How A Journey Into the Past Could Revolutionize the Face of Modern Pharmacy Forever

I love the concept of time travel.

When I was in college, I enjoyed the movie Donnie Darko, which (spoiler alert) is ultimately about time travel. Perhaps it dates me, and maybe I’m weird for liking a cult, indie film, but I love movies about time travel.

I found myself thinking recently about how I could combine 2 things I love: time travel and pharmacy. If I could travel back in time, what would I change about our industry? Where would I go and how would I influence certain outcomes in the pharmaceutical industry?

• 1956: Change the Drug Approval Process

In perhaps the most high-profile case of the last 50 years, the drug thalidomide was introduced in Germany as a sedative in 1956 and was later found to inhibit morning sickness in pregnant women. At the time, drugs weren’t thoroughly tested for harm to a fetus, and medications for pregnant women weren’t tightly controlled.

The drug worked well. Unfortunately, no one anticipated that it would cause significant birth defects and even death.

More than 10,000 babies

were born with birth defects as a result of thalidomide use by expectant mothers.

If drugs like this hadn’t made it to market, thousands of lives might have been saved. Instead, the faulty drug approval process has caused harm to the public, and it has caused Americans to be distrusting of new medications, spurred by the large number of advertisements for lawyers seeking cases related to adverse drug reactions. I work in an anti-coag clinic, and practically every patient who is prescribed Xarelto, Pradaxa, or Eliquis asks about adverse events because of the information presented in TV commercials.

I won’t pretend to know all the regulations that should be implemented in the drug approval process, but I’d love to go back in time and influence decisions that were made regarding drug approval. I’d operate within tight boundaries in order to prevent unnecessary death or harm and regain the trust of the American people.

• 1934: Protect Pharmacies From Corporate Ownership

In 1934, the American Medical Association

recognized the danger

of allowing corporate, for-profit entities to dictate the work of doctors. The AMA feared that doctors’ judgments would be hindered by their loyalty to corporations and that the corporations would exercise undue influence on physicians. The Corporate Practice of Medicine Doctrine prevents corporations from practicing medicine to ensure that medical decisions are based upon sound, independent medical judgments.

Likewise, dentists enjoy the same protection under the CPOM. For almost a century, the dental industry has regulated that only dentists could own dental practices. As a result, there are very few giant conglomerate chains or monopolies within the dental industry.

Unfortunately, the pharmaceutical industry doesn’t share the same protections, which is why the pharmaceutical industry is dominated by giant networks.

If I could travel back in time, I would ensure that the CPOM doctrine protected the interests of pharmacists as it does other medical professionals. I would institute laws that stipulate that only

pharmacists

can run pharmacy businesses so that the industry would be pharmacy-focused and patient-centered rather than money-driven.

• 2007: Mandate Release of Drug Trial Data

In 2007, the FDA passed the FDA Amendments Act requiring that the results of

all

drug testing be submitted to a government database within one year of completion. The legislation was designed to address the very real problem of studies that were completed but not reported.

According to

a 2012 study,

however, only about 22% of the trials were actually submitted.

The reality is that there are huge amounts of drug trial data that are unpublished each year. Drug companies don’t want to publish evidence that indicates that medications don’t work well or don’t work at all because it isn’t in their best interest financially. This failure to publish effectively means that these companies are hiding information. It means that medications that aren’t doing people any good are being introduced into the marketplace.

Dr. Ben Goldacre,

in his 2012 Ted Talk

, pointed out that, by allowing drug data to be withheld, we are putting potentially harmful or useless medications into the marketplace. He suggests that health care practitioners aren’t able to make educated decisions about medications because they don’t have all the information they need. Specifically, they don’t know the negative results of drug trials because the results aren’t being published.

I would require drug companies to publish

all

the data that is gathered from drug trials — even when the data is negative – so that doctors, pharmacists, and health care practitioners could know all the things that are going on behind closed doors. When we have all the information, we might give a second thought to recommending a medication for a patient. We could make decisions based upon what is best for the patient.

Improving Pharmacy Through Time Travel

It’s impossible to say with any certainty how many lives would be impacted by these hypothetical changes, but it’s certainly safe to say they would improve the pharmaceutical industry long-term. Our job as pharmacists is to help patients take care of themselves. We know that medications won’t

fix

their lives, but that

preventive measures

are the key to patient health.

Empowering pharmacists with information and autonomy enables them to care for patients in the best way possible.

It’s intriguing to think of the mistakes we could correct if we could travel to an earlier point in time armed with the information we have now. And though mistakes are unavoidable, we should do everything in our power to correct them when they occur. If we learn from our mistakes and try our best to avoid new ones, our industry and the people we serve will be the winners.