watching is usually accompanied by constant snacking on high carbohydrate foods.

The price of obesity to society moves in several directions including limiting career opportunities, social issues like self-respect and inter gender relationships, and obesity related diseases which can add up to over a million dollars over an obese person’s lifetime.

The bigger culprit in obesity causation is poor diet, which includes junk food containing high sugar, high fat and high salt content.   We are now all aware of the degree of “science” that so called food manufacturers invest in creating the “bliss point” …the exact proportion of fat, salt, & sugar that creates an insatiable craving for larger and more frequent portions.  This is often referred to as addiction.

What an irony it is therefore to witness the amount these “convenience foods” are marketed and sold in pharmacies, especially the large food drug combos and mass merchandisers.  To add insult to injury, some of these mega drug operations actually market themselves as “centres of health promotion and nutrition”.  Diabetes centres, cancer cure runs, nutrition counselling, blood pressure monitoring etc. etc.  All designed to create the illusion that this is a health focussed environment and not a purveyor of all the stuff that causes many of these same disease states.  Hypocrisy is too mild a term.   This self- promoting image while at once promoting the sale of chips, frozen pizzas, candy, pop, and other mega glycemic garbage foods.

In fact, as we have witnessed, these big food retailers have incorporated pharmacies into their operations with unabashed zeal over the last several decades such that it is rare to go into any food store today without a pharmacy cubicle in the middle of it, or right at the front entrance.  It is well established that pharmacies generate high traffic, which in turn provides for more opportunities to create impulse purchases of junk food.   It is well established that the sales for all non-drug related merchandise goes up by a factor of 1.2 when a pharmacy is included in the mix.   It’s a food drug combo for sure, or maybe a better term would be a health and economic disaster combo.

In the province of BC, this duplicity reaches even further comic proportions than the imagination can bear, as these food drug combos have fought and won the right to sell tobacco products…products which provide a 50% guarantee of causing death and a 90% guarantee of causing serious illnesses like emphysema and cancer.

So where is the pharmacist in this toxic mix?  Stuck right in the middle of this environment…literally, physically planted inside these cubicles surrounded by often useless homeopathic/NHPs and other dubious products like “fat flushes” and “flu busters”.

It is a sad sight to see our honourable profession reduced to being a decoy for the mass retailing of products which cause the very diseases that pharmacists position themselves as dedicated to prevent and/or treat.

It should be mandatory for all pharmacy undergraduates, as early as possible in their curriculum, to be taught the reality of the retail pharmacy marketplace and to initiate a personal career plan which steers them towards professional fulfilment, and away from a position of aiding and abetting these negative career environments.

It is the responsibility of the schools of pharmacy, not only to educate their under graduate students, which they do an excellent job of doing, but also to ensure that the talents and skills taught actually land on fertile ground to the benefit of the societies to whom they owe a professional debt.   This is the challenge that academia faces today, and the sooner it assumes this cause, the sooner we can create the paradigm shift we are looking for and put the profession of pharmacy back into the hands of practicing pharmacists.

 

Politics and pharmacy associations…a bad mix

There has never been a time in the province of Ontario when the electorate was in such a quandary as to whom to vote for in the upcoming provincial election.

Each party puts out the usual political Pablum with promises galore: no new taxes, economic growth, more services etc etc.  Happy days are here again!

All parties promise to spend money yet unearned, by people yet unborn, and all to gain or retain power.

It would not be so bad if at least there was a hint of leadership capability; but alas there is none.  The cupboard is bare.

Personally, I predict one of the lowest voter turnouts in Ontario history, as many voters are in the same predicament as I am.

The PC party is led by leader with a master’s degree in economics who is incapable of doing basic arithmetic.  Even when his numbers are challenged by 200 PhD economists he remains resolute to his numbers.

The NDP is led by a leader who has lost sight of her own electoral base.  This leader provoked an unnecessary election and then lacked the funds or platform to fight the election she started.

I save my best for the Liberals.  Where does one begin?  eHealth $1 billion and growing and still no electronic health records.  Ornge Air Ambulance…the report came out today and sights, corruption, incompetence, lack of oversight with hundreds of millions lost.  Gas plants cancelled at costs in the billions.  A health minister who is in way over her head, and now way past her due date.  Pharmacy has suffered much during her tenure.

And in the middle of this our association…the OPA which continues to profess that it represents the 14,000 pharmacists of Ontario (though only about half are really members) comes up with 3 priorities that make little economic sense to government (regardless of party) which has no money.

If this is about saving money for the healthcare system, let’s evaluate the three priorities from the government’s narrow fiscal perspective.

FIRST PRIORITY: An extension to pharmacists to provide injections beyond flu shots. This technical act is being done by others right now…doctors, nurses, public health workers etc. How does switching this function to pharmacists save money?  And have we not repeatedly witnessed Big Retail Pharmacy promoting the heck out of shots in order to create more customer traffic in order to sell more pizzas, chips, Pepsi, and now decadent chocolate chip cookies?

THIRD PRIORITY: Extension of smoking cessation program. Who could argue that the sooner smoking is eradicated from the face of the earth the better (though cigarettes continue to be sold in some pharmacies in Canada?) But the benefits of smoking cessation take time to realize. Politicians, at best, have a three or four year time horizon. From their narrow, self interested driven perspective, this idea is cash flow negative.

SECOND PRIORITY: …which I have deliberately placed out of order and last. This one does make sense economically on the short & long term. Saving one trip to the emergency department for poison ivy rash saves hundreds of dollars. The only issue here is that if pharmacists can save hundreds of dollars through intervention, shouldn’t pharmacists be compensated at least as much as a walk- in clinic would charge for the same intervention? And my pet peeve…to whom will dollars for this intervention be paid? To the pharmacy owner? i.e. Sobeys, Walmart, Loblaw, Costco etc? How do practicing pharmacists who do the critical intervention benefit from this?

Has the OPA even asked this question?  Probably not on the radar screen.