What is a myth that should be dispelled because it is costing us all money?

[MilesTeg]

There are basically three types of brands:

1. brands that make a decent product for a decent price
2. brands that make a product of varying quality (sometimes garbage, sometimes decent, sometimes great) at an inflated price.
3. brands that make a garbage product for a very cheap price

I mean, there's also
4. brands that make great products for a premium price (pretty common, actually)
5. brands that make garbage products for an above-average price (also common, particularly with 'trendy' consumables)
6. brands that make great products for a cheap price (rare, but they exist... and often get bought out quickly)
7. brands that have tiered quality lines at tiered pricing and with corresponding tiered quality
8.  brands that...   I could go on.

Basically, you could think of it graphically with price on the x axis and quality on the y axis, and products that are in every quadrant.  Some brands cluster in different corners, some are all over the map. 
In otherwords, with brands in general, price doesn't always correlate with quality.  With some brands it does (though the it can be an inverse relationship).

I would say all those fall under my three categories. But bottom line: buying the cheapest widget often is a waste of money (because it often fails to have any longevity or simply never works as intended) just like buying the most expensive widget

Do you disagree? If so, why?

As a matter of logic, numbers 4-7 do NOT fall into categories 1-3.

For example, there are companies that make incredible products but charge a huge premium for them.  Festool comes to mind. 

Honestly, I don't get why are you trying to argue on such absolute terms.  In general I could support the sentiment that buying the cheapest or most expensive typically is a bad move, but there are so many exceptions that such statements aren't useful.

How do you figure I'm trying to argue in absolute terms? I'm doing exactly the opposite. I've explicitly said you have to actually compare products not just assume that low price == high value.

[Gremlin]

My mother has a particular medication that she takes.  The generic brand contains gluten and the name brand doesn't.  Very important to know the difference given she is a coeliac.  And yet, the two drugs are considered by the regulator here as "pharmaceutically equivalent".  I don't reckon her example is subjective either.

Well, that's why it's called _pharmaceutically_equivalent_, not identical, and it doesn't make the generic brand an inferior medication, just not suitable for s.o. with coeliac disease (just pointing out because of the thread title).

Okay - pedantically this may not fit the title of the thread as it may not cost *all of us* money - but there's a real degree of information asymmetry here.  Unlike a cereal box on the shelf at the supermarket, you can't pick up a prescription drug and peruse the ingredients unless you've bought it.  She was told by a pharmacist that they didn't have the name brand in stock but she could have the generic brand as the two are equivalent, only to be told afterwards with a *shrug* that they are "pharmaceutically equivalent".  No refunds on purchased medication in my country.  She ended up having to return to her doctor, get another prescription for the original medicine and sourcing the name brand through another pharmacy.  A lot of cost and hassle that should have been unnecessary.

The generic medication my mother was issued was not fit for purpose, yet the name brand she was prescribed was.  As far as I'm concerned, that's inferior.  For other customers it may not be, but for my mother it absolutely was.

This doesn't sound like a problem specific to generics.  It's just as likely that the name brand would have gluten and the generic wouldn't, isn't it?

(Also, why can't you ask the pharmacist about ingredients in medication before you buy it?  That's crazy!  Pharmacists have no other purpose but to answer questions like that - otherwise we could replace them all with pill counting machines for a lot cheaper and probably a far superior accident rate).

All of that is true.  But my mother had a conversation with her doctor who, knowing her circumstances, prescribed her a particular medication - the name brand.  The pharmacist then said "that's not in stock.  But here's the generic.  It's equivalent."  Mum says, "well, okay I'll have that."  Medication issued in her name, she sees the label that states "contains gluten", questions the pharmacist and is given the bullshit response that they are "pharmaceutically equivalent and she should have asked instead whether their composition was identical".  Because it had been issued, the pharmacist refused to accept it as a return (Mum still hadn't even left the pharmacy).

I don't think it's unreasonable to expect if a pharmacist tells a member of the general public that two drugs are equivalent, then a layman's expectation of what "equivalent" means should apply, or at very least, they should explain away any potential misunderstanding.  Whilst the semantics might be clear to a pharmacist that in technical terms "equivalent" is not the same as "identical", in general use of the English language the two words are synonyms.  It was an expensive lesson, the cost of which was borne by my mother.  Unreasonably so, as far as I'm concerned.

[Taran Wanderer]

I think if I was your mother, I would have thrown the medicine at the pharmacist, told the pharmacist what they could do with themselves, and notified my credit card company and insurance company of a fraudulent charge.  (And hopefully not get arrested for attempted assault...)

[Gremlin]

I think if I was your mother, I would have thrown the medicine at the pharmacist, told the pharmacist what they could do with themselves, and notified my credit card company and insurance company of a fraudulent charge.  (And hopefully not get arrested for attempted assault...)

The bolded she did.  But she still needed the medicine and no longer held a prescription.  That meant another trip to the doctor and all subsequent expenses that followed - no way to avoid those.  She was still out of pocket enough money to make it notable.

[Taran Wanderer]

Good for her! Bummer about the rest.

[Wolfpack Mustachian]

Just to throw out some knowledge here. Several things went wrong here, but at least some of them weren't the thought of the pharmacist. The prescription pad has something where it specifies brand only, otherwise, it is legally assumed that you can do substitutions. The doctor could have specified brand only. It is also possible the doctor made the mistake and actually didn't say substitutes were not OK, because then it would be the doctor's fault. However, if it was specified brand only, yes, that was the fault of the pharmacist.

Beyond that, this is mostly a "let's pick on the person who's easiest to yell at". Someone called it out as "just semantics" to call it equivalent, but that's a very biased way to look at it and is actually factually incorrect. Equivalency is a medical standard term for a brand to a generic comparison. So, yeah, the pharmacist would probably have been better off to explain it some more, but again, they are using the legal, medical definition. It's not just semantics. Furthermore, people seem to think that pharmacists should just magically know everything about a patient. Many things about the patient are not readily accessible to them, and there's a very small percentage chance that they had that information available. I'm sorry, but the woman was somewhat at fault here. If she had a serious allergy, she had some responsibility to volunteer that information. Advocate for yourself. People are allergic to a myriad number of things. Mention it.

On the not taking it back part, that's a store issue. Again, the pharmacist probably (not for certain but most likely) doesn't own the store. They can't issue a refund because it's store policy.

So, in all, sure, yell, scream, throw objects at the pharmacist. But just realize, the person who's being a jerk here just might be you.

[GuitarStv]

Just to throw out some knowledge here. Several things went wrong here, but at least some of them weren't the thought of the pharmacist. The prescription pad has something where it specifies brand only, otherwise, it is legally assumed that you can do substitutions. The doctor could have specified brand only. It is also possible the doctor made the mistake and actually didn't say substitutes were not OK, because then it would be the doctor's fault. However, if it was specified brand only, yes, that was the fault of the pharmacist.

Beyond that, this is mostly a "let's pick on the person who's easiest to yell at". Someone called it out as "just semantics" to call it equivalent, but that's a very biased way to look at it and is actually factually incorrect. Equivalency is a medical standard term for a brand to a generic comparison. So, yeah, the pharmacist would probably have been better off to explain it some more, but again, they are using the legal, medical definition. It's not just semantics. Furthermore, people seem to think that pharmacists should just magically know everything about a patient. Many things about the patient are not readily accessible to them, and there's a very small percentage chance that they had that information available. I'm sorry, but the woman was somewhat at fault here. If she had a serious allergy, she had some responsibility to volunteer that information. Advocate for yourself. People are allergic to a myriad number of things. Mention it.

On the not taking it back part, that's a store issue. Again, the pharmacist probably (not for certain but most likely) doesn't own the store. They can't issue a refund because it's store policy.

So, in all, sure, yell, scream, throw objects at the pharmacist. But just realize, the person who's being a jerk here just might be you.

A pharmacist has an incredibly easy job.  The main reason they haven't all been replaced with pill counting machines is that they're supposed to do stuff like check with the person for stuff like medication/allergy conflicts when performing substitutions.  He fucked up when he didn't bother to ask about this.  If he had he would have heard about the celiac condition and known not to make the sale.

Yelling/screaming/throwing objects of course isn't a great way to deal with anyone who has screwed up.

[Hotstreak]

The idea that your lifestyle induced obesity, diabetes, heart disease are "not your fault".  The only person who can fix these issues is you, and shifting blame for their onset also shifts responsibility for solving the problem.  These diseases are chronic and expensive to treat, and we all pay for it through federal healthcare via taxes and through private insurance via higher premiums.

[Wolfpack Mustachian]

Just to throw out some knowledge here. Several things went wrong here, but at least some of them weren't the thought of the pharmacist. The prescription pad has something where it specifies brand only, otherwise, it is legally assumed that you can do substitutions. The doctor could have specified brand only. It is also possible the doctor made the mistake and actually didn't say substitutes were not OK, because then it would be the doctor's fault. However, if it was specified brand only, yes, that was the fault of the pharmacist.

Beyond that, this is mostly a "let's pick on the person who's easiest to yell at". Someone called it out as "just semantics" to call it equivalent, but that's a very biased way to look at it and is actually factually incorrect. Equivalency is a medical standard term for a brand to a generic comparison. So, yeah, the pharmacist would probably have been better off to explain it some more, but again, they are using the legal, medical definition. It's not just semantics. Furthermore, people seem to think that pharmacists should just magically know everything about a patient. Many things about the patient are not readily accessible to them, and there's a very small percentage chance that they had that information available. I'm sorry, but the woman was somewhat at fault here. If she had a serious allergy, she had some responsibility to volunteer that information. Advocate for yourself. People are allergic to a myriad number of things. Mention it.

On the not taking it back part, that's a store issue. Again, the pharmacist probably (not for certain but most likely) doesn't own the store. They can't issue a refund because it's store policy.

