Are Drugs More Than Commodities?

Last month, I suggested that manygroups were not paying attention topharmacy's main message that pharmacistsare important to help people makethe best use of their medicines. I suggestedsome reasons why our messagemay be ignored. Let me suggest anotherreason why our message is ignored.Could it be that what we do speaks louderthan what we say?

What pharmacist practices could lead toviewing drugs as another commodityproduct? Pharmacists say that they shouldbe helping patients achieve pharmaceuticalcare outcomes because the drug productcan cause adverse events. Manypatients are taking a statin product for lipidmanagement. Although rare, patients mayexperience muscle weakness. If pharmacistsconsider the statin product morethan a commodity, wouldn't they ask thepatient, when dispensing a refill prescription,if he or she had experienced any muscleweakness in the past month? When Iasked my students if they were taught thatthis was a good practice, they all agreed.When I asked them if they ever observed thispractice, however, no one had.

Let me use the statin drug to illustratewhy our actions may speak louder thanour words. Statin drugs must be takencontinuously for best results. We all recognizethat many patients who startstatin therapy stop therapy early for avariety of reasons. If the drug product isan important tool to achieve pharmaceuticaloutcomes, than it would seemthat the pharmacist would be concernedthat patients comply or adhere to thedosage schedule and continue therapy. Ionce heard a speaker say that medicationcompliance was a problem lookingfor an owner. We all know continuousstatin therapy is critical to achieve desirablegoals in disease management. It iswell-known that patients do not adhereas they should. Recently, the NationalQuality Forum stated that it was creatingstandards that would change the wayhealth care providers interact withpatients to improve medication adherence.

Yet, how many pharmacists evenknow when patients do not return for arefill, or, even worse, care that thepatient has apparently discontinued hisor her chronic disease therapy?Yes, what we do speaks louder thanwhat we say. If we want legislators, consumers,or other health professionals topay attention to what we say, we need tochange our practices and stop treatingdrug products as a commodity. If we donot, then we can expect that many willnot pay attention to our message.

Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of NorthCarolina at Chapel Hill.