Can You Trust your Pharmacist?

We frequently bash the supplement industry. From the mega-corporations hypocritically pushing a pseudo-noble agenda in order to get a stranglehold on every last drop of profits, to the health food stores where 94% of advice given is based on no scientific truth or loosely based on reasonable evidence.

Today we set our sights on the “Integrative Pharmacy”.  Yup, we’re cannibals.

Pharmacists can be dopes sometimes too.  Some pharmacists are leveraging their trust to slow their eroding profit margins, but almost all are contributing to the momentum of the poorly regulated, misinformed supplement industry.

So we’re going to have to change what we call our pharmacies…  In the past, we’ve used the term “Integrative Pharmacy” as a way to show that we have expertise in the natural products as well as traditional and prescription options.  

But now, there’s this trend to throw some vitamins in your store and change nothing about your process and refer to yourself as “Integrative”.  

Why The Pendulum Is Swinging For Pharmacists

Pharmacists are the natural (pun intended) choice as experts in supplements. We have the most extensive training in therapeutics and medicinal chemistry.  It’s as simple as slightly extending our pharmacy “database” in almost all cases.  

We know how drugs interact. We have access to the newest literature and references, and we’re on the front lines of self-care – right there to help when people need it.

The retail pharmacy industry is dramatically changing.  Pressure from everywhere – the government, private insurance companies (the WORST!), and the competitive environment driven by the big box stores have almost completely made pharmacy a loser as it pertains to business.  

Our margins are poor, our costs are high, and the risk and liability are astronomical.  People spend billions of bucks on supplements.

The pharmacy owners and chain board of directors think, “They’re getting junk and bad advice from a health food or vitamin store, right?  So they can get the same junk with slightly better advice from us, and we can make more money!”

The Most Trusted Profession

The reason, we suggest, that pharmacists are so trusted in the medical field is because they are trustworthy.  This, though, is only because the products they deal in are tightly regulated.  If for example, Lipitor 10mg tablets sometimes had 40mg in them (as a recent independent study found of multi-vitamins), we would lose faith in our pharmacists.

If the world of pharmaceutical products was as complex as a chess game where the board changes randomly (like with vitamins), it would be hard to trust pharmacists.

When pharmacists then toss their hats into the natural products ring, people like us develop a bad swearing habit.  Unless the same rigor exists in the natural product world as the traditional medicine world, pharmacists will destroy their reputation faster than the destruction of their current profit margins.  

Our favorite study has already shown that as high as 27% of the claims made in pharmacies are based loosely on evidence or not at all.  That’s dramatically better than the 94% of vitamin stores and grocers, but 27% is way too high. (Our goal, for comparison, is to have less than 5% error in our recommendations)

The product selection in these “Integrative Pharmacies” is based on two factors:  profit and brand recognition.  We’ve always said that if you go into a store and it has a display “As Recommended By Dr. Oz” you should run away screaming and probably should call 911.  Almost no diligence goes into product selection.  Why would it?  

In the pharmacist’s world their system is regulated – wouldn’t it all be?  These are national brands, right?  If there was really an issue we’d know about it…  They wouldn’t know where to begin.  What’s worse – they don’t know that they SHOULD begin.

Still, the shelves are lined with synthetic chemical isolates and products claiming to be whole food.  Here’s our problem, plain and simple:  The trusted pharmacists give credibility to the untrustworthy supplements.  

When pharmacists vouch for these products by selling them and recommending them to their patient families, it gives legitimacy to the broken system.  Vitamin companies can brag that they’re the “Top pharmacist recommended” supplement line.

At pharmacy trade shows, the booths for natural products are getting close to outnumbering the other vendors.  Everyone has their own products. “Pharmaceutical grade” fish oil doesn’t test for key contaminants and the last potency test (they don’t do it on every lot as they should) allowed 8% less than the labeled amount.

A pill that has all these great cholesterol-fighting ingredients lack the absorbable forms and the right doses of those amazing ingredients to actually do anything. They get excited, fill out the forms, and line their shelves with exclusive garbage.

Homeopathy abounds.  We were guilty of this – our Woodstock store had it because many of our customers were using it.  We recently threw it all on the street (almost literally…) after an internal discussion about who we are.  

Do chain stores have that same talk?  Do the independent owners have team members that keep their company in check and true to their mission?  

What can we say about a pharmacy’s mission if they carry poorly made products (or fake ones like Homeopathy) while 27% or more of the time giving poor advice?

You know what it reminds me of?  In the early 90s after pharmacy profits dropped because of all the insurance stuff, independent pharmacies started doing these weird over-the-counter product mixes in their store.  

It’s not uncommon to see 16 to 20-foot walls of greetings cards.  Maybe some toys for the pool.  What was worse were the “gift” sections – bad ceramic dolls, toys, and chotskies – gathering dust.

Now it’s vitamins.  Though closer to healthcare than wrapping paper may be, it still is a case of an identity crisis for their organization.  They’re grasping at straws.  

Change is Coming

Someday, if we really get this Vitality program right, we’re going to knock on the doors of our independent pharmacist brethren.  We’ll teach them how to do it correctly – to really differentiate us pharmacists from all the wannabes and unqualified practitioners.

To have a clear consistent voice: there is a better way to do supplements and wellness – we ARE trustworthy – and we are working diligently to apply rigorous standards where the system lacks it.  

We’ll all work in a way that matches exactly what our patients want, without deception, but with results. Maybe then, this pharmacist can say we’ve succeeded in changing the system.

Just trying to keep it real…

Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth

Dr. Neal Smoller, Holistic Pharmacist

About Neal Smoller

Dr. Neal Smoller, PharmD, is a licensed pharmacist: and owner of Village Apothecary, an independent pharmacy in the most famous small town in America—Woodstock, NY. He’s also the host of the popular wellness podcast, The Big Mouth Pharmacist.”


The Vital 5

Nutrients you shouldn’t live without
The Vital 5 Nutrients You Shouldn't Live Without