So, in all, sure, yell, scream, throw objects at the pharmacist. But just realize, the person who's being a jerk here just might be you.

A pharmacist has an incredibly easy job.  The main reason they haven't all been replaced with pill counting machines is that they're supposed to do stuff like check with the person for stuff like medication/allergy conflicts when performing substitutions.  He fucked up when he didn't bother to ask about this.  If he had he would have heard about the celiac condition and known not to make the sale.

Yelling/screaming/throwing objects of course isn't a great way to deal with anyone who has screwed up.

Wow, for one, way to ignore all of the points I made first of all and just go to "ignorant generic insult of an entire profession" and full blame without addressing other points.

Second of all, congrats on some grade A level snobbery, condescension, and the general assumption that you understand something you clearly have no experience in. I personally know of interventions of pharmacists that have literally saved lives. They do not have an incredibly easy job. They literally hold responsibility for people's lives in their hands. Have you ever had a job where that's the case? I have, and nothing about a job like that is incredibly easy. Yes, they need to look for drug interactions and a variety of things like that (although they do more than that depending on where their job actually is - again, you apparently don't know this or care to learn before weighing in), but no, they are not always able to ask about every possible personal allergy for every possible thing in the course of giving out medication. There's a crap ton of random allergies out there. Again, as I mentioned, if the doctor didn't specifically put that there must be no substitutions on the prescription, the policy is generally to substitute the generic for it if they don't have the brand as a matter of course. If this was the case, even mentioning it was more than was necessary. Don't like the policy, that's fine - you're talking an overhaul of the whole medical system and yet you're pinning blame on a pharmacist like someone who lost their luggage pins blame on the person at the lost baggage counter.

I am not a pharmacist. I do know people that are and apparently understand more about it than you do from your comments. Please be willing to withhold insults in the future when you clearly don't understand what you're insulting...

ETA: I dug into this a little further. Retail pharmacies often/almost always have people fill out information for their allergies for this very reason. If the lady had put in that she was allergic to gluten in there, the pharmacist would almost certainly have caught the problem as they would have been alerted to the allergy when they were filling it. To rely on a pharmacist to ask every patient about every possible allergy is insane. Primary care doctors have the responsibility of detailed knowledge of their patients because they see 20 patients a day. Pharmacists handle 20 times that many a day. They can't ask everyone about everything. That is why implying the pharmacist should have asked about a particular allergy is ridiculous.

[Metalcat]

Just popping in to say that my pharmacist could never be replaced by a pill counting machine. Any pharmacist who can be is a shitty, shitty pharmacist.

Anyone who has had complex conditions and medications and a competent pharmacist knows they are a critical part of their healthcare team.

If you don't understand the value of pharmacists, you've either been lucky enough not to need their critical services, or you've been unlucky enough to never have a good one.

Sure, a lot of what's done in a pharmacy is pill counting and taking payment. It could be done by a machine, which is why pharmacy assistants don't require any education and don't make much money.

The important work that pharmacists do though, the work they need a doctorate to be able to do? I'm not sure people realize how heavily involved they can be with patient treatment.

As a prescriber, I can't tell you how many phone calls I've had with pharmacists, how many times I've depended on them to collaborate on treatment.

As a complex patient myself, I would be screwed without my pharmacist. I have a half dozen different prescribers on my case who don't talk to each other. If my prescriptions were blindly filled as they are ordered, it would be a disaster. It takes doctoral level knowledge to integrate them into a cohesive treatment plan.

Sorry to continue the total derailment of this thread, but I have a deep respect for good pharmacists.

Actually, let me make this a contribution to the thread.
The myth that pharmacists are useless pill counters has contributed to the continued decimation of the industry and there are fewer and fewer really great, independent pharmacists out there providing high quality care in communities.

My pharmacist owns the only small independent pharmacy in my area, and he's hugely involved in the community, knows practically all of his patients, and provides an exquisite level of care that I've never found in a grocery store pharmacy.

Poor medical care can be incredibly costly to the individual and the system, especially when it comes to prescription medications.

[Morning Glory]

Just popping in to say that my pharmacist could never be replaced by a pill counting machine. Any pharmacist who can be is a shitty, shitty pharmacist.

Anyone who has had complex conditions and medications and a competent pharmacist knows they are a critical part of their healthcare team.

If you don't understand the value of pharmacists, you've either been lucky enough not to need their critical services, or you've been unlucky enough to never have a good one.

Sure, a lot of what's done in a pharmacy is pill counting and taking payment. It could be done by a machine, which is why pharmacy assistants don't require any education and don't make much money.

The important work that pharmacists do though, the work they need a doctorate to be able to do? I'm not sure people realize how heavily involved they can be with patient treatment.

As a prescriber, I can't tell you how many phone calls I've had with pharmacists, how many times I've depended on them to collaborate on treatment.

As a complex patient myself, I would be screwed without my pharmacist. I have a half dozen different prescribers on my case who don't talk to each other. If my prescriptions were blindly filled as they are ordered, it would be a disaster. It takes doctoral level knowledge to integrate them into a cohesive treatment plan.

Sorry to continue the total derailment of this thread, but I have a deep respect for good pharmacists.

Actually, let me make this a contribution to the thread.
The myth that pharmacists are useless pill counters has contributed to the continued decimation of the industry and there are fewer and fewer really great, independent pharmacists out there providing high quality care in communities.

My pharmacist owns the only small independent pharmacy in my area, and he's hugely involved in the community, knows practically all of his patients, and provides an exquisite level of care that I've never found in a grocery store pharmacy.

Poor medical care can be incredibly costly to the individual and the system, especially when it comes to prescription medications.

Agree here. I've caught some holes in the swiss cheese in my time, but I can only guess haw many don't make it that far because of pharmacists

[Wolfpack Mustachian]

Just popping in to say that my pharmacist could never be replaced by a pill counting machine. Any pharmacist who can be is a shitty, shitty pharmacist.

Anyone who has had complex conditions and medications and a competent pharmacist knows they are a critical part of their healthcare team.

If you don't understand the value of pharmacists, you've either been lucky enough not to need their critical services, or you've been unlucky enough to never have a good one.

Sure, a lot of what's done in a pharmacy is pill counting and taking payment. It could be done by a machine, which is why pharmacy assistants don't require any education and don't make much money.

The important work that pharmacists do though, the work they need a doctorate to be able to do? I'm not sure people realize how heavily involved they can be with patient treatment.

As a prescriber, I can't tell you how many phone calls I've had with pharmacists, how many times I've depended on them to collaborate on treatment.

As a complex patient myself, I would be screwed without my pharmacist. I have a half dozen different prescribers on my case who don't talk to each other. If my prescriptions were blindly filled as they are ordered, it would be a disaster. It takes doctoral level knowledge to integrate them into a cohesive treatment plan.

Sorry to continue the total derailment of this thread, but I have a deep respect for good pharmacists.

Actually, let me make this a contribution to the thread.
The myth that pharmacists are useless pill counters has contributed to the continued decimation of the industry and there are fewer and fewer really great, independent pharmacists out there providing high quality care in communities.

My pharmacist owns the only small independent pharmacy in my area, and he's hugely involved in the community, knows practically all of his patients, and provides an exquisite level of care that I've never found in a grocery store pharmacy.

Poor medical care can be incredibly costly to the individual and the system, especially when it comes to prescription medications.

Thank you for this personal account and explanation and for doing a much better job than I could have.

[MudPuppy]

@Wolfpack Mustachian and others

My personal PCP has both an MD and a PharmD, every PharmD I have ever work with in my career has been a top notch interdisciplinary problem solver, and the main pharmacist at my preferred pharmacy always does due diligence with new new meds (and has a delightful personality). Pharmacist are GREAT. They are not vending machines.

[Taran Wanderer]

Here is the way I understood the story above.  Pharmacist receives prescription. Doesn’t have brand name. Offers generic. Patient gets generic. Patient reviews label and finds gluten. (I assume patient hasn’t opened bottle or even left the pharmacy yet.)  Patient tells pharmacist. Pharmacist says, “I’m sorry, I can’t do anything about that.”  Frankly that’s ridiculous. Ridiculous.

I have friends who are pharmacists. Obviously not all pharmacists are bad. Even this pharmacist may have had their hands tied by the corporate giant they work for. It’s still ridiculous.

[Metalcat]

Here is the way I understood the story above.  Pharmacist receives prescription. Doesn’t have brand name. Offers generic. Patient gets generic. Patient reviews label and finds gluten. (I assume patient hasn’t opened bottle or even left the pharmacy yet.)  Patient tells pharmacist. Pharmacist says, “I’m sorry, I can’t do anything about that.”  Frankly that’s ridiculous. Ridiculous.

I have friends who are pharmacists. Obviously not all pharmacists are bad. Even this pharmacist may have had their hands tied by the corporate giant they work for. It’s still ridiculous.

Yep, ridiculous.

What I can't understand is why the patient had to go back to their doctor when the pharmacist could have just called the doctor.

Whatever happened in this case, I agree, it's ridiculous.

[Wolfpack Mustachian]

Here is the way I understood the story above.  Pharmacist receives prescription. Doesn’t have brand name. Offers generic. Patient gets generic. Patient reviews label and finds gluten. (I assume patient hasn’t opened bottle or even left the pharmacy yet.)  Patient tells pharmacist. Pharmacist says, “I’m sorry, I can’t do anything about that.”  Frankly that’s ridiculous. Ridiculous.

I have friends who are pharmacists. Obviously not all pharmacists are bad. Even this pharmacist may have had their hands tied by the corporate giant they work for. It’s still ridiculous.

Again, given your assumptions that the patient hasn't opened the bottle or left the pharmacy, yes, the fact that she couldn't give it back would be ridiculous. However, just because it is ridiculous still doesn't mean it's the pharmacist's fault. Again, if it really was not able to be taken back, it would almost certainly be a store manager's decision, not the pharmacist's. In this situation, the pharmacist is just getting the brunt of your hypothetical ire when there is nothing they can do about it.

