After 30 years in practice, here are six things I know for sure

This Spring I celebrated a milestone. It’s my 30th year at the pharmacy in Baddeck, Nova Scotia where I began work as a newly-minted pharmacist after graduating from Dalhousie University College of Pharmacy in 1993. Since that time, there has been a lot of change in the profession. For example, back then there was no internet as such in pharmacies. I recall someone calling to ask if we had an email address, to a lot of shrugged shoulders. Since then, the internet has become essential to our daily work. There have been numerous other significant developments in the past three decades—too many to recall. But here are six things I’ve learned that help to firmly guide my decision making in the dispensary. I’m sure that regardless of how long you’ve been practicing as a pharmacist you have your own list. 1. It’s been a rough road for probiotics If you’re like me, for most of your pharmacy career you’ve rooted for probiotics, but just hoped that they could deliver. It turns out that a lot of the mystery in probiotic effectiveness is the simple lack of specificity in claims. Given the hundreds of probiotic strains out there, it’s not surprising to learn that just one specific strain might be the one that works to help one medical issue. Imagine if a person heard that some prescription drugs were good to lower blood pressure. Then imagine this person walking into your pharmacy and grabbing a random bottle of a prescription medication in the hopes it will lower their high blood pressure. Turns out they got a dose of a gout medication, and their pressure didn’t change. Their conclusion would be that prescription meds do nothing for blood pressure. This is exactly how the informatjon is often disseminated from study to the public forum. For example, probiotics are named for a genus and species and a subspecies as well as a strain designation, like Bifidobacterium animalis lactis DN-173 010. Some negative studies using a Bifidobacterium probiotic with a negative result might conclude that Bifidobacterium is of no use in a given medical issue. This makes its way into the media and then we hear the public saying that, for example, probiotics don’t work for traveller’s diarrhea. My favorite reference in this space is AEProbio.com headed by fellow pharmacist Dragana Skokovic-Sunjic. It’s an amazing evidence-based reference that all of us can use that show Health Canada-approved products and the level of evidence for many medical issues for various probiotics available in Canada and the US. It has become a topic so incredibly powerful it will be the focus of my new book, Gut Logic (the follow up to Healthy Logic). Lindsay Dixon has done a wonderful interview with Dragana on this topic that can be found on YouTube. 2. The efficacy of vaginal estrogen for UTI This wouldn’t be a healthy aging blog from me without adding at least one topic that specifically speaks to better health as we get older. One topic I urge you to explore is the safe use of vaginal estrogen for the prevention of recurring urinary tract infections. In the years since the Women’s Health Initiative Study, the dust has started to settle psychologically with prescribers and other health care stakeholders. Overnight we saw the biggest-selling prescriptions of the time—hormonal therapy for menopause—effectively discontinued. The unfortunate interpretations of this study (regarding HRT’s use and breast cancer and the effectiveness of even starting this type of therapy) and its communication by the media led to many women going through many years of menopausal symptoms with no relief at all. Alternate therapies like antidepressants were used instead and although deemed safer by the medical community, left patients wondering what was wrong with themselves now that they were on this treatment we hadn’t used all that much before the study’s results were made public. Being on an antidepressant comes with some unfortunate baggage and stigma that took some time to explain on our end. Thankfully, we are starting to see prescribers come around again to prescribing hormone therapy for menopause symptoms to make life more bearable. Back to my original topic, the usefulness of estrogen for UTI prevention: prominent voices in the field are now reminding us that this is a safe option for those with recurrent UTI as the integrity of the tissue in the urinary tract begins to change with menopause, allowing infections to become more plentiful for some. Ashley Winter MD, a popular urologist on Twitter has repeatedly promoted this treatment and even gone as far as to suggest that estrogen as a UTI preventative be available OTC. 3. The uselessness of homeopathy I recall in the 90’s the introduction of homeopathy in the pharmacy where I work. At the time the owner and I discussed how this odd treatment could possibly work, but accepted it because of two things: the public’s acceptance of this treatment and the commitment of the company that was selling it. We dedicated a whole section in the OTC aisle of the store to these products. Over the years, it just kind of became part of the tapestry of what we sold. Even after I purchased the pharmacy in 2001, these products remained as a go-to for those that couldn’t take other products because of interactions, or just wanted the safety of no side effects. It wouldn’t be until 2018 that I finally came to the realization that I was living the nightmare that any pharmacist fears after dispensing errors: that you are selling quack therapies in exchange for money to a public that relies on you for recommendations. Without going into the background of just how harmful homeopathy is (even though it has nothing in it), I ended up publicly apologizing to patients from whom I took money for a product that had essentially nothing more than water, alcohol, or sugar in fancy packaging that promised to fix the medical issue they took the time out of their day to