Stop Accrediting Pharmacies…a not so radical idea

There was a time when accreditation of pharmacies by pharmacy regulatory bodies made some sense; not so anymore. The “pharmacy” was a bit like a laboratory or a pharmaceutical manufacturing facility.  Accordingly the physical plant had to meet certain criteria as to size, adequate equipment, hygiene and so forth.   Hospitals continue to be accredited today because clearly the provision of hospital services like surgery cannot be performed without the hospital and the vast amount of equipment within the hospital itself.

Today, as the pharmacy profession moves in a new direction towards becoming a knowledge based profession, the importance of the physical plant has become greatly diminished.  In fact, an argument could be made that the physical pharmacy plant is actually acting as an impediment to professional development; it is undebatable that it acts as an impediment to direct remuneration, and accordingly control and independence.

The pharmacy has become an anachronism, perhaps even an albatross.

In reality, the existence of the pharmacy as a legal entity, a licensed location, or an “accredited” facility is serving to retard the progress the profession of pharmacy.  Pharmacy urgently seeks to move towards becoming knowledge based, independent of inventory (even drug inventory) and independent of location or physical plant.

Incredibly today, “pharmacies” (which are things not people) are reimbursed for professional knowledge based services, but more incredibly, there is no mechanism for reimbursing the professional who delivers the actual service herself.  This fact alone works to entrench the balance of power away from the service provider to the owner of the physical plant who, in the vast majority of cases, is not a pharmacist and whose single focus is the sale of as much stuff as possible, much of which is totally not health related, and often actually exacerbate diseases like diabetes, heart disease, hypertension etc.  How can this be good for the patient or the pharmacist?  It solidifies control away from the pharmacist to the non-pharmacist owner with all the subsequent horrors (quotas, forced flu shots, performance metrics etc.) that we are witnessing today and we get to watch on CBC TV nightly.

If accredited pharmacies did not exist, it would be impossible for governments or any other insurers to pay them; it is not possible to pay or even acknowledge something which does not exist. This would mean that payment for services rendered would have to be made to whoever provided the service of value, i.e. the only legal entity standing, the licensed pharmacist.

One of the darkest periods in pharmacy’s history occurred when pharmacy corporations, pre 1954, were grandfathered and subsequently were allowed to be sold to non-pharmacists.  Every entity in the Big Pharmacy Retail (BPR) Club…Rexall, SDM, Costco, Sobeys, Loblaw, Metro etc. owe their existence today to this loophole, which allowed these big corporate retailers to purchase a single 500 sq. ft. drugstore incorporated pre the 1954 charter.  These entities now control 85% of the pharmacy business in Canada, while occupying maybe 50% of actual physical locations.  Owning a pre-1954 chartered pharmacy was like owning a gold mine, and big bucks were paid for these old numbered corporations.  The loss of control of the pharmacy profession can be sourced back to this single point/event in time.

By cancelling the whole notion of accrediting pharmacies, BPR would be left with plenty of real estate, bricks & mortar, inventory, and lease liabilities but no connection to the profession of pharmacy except through the pharmacist on duty on location.  In other words, the physical location does not become a pharmacy until the pharmacist enters the building.  And when the pharmacist leaves, only a shell is left behind…not a pharmacy.  The notion of goodwill is largely eliminated.

With this one bold move a paradigm shift would be created.  The balance of power would move markedly away from pharmacy owner to pharmacy services provider in one fell swoop.  The profession has the power to do this.  Sure there probably will be some regulatory legal hoops to jump through, but it could be done if the resolve was there.  It makes eminent sense.

All the players who have big stakes in the status quo would resist fiercely… like BPR operations who would see hundreds of millions of dollars fall off their balance sheets.  And the regulatory bodies/colleges of pharmacists who would lose the fat fees associated with accreditation.  They would all offer huge resistance.  There would be much weeping and gnashing of teeth.

But the Colleges of Pharmacists could easily be appeased in order to get them on board and to allow them to continue to live according to the comfort & style they have been accustomed to.   Simply double the individual pharmacist /registrant’s annual fee; it would be worth it in order to create this kind of shift in power, the shift practicing pharmacists are seeking.  An extra $500 bucks a year per registrant that could move the agenda forward decades in terms of shifting the control of the profession of pharmacy back into the hands of pharmacists.   In terms of direct benefit to pharmacists, this extra $500 would be a far better investment than the one presently made to pharmacy associations who appear powerless or unwilling to improve the professional lives of practicing pharmacists.

This is a case of pharmacists learning at how to play the game, and then changing the rules of the game in their favour.  What’s so radical about this?  What will it take to begin this dialogue and make it happen?

 

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.