What got me so frustrated was your comment that you would throw the medicine back at the pharmacist, tell the pharmacist what they could do with themselves, and so on. That's asinine behavior. Maybe you meant your comment tongue in cheek, but my take is you are an A #1 @#4hole if that would really be your reaction in that situation. Perhaps it's just because someone I'm close to is a pharmacist, but I'm especially sensitive to people treating pharmacists like they are subhuman. I get that it happens to all retail people, but from what I've been given a glimpse of, pharmacists are treated even worse than regular retail people or are treated as badly more often, and as opposed to general retail situations, what they're being cursed at, screamed at,  and so on is often not only just against store policy on (i.e. you'd get fired from the store if you did what the customer asked you to do), but could literally get them in legal trouble if they did what they were being cursed at about. So, yeah, I'm fairly easily frustrated with people who take things out on pharmacists, and just know that if you truly did something remotely like this, you would be an incredible jerk not just in how you reacted but even worse because you would be very likely berating someone who could do nothing to fix your problem.

[Gremlin]

Just to add a bit more information to the discussion as to whether my mother is a jerk or not...

The pharmacy already had it on record that she was coeliac.  The pharmacist proceeded to issue her with an alternative to the prescribed medication that contained gluten.  The pharmacist could have said, "well according to our records, you are coeliac and the only alternative I have in stock is the generic brand which contains gluten, so I would recommend seeing if Pharmacy X five minutes away can help you with the name brand."  But that's not how it transpired.

She didn't open the medication, nor had she left the pharmacy when she noticed that the medication contained gluten and took it back to the issuing pharmacist.

There is an element of trust in such a relationship as there is a clear degree of information asymmetry between pharmacist and patient.  I think it's reasonable that, given the pharmacy had it on record that my mother was coeliac, would not issue her with medication containing gluten.  I think to do so, and not to acknowledge and rectify the problem, is a clear breach of trust.  If it's beyond the pharmacist's authority to do so, I would expect the pharmacist to own the problem and raise it with whomever has the authority to respond.  I continue to believe this was nothing short of an appalling failure of duty of care towards my elderly mother.

[Wolfpack Mustachian]

Just to add a bit more information to the discussion as to whether my mother is a jerk or not...

The pharmacy already had it on record that she was coeliac.  The pharmacist proceeded to issue her with an alternative to the prescribed medication that contained gluten.  The pharmacist could have said, "well according to our records, you are coeliac and the only alternative I have in stock is the generic brand which contains gluten, so I would recommend seeing if Pharmacy X five minutes away can help you with the name brand."  But that's not how it transpired.

She didn't open the medication, nor had she left the pharmacy when she noticed that the medication contained gluten and took it back to the issuing pharmacist.

There is an element of trust in such a relationship as there is a clear degree of information asymmetry between pharmacist and patient.  I think it's reasonable that, given the pharmacy had it on record that my mother was coeliac, would not issue her with medication containing gluten.  I think to do so, and not to acknowledge and rectify the problem, is a clear breach of trust.  If it's beyond the pharmacist's authority to do so, I would expect the pharmacist to own the problem and raise it with whomever has the authority to respond.  I continue to believe this was nothing short of an appalling failure of duty of care towards my elderly mother.

Given this information, the pharmacist clearly made a mistake and should have certainly worked to rectify it.

[GuitarStv]

Just to throw out some knowledge here. Several things went wrong here, but at least some of them weren't the thought of the pharmacist. The prescription pad has something where it specifies brand only, otherwise, it is legally assumed that you can do substitutions. The doctor could have specified brand only. It is also possible the doctor made the mistake and actually didn't say substitutes were not OK, because then it would be the doctor's fault. However, if it was specified brand only, yes, that was the fault of the pharmacist.

Beyond that, this is mostly a "let's pick on the person who's easiest to yell at". Someone called it out as "just semantics" to call it equivalent, but that's a very biased way to look at it and is actually factually incorrect. Equivalency is a medical standard term for a brand to a generic comparison. So, yeah, the pharmacist would probably have been better off to explain it some more, but again, they are using the legal, medical definition. It's not just semantics. Furthermore, people seem to think that pharmacists should just magically know everything about a patient. Many things about the patient are not readily accessible to them, and there's a very small percentage chance that they had that information available. I'm sorry, but the woman was somewhat at fault here. If she had a serious allergy, she had some responsibility to volunteer that information. Advocate for yourself. People are allergic to a myriad number of things. Mention it.

On the not taking it back part, that's a store issue. Again, the pharmacist probably (not for certain but most likely) doesn't own the store. They can't issue a refund because it's store policy.

So, in all, sure, yell, scream, throw objects at the pharmacist. But just realize, the person who's being a jerk here just might be you.

A pharmacist has an incredibly easy job.  The main reason they haven't all been replaced with pill counting machines is that they're supposed to do stuff like check with the person for stuff like medication/allergy conflicts when performing substitutions.  He fucked up when he didn't bother to ask about this.  If he had he would have heard about the celiac condition and known not to make the sale.

Yelling/screaming/throwing objects of course isn't a great way to deal with anyone who has screwed up.

Wow, for one, way to ignore all of the points I made first of all and just go to "ignorant generic insult of an entire profession" and full blame without addressing other points.

Second of all, congrats on some grade A level snobbery, condescension, and the general assumption that you understand something you clearly have no experience in. I personally know of interventions of pharmacists that have literally saved lives. They do not have an incredibly easy job. They literally hold responsibility for people's lives in their hands. Have you ever had a job where that's the case? I have, and nothing about a job like that is incredibly easy. Yes, they need to look for drug interactions and a variety of things like that (although they do more than that depending on where their job actually is - again, you apparently don't know this or care to learn before weighing in), but no, they are not always able to ask about every possible personal allergy for every possible thing in the course of giving out medication. There's a crap ton of random allergies out there. Again, as I mentioned, if the doctor didn't specifically put that there must be no substitutions on the prescription, the policy is generally to substitute the generic for it if they don't have the brand as a matter of course. If this was the case, even mentioning it was more than was necessary. Don't like the policy, that's fine - you're talking an overhaul of the whole medical system and yet you're pinning blame on a pharmacist like someone who lost their luggage pins blame on the person at the lost baggage counter.

I am not a pharmacist. I do know people that are and apparently understand more about it than you do from your comments. Please be willing to withhold insults in the future when you clearly don't understand what you're insulting...

ETA: I dug into this a little further. Retail pharmacies often/almost always have people fill out information for their allergies for this very reason. If the lady had put in that she was allergic to gluten in there, the pharmacist would almost certainly have caught the problem as they would have been alerted to the allergy when they were filling it. To rely on a pharmacist to ask every patient about every possible allergy is insane. Primary care doctors have the responsibility of detailed knowledge of their patients because they see 20 patients a day. Pharmacists handle 20 times that many a day. They can't ask everyone about everything. That is why implying the pharmacist should have asked about a particular allergy is ridiculous.

I'm not trying to disparage your significant other.  I don't know exactly how pharmacists operate in your country.  Here, they take your prescription and type it into their computer system.  The computer system then gives them a printout of all potential side-effects, ingredients in the medication, contraindications, and conflicts with medication.  The pharmacist then reads this information to the person receiving the prescription.  Part of this is supposed to be a discussion that covers allergies . . . and if the pharmacist is recommending a replacement drug, allergies definitely need to be discussed - for obvious reasons.  (Typically pharmacies here don't have any access to medical history or information about the person they're dispensing medication to and you're not required to fill out any information when picking up drugs.)

Besides counting pills, that's most of the job for a pharmacist here.  This is easily automatable, and would radically reduce human error if we did so.  (Some aspects that pharmacists will do such as compounding and mixing stuff up would be more difficult to automate . . . but today it's hard to find a drug store where they offer this service anyway.  Seems like only about one in four or one in five pharmacists around here actually do compounding.)

[dreadmoose]

I'm not trying to disparage your significant other.  I don't know exactly how pharmacists operate in your country.  Here, they take your prescription and type it into their computer system.  The computer system then gives them a printout of all potential side-effects, ingredients in the medication, contraindications, and conflicts with medication.  The pharmacist then reads this information to the person receiving the prescription.  Part of this is supposed to be a discussion that covers allergies . . . and if the pharmacist is recommending a replacement drug, allergies definitely need to be discussed - for obvious reasons.  (Typically pharmacies here don't have any access to medical history or information about the person they're dispensing medication to and you're not required to fill out any information when picking up drugs.)

Besides counting pills, that's most of the job for a pharmacist here.  This is easily automatable, and would radically reduce human error if we did so.  (Some aspects that pharmacists will do such as compounding and mixing stuff up would be more difficult to automate . . . but today it's hard to find a drug store where they offer this service anyway.  Seems like only about one in four or one in five pharmacists around here actually do compounding.)

You are sounding pretty obtuse here.

I'd harken say you should educate yourself, but if you've whittled down your respect for Pharmacists from the medication management experts that Doctors rely on to counting your heart pills and reading a printout, then you probably don't care to expand it back out.

I hope the people in your life treat you with more respect, even if they don't understand everything you do or what it took to get there.

[GuitarStv]

I'm not trying to disparage your significant other.  I don't know exactly how pharmacists operate in your country.  Here, they take your prescription and type it into their computer system.  The computer system then gives them a printout of all potential side-effects, ingredients in the medication, contraindications, and conflicts with medication.  The pharmacist then reads this information to the person receiving the prescription.  Part of this is supposed to be a discussion that covers allergies . . . and if the pharmacist is recommending a replacement drug, allergies definitely need to be discussed - for obvious reasons.  (Typically pharmacies here don't have any access to medical history or information about the person they're dispensing medication to and you're not required to fill out any information when picking up drugs.)