come specifically to my pharmacy for and purchase because I was a trusted health professional. Read: Well-researched: New book on Healthy aging from pharmacist who banned homeopathic products and sugary drinks from his store 4. The power of the media to promote you and the profession There are many forms of media at your disposal to not only promote your profession (an act that is your duty as a pharmacist), but to promote your personal brand. Every pharmacy has a customer, or customers, who specifically ask for a certain pharmacist to answer their questions. Sometimes it’s because of the repeated performance of that one pharmacist in a one-on-one basis, or maybe it’s because they have also seen this pharmacist in another light. Maybe they know this pharmacist contributes to their community on a volunteer basis, or they are an owner that contributes to a local cause with a donation. The pharmacist may be known online through Twitter, Facebook YouTube or LinkedIn. Maybe their own store’s website is continually educating the public. And don’t underestimate the value of becoming one or two reporters’ go-to expert when pharmacy issues arise. This will benefit both you and the reporter to the point that people will seek you out as a trusted source. Your brand will evolve and become a platform to promote your passion project. Get some coaching if you’re new to speaking with the media. There’s lots to learn about being an effective educator through the voice of another reporter, but it is worthwhile. And being in a live environment like radio gives you the upper hand, in that your full story comes out unedited as you intend it to. 5. The many benefits of getting yourself published Having your name on a published work for which you have a great passion is a calling card that keeps delivering. There is little that can help to promote the profession of pharmacy as much as when a pharmacist or pharmacy tech puts their money where their mouth is—by doing a study that proves the value of what they do, or by writing a book on a topic they feel they ‘own.’ A study could be relatively simple with a bit of contribution on your end with some data. Leave the bull work for the experts. As scientists we know what makes a study either good or bad, but setting up, designing and funding a study requires an expert who does it for a living. Check with your local university and see what they can offer you to help you plan a study. They are the experts at getting money for their own people for studies and they have the scientists with the expertise. The topic could be something you’ve had a long-standing public connection with, such as palliative care, healthcare costs or the effectiveness of addressing errors. The topics are endless, really. Use the study to promote what you do in the media, via your social media channels and with your customers. Writing a book on a topic you are passionate about is one of the most rewarding things you can do. Once published, your book is out there as a continual advertisement of your personal brand. Being part of a pharmacy team and being associated with a pharmacy banner are all important, but let’s face it, when a customer comes in looking for you specifically, it’s because of YOUR reputation as a respected and knowledgeable healthcare provider, regardless of where you are working. A book is like a miniature version of you, giving a presentation wherever someone happens to open it. The doors it will open to strengthen your brand are limitless. The peer recognition is helpful also when someone needs a recommendation. Start by reaching out to someone who has gone through the process and give it a serious consideration! 6. The continuum of strength in protecting humanity If there is one thing Covid taught us (and there’s a lot to unpack here), it’s that we may have been wrong in how we thought we knew people. That customer we saw every week for years, was suddenly shown in a different light when forced to decide between science and their own personal beliefs. I hung onto mandatory masking in my pharmacy until just this spring. I finally made the decision to drop the mandate. not because I didn’t think masks were needed anymore, but because I just couldn’t put my staff through the random, albeit rare verbal abuses they would take from customers. Now don’t get me wrong. Until my dying day I will be eternally grateful to the residents of Baddeck and surrounding area for simply putting on a free mask we supplied at the front cash. Even when I know some really didn’t want to and maybe had some unfavorable discussions on the topic outside the store, they just went ahead and wore one anyway. The amount of respect they showed me was humbling. Hopefully it was a reflection of their recognition of a pharmacist’s decision to hold to that safety measure unlike most other places which stopped as soon as the government said they could. The timing of this decision with the expected influx of people from all over the world this upcoming summer wasn’t a coincidence. The amount of work the average person will put into protecting others is really all over the board and it took a worldwide epidemic to show us where everyone eventually landed on that continuum. It should also underscore the importance of a pharmacist’s and pharmacy technician’s role in being a reputable source of information. By this point I would agree that we are all beyond arguing with anyone on any conspiracy theories they may believe, but we should be a constant source of accurate information that leans away from personal beliefs and towards scientific fact. It was hard to watch seemingly reputable healthcare professionals publicly going against science, as it further complicated the ability of the public to understand what was happening.

After 30 years in practice, here are six things I know for sure

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Graham MacKenzie

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