Besides counting pills, that's most of the job for a pharmacist here.  This is easily automatable, and would radically reduce human error if we did so.  (Some aspects that pharmacists will do such as compounding and mixing stuff up would be more difficult to automate . . . but today it's hard to find a drug store where they offer this service anyway.  Seems like only about one in four or one in five pharmacists around here actually do compounding.)

You are sounding pretty obtuse here.

I'd harken say you should educate yourself, but if you've whittled down your respect for Pharmacists from the medication management experts that Doctors rely on to counting your heart pills and reading a printout, then you probably don't care to expand it back out.

I hope the people in your life treat you with more respect, even if they don't understand everything you do or what it took to get there.

It's certainly possible that some pharmacists are 'medication management experts that doctors rely on'.  The vast majority of the prescriptions that I've had filled for me, my mom, my wife, my son that certainly didn't go on.  I've only known three instances where people had problems with medication prescribed.

1.  My father was overprescribed heavy painkillers after his leg was amputated.  That was the doctor's fault (was written into the prescription), but the pharmacist certainly didn't say anything about it when handing over the pills.  Caused some pretty terrible withdrawal on my dad's part (vomiting, shakes, trouble sleeping, weight loss, etc.).  That would have been caught by an automated system given that it was higher than the usual dose by a factor of five.

2.  My grandmother was prescribed a cocktail of various drugs for old people problems (heart, thyroid, arthritis, etc.).  She was once recommended a generic by the pharmacist that conflicted with another of her medications and ended up in the hospital because of it.  Apparently the non-generic drug did not have this conflict.  That definitely would have been caught by an automated system.

3.  My best friend was given the incorrect dose of some of his lung cancer drugs by the pharmacist (it didn't match the prescription).  Not sure what the end result would have been if he had taken the wrong pills, but likely not good.  His wife caught that after they had gone home and before he took the dose.  He was on a lot of unusual drugs towards the end, so I'm not sure if this would have been caught by an automated system.

Doctors (in Ontario anyway) don't often contact pharmacists when prescribing medication.  Pharmacists typically fill the prescription, and don't second guess the doctor.  At least in my experience.  Everyone is human, and errors occasionally happen.  It's possible that these miracle working pharmacists who carefully double check and question every prescription handed out by a doctor exist in reality . . . but I've never run into one.

[nereo]

I worked in medical records - pharmacists called us constantly about medications.  Like every single day.  Often it was to verify a Rx, but sometimes to discuss regiments and possible alternatives. It wasn’t unusual to have the pharmacist spot potential harmful drug interactions the doctor missed because the doctor is frequently seeing a patient for one particular medical condition whereas the pharmacist seeing all the drugs that person has been taking. THe patient is supposed to tell the doctor but that information is often missed (either because the patient didn’t disclose or forgot, or because the doctor didn’t record that information or - often - didn’t know about a particular potential interaction from the literally millions of drug combinations possible from just a few dozen commonly prescribed medicines.

So I’m definitely on the side of pharmacists being far more than automatic pill-sorting machines.

[MudPuppy]

All of your examples of are of when the process goes wrong. You probably don’t have “right” examples because when things go right and catches are made, you probably never get told.

fwiw, the hospital I work with has computer systems and people checking both checking everything. The computer doesn’t always catch potential issues because computers are bad at nuance.

[Metalcat]

I'm not trying to disparage your significant other.  I don't know exactly how pharmacists operate in your country.  Here, they take your prescription and type it into their computer system.  The computer system then gives them a printout of all potential side-effects, ingredients in the medication, contraindications, and conflicts with medication.  The pharmacist then reads this information to the person receiving the prescription.  Part of this is supposed to be a discussion that covers allergies . . . and if the pharmacist is recommending a replacement drug, allergies definitely need to be discussed - for obvious reasons.  (Typically pharmacies here don't have any access to medical history or information about the person they're dispensing medication to and you're not required to fill out any information when picking up drugs.)

Besides counting pills, that's most of the job for a pharmacist here.  This is easily automatable, and would radically reduce human error if we did so.  (Some aspects that pharmacists will do such as compounding and mixing stuff up would be more difficult to automate . . . but today it's hard to find a drug store where they offer this service anyway.  Seems like only about one in four or one in five pharmacists around here actually do compounding.)

You are sounding pretty obtuse here.

I'd harken say you should educate yourself, but if you've whittled down your respect for Pharmacists from the medication management experts that Doctors rely on to counting your heart pills and reading a printout, then you probably don't care to expand it back out.

I hope the people in your life treat you with more respect, even if they don't understand everything you do or what it took to get there.

It's certainly possible that some pharmacists are 'medication management experts that doctors rely on'.  The vast majority of the prescriptions that I've had filled for me, my mom, my wife, my son that certainly didn't go on.  I've only known three instances where people had problems with medication prescribed.

1.  My father was overprescribed heavy painkillers after his leg was amputated.  That was the doctor's fault (was written into the prescription), but the pharmacist certainly didn't say anything about it when handing over the pills.  Caused some pretty terrible withdrawal on my dad's part (vomiting, shakes, trouble sleeping, weight loss, etc.).  That would have been caught by an automated system given that it was higher than the usual dose by a factor of five.

2.  My grandmother was prescribed a cocktail of various drugs for old people problems (heart, thyroid, arthritis, etc.).  She was once recommended a generic by the pharmacist that conflicted with another of her medications and ended up in the hospital because of it.  Apparently the non-generic drug did not have this conflict.  That definitely would have been caught by an automated system.

3.  My best friend was given the incorrect dose of some of his lung cancer drugs by the pharmacist (it didn't match the prescription).  Not sure what the end result would have been if he had taken the wrong pills, but likely not good.  His wife caught that after they had gone home and before he took the dose.  He was on a lot of unusual drugs towards the end, so I'm not sure if this would have been caught by an automated system.

Doctors (in Ontario anyway) don't often contact pharmacists when prescribing medication.  Pharmacists typically fill the prescription, and don't second guess the doctor.  At least in my experience.  Everyone is human, and errors occasionally happen.  It's possible that these miracle working pharmacists who carefully double check and question every prescription handed out by a doctor exist in reality . . . but I've never run into one.

I'm in Ontario, and as I said in my post, I had phone calls with pharmacists regularly.

However, I also mentioned that the pharmacy industry has been decimated in many ways, and your examples are exactly what happens when pharmacy is no longer treated like the serious discipline that it is.

It's also why I'm so picky about which pharmacists I will go to for my own prescriptions.

Your examples actually prove the value of good pharmacy care, it's just tragic that you and your loved ones didn't get it.

That's also exactly what I said in my previous post, anyone who doesn't value pharmacists is either lucky enough not to have needed their care, or unlucky enough not to have received it when they did need it.

[nereo]

fwiw, the hospital I work with has computer systems and people checking both checking everything. The computer doesn’t always catch potential issues because computers are bad at nuance.

And I'd add - the computer doesn't always catch potential issues because often the data they have is incomplete.  OTC medications aren't recorded, as are supplements and herbal remedies. People also take medication prescribed to someone else All. The. Time.  ("oh, you have an ear infection?  I had one last month adn this cleared it right up!" or: "save the $X/time and use my pills, I don't need 'em anymore!").

Pharmacists see the patient at the point of sale.  Many Rx require a consult with the pharmacist for this reason.  S/he can catch things like "with this medicine you must avoid these common supplments, and I see you are buying a medicine with pseudoephedrine - you take that with this Rx".
OR - s/he will often be the first medical professional to hear about side effects, prompting a question like: you are taking these Rx - have you taken these supplements/medicines/foods? 
etc.

[Steeze]

I don't think I've ever had a pharmacist tell me any information about the prescription I was picking up unless I asked. Most the time, maybe all the time, it is a pharmacy tech that is checking me out. On occasion I have consulted with the pharmacist on duty to see if any cheaper alternatives are available, or if it is safe to take something with something else. Never have I been asked about an allergy or any other drugs I might be on. My doctor asks those questions though.

The only time I have successfully gotten a prescription changed due to costs the pharmacist was not willing to do this on the spot, and insisted we wait for the doctor to change the script. So I had to wait a couple days for the doctor to respond to their request and fax a new script.

Hell, I used to pick up my friend's grandmother's scripts for her. I don't even know what they were, she was on all sorts of stuff - no one even asks for an ID or anything. Just payment, no questions asked.

[Green_Tea]

Just to add a bit more information to the discussion as to whether my mother is a jerk or not...

The pharmacy already had it on record that she was coeliac.  The pharmacist proceeded to issue her with an alternative to the prescribed medication that contained gluten.  The pharmacist could have said, "well according to our records, you are coeliac and the only alternative I have in stock is the generic brand which contains gluten, so I would recommend seeing if Pharmacy X five minutes away can help you with the name brand."  But that's not how it transpired.

She didn't open the medication, nor had she left the pharmacy when she noticed that the medication contained gluten and took it back to the issuing pharmacist.

There is an element of trust in such a relationship as there is a clear degree of information asymmetry between pharmacist and patient.  I think it's reasonable that, given the pharmacy had it on record that my mother was coeliac, would not issue her with medication containing gluten.  I think to do so, and not to acknowledge and rectify the problem, is a clear breach of trust.  If it's beyond the pharmacist's authority to do so, I would expect the pharmacist to own the problem and raise it with whomever has the authority to respond.  I continue to believe this was nothing short of an appalling failure of duty of care towards my elderly mother.

Hey Gremlin, I don't think your mom is at fault at all! Sure the Pharmacologist was right in saying it is equivalent but I think part of being a professional with expert knowledge should be realizing that people not working in this very professional field might not understand the meaning of those specific words and making sure they do understand it (e.g. I have an alternative medication which is pharmaceutically equivalent, meaning it is the same drug and will have the same effect, but there is some difference in the pharmaceutical excipients (not an english speaker so not sure if this is a commonly used word)).
Sorry for the bad experience!

[nereo]

I don't think I've ever had a pharmacist tell me any information about the prescription I was picking up unless I asked. Most the time, maybe all the time, it is a pharmacy tech that is checking me out. On occasion I have consulted with the pharmacist on duty to see if any cheaper alternatives are available, or if it is safe to take something with something else. Never have I been asked about an allergy or any other drugs I might be on. My doctor asks those questions though.

The only time I have successfully gotten a prescription changed due to costs the pharmacist was not willing to do this on the spot, and insisted we wait for the doctor to change the script. So I had to wait a couple days for the doctor to respond to their request and fax a new script.

Hell, I used to pick up my friend's grandmother's scripts for her. I don't even know what they were, she was on all sorts of stuff - no one even asks for an ID or anything. Just payment, no questions asked.

The problem with such anecdotes is that people assume their relatively passive experience defines the overall usefulness of the profession.

I remember my supervisor remarking that 10% of patients accounted for over 80% of practice’s resources. Same goes, i assume, for pharmacists.  You didn’t observe the pharmacist asking you any questions, so you’re perception is that they do this. More likely, you weren’t a case to be concerned about. Most medicines are tolerated well, and you apparently weren’t suffering from severe side effects. 
It would be very unusual (and generally improper) for a pharmacist to change your medicine “on the spot” without consulting your primary care - which sounds like exactly what s/he did.  In fact, they do this all the time, which is what I was pointing out in my post up thread.

[DaMa]

I don't think I've ever had a pharmacist tell me any information about the prescription I was picking up unless I asked. Most the time, maybe all the time, it is a pharmacy tech that is checking me out. On occasion I have consulted with the pharmacist on duty to see if any cheaper alternatives are available, or if it is safe to take something with something else. Never have I been asked about an allergy or any other drugs I might be on. My doctor asks those questions though.

The only time I have successfully gotten a prescription changed due to costs the pharmacist was not willing to do this on the spot, and insisted we wait for the doctor to change the script. So I had to wait a couple days for the doctor to respond to their request and fax a new script.

Hell, I used to pick up my friend's grandmother's scripts for her. I don't even know what they were, she was on all sorts of stuff - no one even asks for an ID or anything. Just payment, no questions asked.

The problem with such anecdotes is that people assume their relatively passive experience defines the overall usefulness of the profession.

I remember my supervisor remarking that 10% of patients accounted for over 80% of practice’s resources. Same goes, i assume, for pharmacists.  You didn’t observe the pharmacist asking you any questions, so you’re perception is that they do this. More likely, you weren’t a case to be concerned about. Most medicines are tolerated well, and you apparently weren’t suffering from severe side effects. 
It would be very unusual (and generally improper) for a pharmacist to change your medicine “on the spot” without consulting your primary care - which sounds like exactly what s/he did.  In fact, they do this all the time, which is what I was pointing out in my post up thread.

I was taking a new antibiotic.  Started it on Thursday, then went away Friday for a scrapbooking weekend with a friend.  I had gradual onset of joint pain.  I initially thought it was just from all the sitting.  But by the time we got home, the pain was getting worrisome, but not yet emergency level.  It was Sunday, so I called the pharmacy which was open.  I asked the pharmacist if the new drug could be an issue.  He said absolutely and quit taking it immediately.  He told me it was a rare reaction, but known.  I felt much better on Monday, and completely better by Tuesday.  When I discussed it with the doctor later, she had never heard of that reaction.

FYI, the drug was Levaquin.  Joint pain isn't a "side effect."  It's an "adverse reaction." 

[Wolfpack Mustachian]

Just to throw out some knowledge here. Several things went wrong here, but at least some of them weren't the thought of the pharmacist. The prescription pad has something where it specifies brand only, otherwise, it is legally assumed that you can do substitutions. The doctor could have specified brand only. It is also possible the doctor made the mistake and actually didn't say substitutes were not OK, because then it would be the doctor's fault. However, if it was specified brand only, yes, that was the fault of the pharmacist.

Beyond that, this is mostly a "let's pick on the person who's easiest to yell at". Someone called it out as "just semantics" to call it equivalent, but that's a very biased way to look at it and is actually factually incorrect. Equivalency is a medical standard term for a brand to a generic comparison. So, yeah, the pharmacist would probably have been better off to explain it some more, but again, they are using the legal, medical definition. It's not just semantics. Furthermore, people seem to think that pharmacists should just magically know everything about a patient. Many things about the patient are not readily accessible to them, and there's a very small percentage chance that they had that information available. I'm sorry, but the woman was somewhat at fault here. If she had a serious allergy, she had some responsibility to volunteer that information. Advocate for yourself. People are allergic to a myriad number of things. Mention it.

On the not taking it back part, that's a store issue. Again, the pharmacist probably (not for certain but most likely) doesn't own the store. They can't issue a refund because it's store policy.

So, in all, sure, yell, scream, throw objects at the pharmacist. But just realize, the person who's being a jerk here just might be you.

A pharmacist has an incredibly easy job.  The main reason they haven't all been replaced with pill counting machines is that they're supposed to do stuff like check with the person for stuff like medication/allergy conflicts when performing substitutions.  He fucked up when he didn't bother to ask about this.  If he had he would have heard about the celiac condition and known not to make the sale.

Yelling/screaming/throwing objects of course isn't a great way to deal with anyone who has screwed up.

Wow, for one, way to ignore all of the points I made first of all and just go to "ignorant generic insult of an entire profession" and full blame without addressing other points.

Second of all, congrats on some grade A level snobbery, condescension, and the general assumption that you understand something you clearly have no experience in. I personally know of interventions of pharmacists that have literally saved lives. They do not have an incredibly easy job. They literally hold responsibility for people's lives in their hands. Have you ever had a job where that's the case? I have, and nothing about a job like that is incredibly easy. Yes, they need to look for drug interactions and a variety of things like that (although they do more than that depending on where their job actually is - again, you apparently don't know this or care to learn before weighing in), but no, they are not always able to ask about every possible personal allergy for every possible thing in the course of giving out medication. There's a crap ton of random allergies out there. Again, as I mentioned, if the doctor didn't specifically put that there must be no substitutions on the prescription, the policy is generally to substitute the generic for it if they don't have the brand as a matter of course. If this was the case, even mentioning it was more than was necessary. Don't like the policy, that's fine - you're talking an overhaul of the whole medical system and yet you're pinning blame on a pharmacist like someone who lost their luggage pins blame on the person at the lost baggage counter.

I am not a pharmacist. I do know people that are and apparently understand more about it than you do from your comments. Please be willing to withhold insults in the future when you clearly don't understand what you're insulting...

ETA: I dug into this a little further. Retail pharmacies often/almost always have people fill out information for their allergies for this very reason. If the lady had put in that she was allergic to gluten in there, the pharmacist would almost certainly have caught the problem as they would have been alerted to the allergy when they were filling it. To rely on a pharmacist to ask every patient about every possible allergy is insane. Primary care doctors have the responsibility of detailed knowledge of their patients because they see 20 patients a day. Pharmacists handle 20 times that many a day. They can't ask everyone about everything. That is why implying the pharmacist should have asked about a particular allergy is ridiculous.

I'm not trying to disparage your significant other.  I don't know exactly how pharmacists operate in your country.  Here, they take your prescription and type it into their computer system.  The computer system then gives them a printout of all potential side-effects, ingredients in the medication, contraindications, and conflicts with medication.  The pharmacist then reads this information to the person receiving the prescription.  Part of this is supposed to be a discussion that covers allergies . . . and if the pharmacist is recommending a replacement drug, allergies definitely need to be discussed - for obvious reasons.  (Typically pharmacies here don't have any access to medical history or information about the person they're dispensing medication to and you're not required to fill out any information when picking up drugs.)

Besides counting pills, that's most of the job for a pharmacist here.  This is easily automatable, and would radically reduce human error if we did so.  (Some aspects that pharmacists will do such as compounding and mixing stuff up would be more difficult to automate . . . but today it's hard to find a drug store where they offer this service anyway.  Seems like only about one in four or one in five pharmacists around here actually do compounding.)

I realized looking back on this that I got overly sensitive because of my indirect experiences and the frustrations I had at seeing people be so unnecessarily antagonistic and cause so much pain just because they were allowing their emotions to get the better of them and just in general acting like terrible people.

I completely understand that your perception of pharmacists is colored by your own experiences just like mine are, and it sounds like you've had some crappy experiences, so it makes sense that that's where you're coming from.

I will say that there are a number of pharmacists that are not your standard retail pharmacists that most people are unaware of. You mentioned some in terms of compounding. Other examples are pharmacists as a part of larger-scale operations like hospitals, mental health institutions, etc., who do all kinds of critical things, including drug substitutions for what doctors prescribe, patient counseling, help in the evaluation of actual conditions, and making drug recommendations, etc.

My point is, pharmacists do many other jobs besides just the retail ones that the public sees, and there's a good percentage of them that work in these jobs. All pharmacists do (or should) receive the education to be able to do this kind of stuff, so they are a wealth of knowledge and are the subject matter experts on drugs, much more so than doctors. What you're seeing in retail pharmacies is the result of so many patients to so few pharmacists. As I mentioned, a retail pharmacist may be working with 400+ patients on a single shift just for drugs while also being the person who gives flu shots if needed and other assorted duties. The system they are in really doesn't allow for any kind of advocating for a patient beyond checking stuff in the system and waiting for them to ask questions. Additionally, I know you said that the system would do a better job of checking for interactions, and that might be true in a world of perfect information. Again, though, I can tell you from 1st hand experience that the information in those programmed systems is not always correct, and I've had the aid of a pharmacist who helped with a dangerous situation with someone in my family where the information was not correct in the system. The point is, pharmacists provide a critical check with their knowledge, admittedly if they do a good job and can provide invaluable help to patients and prevent serious issues.

[GuitarStv]

Just to throw out some knowledge here. Several things went wrong here, but at least some of them weren't the thought of the pharmacist. The prescription pad has something where it specifies brand only, otherwise, it is legally assumed that you can do substitutions. The doctor could have specified brand only. It is also possible the doctor made the mistake and actually didn't say substitutes were not OK, because then it would be the doctor's fault. However, if it was specified brand only, yes, that was the fault of the pharmacist.

Beyond that, this is mostly a "let's pick on the person who's easiest to yell at". Someone called it out as "just semantics" to call it equivalent, but that's a very biased way to look at it and is actually factually incorrect. Equivalency is a medical standard term for a brand to a generic comparison. So, yeah, the pharmacist would probably have been better off to explain it some more, but again, they are using the legal, medical definition. It's not just semantics. Furthermore, people seem to think that pharmacists should just magically know everything about a patient. Many things about the patient are not readily accessible to them, and there's a very small percentage chance that they had that information available. I'm sorry, but the woman was somewhat at fault here. If she had a serious allergy, she had some responsibility to volunteer that information. Advocate for yourself. People are allergic to a myriad number of things. Mention it.

On the not taking it back part, that's a store issue. Again, the pharmacist probably (not for certain but most likely) doesn't own the store. They can't issue a refund because it's store policy.

So, in all, sure, yell, scream, throw objects at the pharmacist. But just realize, the person who's being a jerk here just might be you.

A pharmacist has an incredibly easy job.  The main reason they haven't all been replaced with pill counting machines is that they're supposed to do stuff like check with the person for stuff like medication/allergy conflicts when performing substitutions.  He fucked up when he didn't bother to ask about this.  If he had he would have heard about the celiac condition and known not to make the sale.

Yelling/screaming/throwing objects of course isn't a great way to deal with anyone who has screwed up.

Wow, for one, way to ignore all of the points I made first of all and just go to "ignorant generic insult of an entire profession" and full blame without addressing other points.

Second of all, congrats on some grade A level snobbery, condescension, and the general assumption that you understand something you clearly have no experience in. I personally know of interventions of pharmacists that have literally saved lives. They do not have an incredibly easy job. They literally hold responsibility for people's lives in their hands. Have you ever had a job where that's the case? I have, and nothing about a job like that is incredibly easy. Yes, they need to look for drug interactions and a variety of things like that (although they do more than that depending on where their job actually is - again, you apparently don't know this or care to learn before weighing in), but no, they are not always able to ask about every possible personal allergy for every possible thing in the course of giving out medication. There's a crap ton of random allergies out there. Again, as I mentioned, if the doctor didn't specifically put that there must be no substitutions on the prescription, the policy is generally to substitute the generic for it if they don't have the brand as a matter of course. If this was the case, even mentioning it was more than was necessary. Don't like the policy, that's fine - you're talking an overhaul of the whole medical system and yet you're pinning blame on a pharmacist like someone who lost their luggage pins blame on the person at the lost baggage counter.

I am not a pharmacist. I do know people that are and apparently understand more about it than you do from your comments. Please be willing to withhold insults in the future when you clearly don't understand what you're insulting...

ETA: I dug into this a little further. Retail pharmacies often/almost always have people fill out information for their allergies for this very reason. If the lady had put in that she was allergic to gluten in there, the pharmacist would almost certainly have caught the problem as they would have been alerted to the allergy when they were filling it. To rely on a pharmacist to ask every patient about every possible allergy is insane. Primary care doctors have the responsibility of detailed knowledge of their patients because they see 20 patients a day. Pharmacists handle 20 times that many a day. They can't ask everyone about everything. That is why implying the pharmacist should have asked about a particular allergy is ridiculous.

I'm not trying to disparage your significant other.  I don't know exactly how pharmacists operate in your country.  Here, they take your prescription and type it into their computer system.  The computer system then gives them a printout of all potential side-effects, ingredients in the medication, contraindications, and conflicts with medication.  The pharmacist then reads this information to the person receiving the prescription.  Part of this is supposed to be a discussion that covers allergies . . . and if the pharmacist is recommending a replacement drug, allergies definitely need to be discussed - for obvious reasons.  (Typically pharmacies here don't have any access to medical history or information about the person they're dispensing medication to and you're not required to fill out any information when picking up drugs.)

Besides counting pills, that's most of the job for a pharmacist here.  This is easily automatable, and would radically reduce human error if we did so.  (Some aspects that pharmacists will do such as compounding and mixing stuff up would be more difficult to automate . . . but today it's hard to find a drug store where they offer this service anyway.  Seems like only about one in four or one in five pharmacists around here actually do compounding.)

I realized looking back on this that I got overly sensitive because of my indirect experiences and the frustrations I had at seeing people be so unnecessarily antagonistic and cause so much pain just because they were allowing their emotions to get the better of them and just in general acting like terrible people.

I completely understand that your perception of pharmacists is colored by your own experiences just like mine are, and it sounds like you've had some crappy experiences, so it makes sense that that's where you're coming from.

I will say that there are a number of pharmacists that are not your standard retail pharmacists that most people are unaware of. You mentioned some in terms of compounding. Other examples are pharmacists as a part of larger-scale operations like hospitals, mental health institutions, etc., who do all kinds of critical things, including drug substitutions for what doctors prescribe, patient counseling, help in the evaluation of actual conditions, and making drug recommendations, etc.

My point is, pharmacists do many other jobs besides just the retail ones that the public sees, and there's a good percentage of them that work in these jobs. All pharmacists do (or should) receive the education to be able to do this kind of stuff, so they are a wealth of knowledge and are the subject matter experts on drugs, much more so than doctors. What you're seeing in retail pharmacies is the result of so many patients to so few pharmacists. As I mentioned, a retail pharmacist may be working with 400+ patients on a single shift just for drugs while also being the person who gives flu shots if needed and other assorted duties. The system they are in really doesn't allow for any kind of advocating for a patient beyond checking stuff in the system and waiting for them to ask questions. Additionally, I know you said that the system would do a better job of checking for interactions, and that might be true in a world of perfect information. Again, though, I can tell you from 1st hand experience that the information in those programmed systems is not always correct, and I've had the aid of a pharmacist who helped with a dangerous situation with someone in my family where the information was not correct in the system. The point is, pharmacists provide a critical check with their knowledge, admittedly if they do a good job and can provide invaluable help to patients and prevent serious issues.

It's also entirely possible that my experience has been unique and/or that much of the real work of pharmacists is hidden from view.

(And the comments about automation weren't a dig against pharmacists either - I'm a big fan of automation and integration.  A properly automated process is hundreds of times safer and more reliable than a human operated one.  It pains me that most health care systems are so mish-mash and haphazard.  Everything needs to be standardized, and everyone needs to be using the same linked systems.  The increase in safety, in ease of diagnosis, and in patient care would be incredible.)

[nereo]

It's also entirely possible that my experience has been unique and/or that much of the real work of pharmacists is hidden from view.

I would postulate that your experience isn't unique - and that's a key point here.  For the majority of interactions, there's little a pharmacist has to do beyond fill an Rx.  But that misses their value, training and expertise - which happens in a minority of cases that are more complex.

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

[GuitarStv]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

[nereo]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

Perhaps.  The challenge of course is in identifying which patients/customers/clients will need the expertise of a professional, and which can be serviced by automation.  This isn't a new phenomenon either - there's a rigorous debate among all sorts of professions about when it's appropriate to outsource work to either computers or less-trained individuals. On one side is efficency and cost reduction - on the other is safety, protection of a particular class and trust.

Many doctors would argue that its in those routine visits that they occasionally recognize an ailment that the patient glossed over which uncovered a more serious condition.  Those are hard to spot unless you are a trained professional.

[Metalcat]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

Yeah...no

People think this way, but it's really not at all the way it works. My patients used to fill out a 4 page questionnaire, which technical contained all of the information I needed to draw a lot of conclusions, except that patients are terrible narrators of their own conditions.

The 4 pages covered my liability for certain things, but mostly provided a framework for my questions, from which I actually gleaned real information. Which means, I still went over every question with them, and always had to ask a ton of clarifying questions, which I would have to base on my assessment of their level of comprehension of the concepts we were discussing.

Some degree of filtering by concern is absolutely possible, which is why receptionists usually ask what the problem is before booking, but beyond that, there's sooooo much art to medicine after that point that automation really fails in utility.

Not to say that there isn't a huge role for automation in medicine. I was reading all about AI for melanoma diagnosis, very interesting. It just can't really be implemented Idiocracy-style as a first line Q&A => diagnosis =>treatment kind of thing.

[markbike528CBX]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

In my former profession as a chemist (American-style, not a British pharmacist), I could train a reasonably bright high school student to do the hands-on part of my job if nothing went wrong.
Of course, if it did go sideways or was heading that way, then my years of chemistry training and experience came in damn handy.
Seeing something like a calculation result or the amount of chemicals, or a out of bounds analysis result and recognizing that it "wasn't quite right" is key.  Doing this while fatigued from many days of 13 hour shifts is NOT something that comes naturally.

[Rhinodad]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

In my former profession as a chemist (American-style, not a British pharmacist), I could train a reasonably bright high school student to do the hands-on part of my job if nothing went wrong.
Of course, if it did go sideways or was heading that way, then my years of chemistry training and experience came in damn handy.
Seeing something like a calculation result or the amount of chemicals, or a out of bounds analysis result and recognizing that it "wasn't quite right" is key.  Doing this while fatigued from many days of 13 hour shifts is NOT something that comes naturally.

Take this even further. I read a study done that something like 80% of the advice given in the ER has no basis in evidence...and I don't blame the doctor. We, as the consumer want AN answer, something to point to as the causation, and then what the solution is, and what to do about it immediately. Not one person wants the doctor to shrug, and say "I'm not sure what it is, but the odds are great that it will clear up on its own"...but most of the time, that's exactly what will happen (low back pain, headaches, GI issues, etc.) Can you imagine the rage if a computer outputs "Yeah, it's mostly in your head...it will clear up on its own".

[Metalcat]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

In my former profession as a chemist (American-style, not a British pharmacist), I could train a reasonably bright high school student to do the hands-on part of my job if nothing went wrong.
Of course, if it did go sideways or was heading that way, then my years of chemistry training and experience came in damn handy.
Seeing something like a calculation result or the amount of chemicals, or a out of bounds analysis result and recognizing that it "wasn't quite right" is key.  Doing this while fatigued from many days of 13 hour shifts is NOT something that comes naturally.

Take this even further. I read a study done that something like 80% of the advice given in the ER has no basis in evidence...and I don't blame the doctor. We, as the consumer want AN answer, something to point to as the causation, and then what the solution is, and what to do about it immediately. Not one person wants the doctor to shrug, and say "I'm not sure what it is, but the odds are great that it will clear up on its own"...but most of the time, that's exactly what will happen (low back pain, headaches, GI issues, etc.) Can you imagine the rage if a computer outputs "Yeah, it's mostly in your head...it will clear up on its own".

It's more like "I don't know what the fuck it is and the ER is not the place to try and find out, go talk to your GP who also doesn't have much time for you"

I've been to the ER over a half dozen times over the past few years, and I usually go for one purpose only, to rule out that the thing that hurts might kill me.

Once I know that I'm like "cool, I'm out of here and don't want to talk anymore, I've got a family doc for that"

[Rhinodad]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

In my former profession as a chemist (American-style, not a British pharmacist), I could train a reasonably bright high school student to do the hands-on part of my job if nothing went wrong.
Of course, if it did go sideways or was heading that way, then my years of chemistry training and experience came in damn handy.
Seeing something like a calculation result or the amount of chemicals, or a out of bounds analysis result and recognizing that it "wasn't quite right" is key.  Doing this while fatigued from many days of 13 hour shifts is NOT something that comes naturally.

Take this even further. I read a study done that something like 80% of the advice given in the ER has no basis in evidence...and I don't blame the doctor. We, as the consumer want AN answer, something to point to as the causation, and then what the solution is, and what to do about it immediately. Not one person wants the doctor to shrug, and say "I'm not sure what it is, but the odds are great that it will clear up on its own"...but most of the time, that's exactly what will happen (low back pain, headaches, GI issues, etc.) Can you imagine the rage if a computer outputs "Yeah, it's mostly in your head...it will clear up on its own".

It's more like "I don't know what the fuck it is and the ER is not the place to try and find out, go talk to your GP who also doesn't have much time for you"

I've been to the ER over a half dozen times over the past few years, and I usually go for one purpose only, to rule out that the thing that hurts might kill me.

Once I know that I'm like "cool, I'm out of here and don't want to talk anymore, I've got a family doc for that"

Exactly...I would love to see a study done to show how much "cost" is put on the health system that a placebo fixes...i.e. time. We also need to change our definitions...muscle relaxers aren't muscle relaxers, they are tranquilizers, they don't loosen muscles, etc.

Heck, they have never, ever, not one time ever found a "knot", or restriction, when doing an autopsy, yet people still buy foam rollers, go get a massage, etc. to get knots out, etc. Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

[Hotstreak]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

In my former profession as a chemist (American-style, not a British pharmacist), I could train a reasonably bright high school student to do the hands-on part of my job if nothing went wrong.
Of course, if it did go sideways or was heading that way, then my years of chemistry training and experience came in damn handy.
Seeing something like a calculation result or the amount of chemicals, or a out of bounds analysis result and recognizing that it "wasn't quite right" is key.  Doing this while fatigued from many days of 13 hour shifts is NOT something that comes naturally.

Take this even further. I read a study done that something like 80% of the advice given in the ER has no basis in evidence...and I don't blame the doctor. We, as the consumer want AN answer, something to point to as the causation, and then what the solution is, and what to do about it immediately. Not one person wants the doctor to shrug, and say "I'm not sure what it is, but the odds are great that it will clear up on its own"...but most of the time, that's exactly what will happen (low back pain, headaches, GI issues, etc.) Can you imagine the rage if a computer outputs "Yeah, it's mostly in your head...it will clear up on its own".

It's more like "I don't know what the fuck it is and the ER is not the place to try and find out, go talk to your GP who also doesn't have much time for you"

I've been to the ER over a half dozen times over the past few years, and I usually go for one purpose only, to rule out that the thing that hurts might kill me.

Once I know that I'm like "cool, I'm out of here and don't want to talk anymore, I've got a family doc for that"

Exactly...I would love to see a study done to show how much "cost" is put on the health system that a placebo fixes...i.e. time. We also need to change our definitions...muscle relaxers aren't muscle relaxers, they are tranquilizers, they don't loosen muscles, etc.

Heck, they have never, ever, not one time ever found a "knot", or restriction, when doing an autopsy, yet people still buy foam rollers, go get a massage, etc. to get knots out, etc. Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

People don't get massages to prevent dying of muscle knot, they do it to feel good while they are alive.

[Metalcat]

FWIW I think this happens with a lot of professions.  The expertise part is for navigating tricky situations, whereas a majority of the daily work just routine and takes little thought. As a healthy young adult most of my experiences with my doctor has been with 5 minute checkups where he just reviews the bios the nurse took and says "yup, you seem healthy, any questions or concerns?"  I could (incorrectly) deduce from those interactions that doctors could be replaced by automated questionaires.  But that misses the important work they do when faced with a real problem.

See, I have a different take on your comment.

You would correctly deduce that the standard checkup interactions could be replaced by automated questionnaires, and then patients forwarded to doctors only when there is a need (at least for healthy young adults).  This would radically reduce wasted doctor time, allowing them to do more of the work they trained for and less of the repetitive/boring, largely useless tasks that currently take up so much of their day.  It's a win-win for everyone!

In my former profession as a chemist (American-style, not a British pharmacist), I could train a reasonably bright high school student to do the hands-on part of my job if nothing went wrong.
Of course, if it did go sideways or was heading that way, then my years of chemistry training and experience came in damn handy.
Seeing something like a calculation result or the amount of chemicals, or a out of bounds analysis result and recognizing that it "wasn't quite right" is key.  Doing this while fatigued from many days of 13 hour shifts is NOT something that comes naturally.

Take this even further. I read a study done that something like 80% of the advice given in the ER has no basis in evidence...and I don't blame the doctor. We, as the consumer want AN answer, something to point to as the causation, and then what the solution is, and what to do about it immediately. Not one person wants the doctor to shrug, and say "I'm not sure what it is, but the odds are great that it will clear up on its own"...but most of the time, that's exactly what will happen (low back pain, headaches, GI issues, etc.) Can you imagine the rage if a computer outputs "Yeah, it's mostly in your head...it will clear up on its own".

It's more like "I don't know what the fuck it is and the ER is not the place to try and find out, go talk to your GP who also doesn't have much time for you"

I've been to the ER over a half dozen times over the past few years, and I usually go for one purpose only, to rule out that the thing that hurts might kill me.

Once I know that I'm like "cool, I'm out of here and don't want to talk anymore, I've got a family doc for that"

Exactly...I would love to see a study done to show how much "cost" is put on the health system that a placebo fixes...i.e. time. We also need to change our definitions...muscle relaxers aren't muscle relaxers, they are tranquilizers, they don't loosen muscles, etc.

Heck, they have never, ever, not one time ever found a "knot", or restriction, when doing an autopsy, yet people still buy foam rollers, go get a massage, etc. to get knots out, etc. Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

People don't get massages to prevent dying of muscle knot, they do it to feel good while they are alive.

Also https://stm.sciencemag.org/content/4/119/119ra13.abstract

The failure of researchers to produce an experimental result that proves the action of a therapy doesn't invalidate the action of a therapy.

Not knowing why massage works doesn't necessarily mean it is a placebo. We have absolutely no idea how on earth lithium works, but no one is saying that it's actions on bipolar are a placebo. There are boat loads of examples like this.

People aren't walking around with the wildly inaccurate notion that we understand how most drugs and medical treatment work, are they? Because that's kind of hilarious.

Also, just because an industry's own explanation for something is wrong doesn't mean the treatment doesn't work. RMTs may have been taught about knots and lactic acid, but that also doesn't negate there being an actual therapeutic action of massage.

I worked in a specific area of treating chronic pain where the main therapy I used was developed with nonsense logic about retraining neural feedback or some fucking stupid bullshit that sounded fancy and scientific and complicated.

It was only decades after the treatment was invented that someone figured out why it worked, and the explanation was quite simple and easily demonstrated with simple studies once someone figured out what theory to test.

It's the things that we know work but don't know why or how that are the hardest to design experiments to prove. Plus, who's walking around throwing out grant money to explain why something that works works. It works, so who cares? Which means the research resources will be limited because the results can't be monetized. Hence why no drug company is clamouring to prove how lithium works after decades of selling it to millions of people.

That's not to say there isn't plenty of garbage in medicine. Prednisone is given out like candy for all sorts of conditions that even the doctors prescribing it don't have faith it will help with but feel they should do *something* and that's what's always been done, so that's what they try.

Nor am I saying that placebo isn't a huge factor in almost all treatment, and it's impossible to know the extent of the role that placebo plays in even surgical treatments.

I'm simply saying it's not as black and white that if science fails to prove how something works that it must be placebo.

[APowers]

People aren't walking around with the wildly inaccurate notion that we understand how most drugs and medical treatment work, are they? Because that's kind of hilarious.

...[snip]...

Uh. Yes. Yes, they are. So much yes. Also, more scary than hilarious.

I think it's the same for most "professions"; for instance, I'm a handyman by trade, and a pretty good one, imo. But in reality, I'm just a guy who happens to know how to use some tools-- do I know why your one sink drains slow and the other one drains fast? Uh. No, not really. But people assume I have some kind of high-level knowledge about all this. I don't. I just take things apart and put them back together-- if there's something that moves that shouldn't, I fasten it down; if there's something that doesn't move that should, I loosen it up-- and pray that they start working the way they're supposed to.

Also...

[snip]... Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

Just because something is a placebo doesn't mean it doesn't "do" anything. Placebos are really really surprisingly effective. Like, actually effective-- so much so that they are a benchmark effectiveness level that other treatments have to surpass in order to be considered quote-unquote "effective". Way more than random chance can possibly explain. Do we know why people imagining themselves getting effective treatment actually -makes- them better? Nope. But it does.

[Psychstache]

People aren't walking around with the wildly inaccurate notion that we understand how most drugs and medical treatment work, are they? Because that's kind of hilarious.

...[snip]...

Uh. Yes. Yes, they are. So much yes. Also, more scary than hilarious.

I think it's the same for most "professions"; for instance, I'm a handyman by trade, and a pretty good one, imo. But in reality, I'm just a guy who happens to know how to use some tools-- do I know why your one sink drains slow and the other one drains fast? Uh. No, not really. But people assume I have some kind of high-level knowledge about all this. I don't. I just take things apart and put them back together-- if there's something that moves that shouldn't, I fasten it down; if there's something that doesn't move that should, I loosen it up-- and pray that they start working the way they're supposed to.

Also...

[snip]... Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

Just because something is a placebo doesn't mean it doesn't "do" anything. Placebos are really really surprisingly effective. Like, actually effective-- so much so that they are a benchmark effectiveness level that other treatments have to surpass in order to be considered quote-unquote "effective". Way more than random chance can possibly explain. Do we know why people imagining themselves getting effective treatment actually -makes- them better? Nope. But it does.

Ah yes, the old duct-tape/WD40 flowchart. Big fan.

[Metalcat]

People aren't walking around with the wildly inaccurate notion that we understand how most drugs and medical treatment work, are they? Because that's kind of hilarious.

...[snip]...

Uh. Yes. Yes, they are. So much yes. Also, more scary than hilarious.

I think it's the same for most "professions"; for instance, I'm a handyman by trade, and a pretty good one, imo. But in reality, I'm just a guy who happens to know how to use some tools-- do I know why your one sink drains slow and the other one drains fast? Uh. No, not really. But people assume I have some kind of high-level knowledge about all this. I don't. I just take things apart and put them back together-- if there's something that moves that shouldn't, I fasten it down; if there's something that doesn't move that should, I loosen it up-- and pray that they start working the way they're supposed to.

Also...

[snip]... Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

Just because something is a placebo doesn't mean it doesn't "do" anything. Placebos are really really surprisingly effective. Like, actually effective-- so much so that they are a benchmark effectiveness level that other treatments have to surpass in order to be considered quote-unquote "effective". Way more than random chance can possibly explain. Do we know why people imagining themselves getting effective treatment actually -makes- them better? Nope. But it does.

Ah yes, the old duct-tape/WD40 flowchart. Big fan.

This is basically how I fixed our new Christmas lights that the cat pulled off the wall. They have a little battery powered control box, which stopped working after it hit the ground, twice.

I dug out my tiny screwdriver set, took it apart, put it back together, and it worked again.

DH now thinks I know something about fixing electronics.
I most certainly do not.

[Retireatee1]

Bond funds are riskier than buying bonds directly.

We can thank Suze Orman for that one.

[Rhinodad]

People aren't walking around with the wildly inaccurate notion that we understand how most drugs and medical treatment work, are they? Because that's kind of hilarious.

...[snip]...

Uh. Yes. Yes, they are. So much yes. Also, more scary than hilarious.

I think it's the same for most "professions"; for instance, I'm a handyman by trade, and a pretty good one, imo. But in reality, I'm just a guy who happens to know how to use some tools-- do I know why your one sink drains slow and the other one drains fast? Uh. No, not really. But people assume I have some kind of high-level knowledge about all this. I don't. I just take things apart and put them back together-- if there's something that moves that shouldn't, I fasten it down; if there's something that doesn't move that should, I loosen it up-- and pray that they start working the way they're supposed to.

Also...

[snip]... Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

Just because something is a placebo doesn't mean it doesn't "do" anything. Placebos are really really surprisingly effective. Like, actually effective-- so much so that they are a benchmark effectiveness level that other treatments have to surpass in order to be considered quote-unquote "effective". Way more than random chance can possibly explain. Do we know why people imagining themselves getting effective treatment actually -makes- them better? Nope. But it does.

Ah yes, the old duct-tape/WD40 flowchart. Big fan.

I’m not sure on your point there, as the thread is things that are costing us money that shouldn’t. A placebo, by definition, could be free.
..so shouldn’t cost anything

[nereo]

People aren't walking around with the wildly inaccurate notion that we understand how most drugs and medical treatment work, are they? Because that's kind of hilarious.

...[snip]...

Uh. Yes. Yes, they are. So much yes. Also, more scary than hilarious.

I think it's the same for most "professions"; for instance, I'm a handyman by trade, and a pretty good one, imo. But in reality, I'm just a guy who happens to know how to use some tools-- do I know why your one sink drains slow and the other one drains fast? Uh. No, not really. But people assume I have some kind of high-level knowledge about all this. I don't. I just take things apart and put them back together-- if there's something that moves that shouldn't, I fasten it down; if there's something that doesn't move that should, I loosen it up-- and pray that they start working the way they're supposed to.

Also...

[snip]... Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

Just because something is a placebo doesn't mean it doesn't "do" anything. Placebos are really really surprisingly effective. Like, actually effective-- so much so that they are a benchmark effectiveness level that other treatments have to surpass in order to be considered quote-unquote "effective". Way more than random chance can possibly explain. Do we know why people imagining themselves getting effective treatment actually -makes- them better? Nope. But it does.

Ah yes, the old duct-tape/WD40 flowchart. Big fan.

I’m not sure on your point there, as the thread is things that are costing us money that shouldn’t. A placebo, by definition, could be free.
..so shouldn’t cost anything

A bit of devil’s advocate here, but roughly 1/3 of the population respond to placebos (even though far, far fewer *think* they respond).  If we didn’t have that very real and very large effect from placebos, we could run all sorts of human experiments (drugs, etc) with no placebo group.  Further, all sorts of quack treatments that don’t actually cure ailments are perpetuated because people perceive that they work for them.

That weird little quirk between our brains and bodies probably costs more money than anything else in medicine.

[Metalcat]

People aren't walking around with the wildly inaccurate notion that we understand how most drugs and medical treatment work, are they? Because that's kind of hilarious.

...[snip]...

Uh. Yes. Yes, they are. So much yes. Also, more scary than hilarious.

I think it's the same for most "professions"; for instance, I'm a handyman by trade, and a pretty good one, imo. But in reality, I'm just a guy who happens to know how to use some tools-- do I know why your one sink drains slow and the other one drains fast? Uh. No, not really. But people assume I have some kind of high-level knowledge about all this. I don't. I just take things apart and put them back together-- if there's something that moves that shouldn't, I fasten it down; if there's something that doesn't move that should, I loosen it up-- and pray that they start working the way they're supposed to.

Also...

[snip]... Those are all placebo's...and I don't deny they feel good, but they don't actually "do" anything. At least those people are self advocating and find a placebo for the human condition.

Just because something is a placebo doesn't mean it doesn't "do" anything. Placebos are really really surprisingly effective. Like, actually effective-- so much so that they are a benchmark effectiveness level that other treatments have to surpass in order to be considered quote-unquote "effective". Way more than random chance can possibly explain. Do we know why people imagining themselves getting effective treatment actually -makes- them better? Nope. But it does.

Ah yes, the old duct-tape/WD40 flowchart. Big fan.

I’m not sure on your point there, as the thread is things that are costing us money that shouldn’t. A placebo, by definition, could be free.
..so shouldn’t cost anything

Ah, but we rarely know when something is a placebo, and if we do, it doesn't work anymore.

Let's say you have two treatments, they both work for you and they both cost the same thing, except one is an active medication with side effects and one is a placebo, with no side effects, you just don't know it, which is why it works.

Which would you prefer? And which is worth more?

Think about it, the answer isn't obvious, or, it shouldn't be.

[Rhinodad]

Well, neither actually “worked”, because if a placebo actually fixes anything, you never really had anything “wrong” to begin with.

[Green_Tea]

Ah, but we rarely know when something is a placebo, and if we do, it doesn't work anymore.

Let's say you have two treatments, they both work for you and they both cost the same thing, except one is an active medication with side effects and one is a placebo, with no side effects, you just don't know it, which is why it works.

Which would you prefer? And which is worth more?

Think about it, the answer isn't obvious, or, it shouldn't be.

In this case I would advocate for a third option, that is in my opinion the best way: finding out how the placebo effect helps and work out how to replicate it without either medication or placebo.

Here is a simple example. I know a couple of people who take some placebo medication if they bumped into stuff because they believe they will be getting less hematomas. If they realized that a small superficial hematoma isn't a bad thing at all, they wouldn't need the placebo in the first place, saving themselves the money, the worry and a good minute going to the fridge to get the placebo pill. This would even work if they had a medication that actually worked.

Other placebo effects might be more difficult to get though because they might be more complex to figure out or more difficult for people to comprehend or to execute. Examples could include that people relax in anticipation of relief and that that helps with the symptoms. In this case relaxation exercises could work.

I'm not totally against using the placebo effect, but I don't think it's the optimal way.

Also, just to add: Placebos can produce placebo side effects too.