Prescription For Trouble

[Lovejoy]

Patients don't always get the details correct. If the pharmacist has a question, it should be directed to the physician...especially with the privacy laws now in place. And because a patient won't always know about medication interactions or warnings because of other medical conditions.

The info always has to come from the patient first, even for the doc. And the HIPAA laws are about transportation and sharing of information, making it more difficult to get the info from the doc, not the patient (though it is hard to have a private discussion with a pharmacist, which is why the make those "no standing or stopping" zones around the counter). If there is a question about what is written on the prescription, the question goes back to the doctor. But if the question is about factors the doctor may have not considered (as in the doctor not entirely understanding what needs to be ascertained about the cliend in regards to the med, which happens all the time) it needs to come from the patient. Pharmacists are liscenced health professionals, with all the responsibilities and rights that go along with that. I fear that they are being marginalized in public opinion though. I am willing to bet that they save thousands (upon thousands) of lives every year from physician errors by taking a few moments to interview patients.

 

[Pepper]

It still doesn't seem right for them to be able to push their morals on other people. If someone was prescribed a certain medication by a doctor, than that's their business. The only time a pharmacist should be able to refuse the medication is if it is in conflict with another medication that the patient is taking. If the doctor prescribed the medication to the patient, they should be able to get it. Pharmacists should remain professional when they are at work. If they are so opposed to certain drugs than they should either 1. work at a pharmacy where these drugs are not available or 2. not work in a pharmacy at all. If I go to buy cigarettes and the person says "You know these are bad for you?" that's one thing, but if I go to buy cigarettes and the person says "these are bad for you and people around you and I refuse to sell them to you". That person would get fired. Why is it any different with pharmacists? It's not up to them to decide what a patient should and should not take as far as medications go unless two of their medications will conflict and cause medical problems.

 

[firechyld]

If the patient doesn't have a pharmacy within 50 miles she can buy by phone or web.

I'm not entirely sure how that system works, as we don't have access to anything like that in Australia. What we do have are a hell of a lot of small towns who have only one pharmacy within up to several hundred kilometres.

Conventional "emergencies" don't require morally questionable drugs.

Depends on your definition of emergency. I'm one of those people who have to take the "contraceptive" pill for medical reasons. Denying me access to it leaves me bedridden and in intense pain, risking passing out if I get up for any reason. Hardly able to jump a train to the next town and see if the pharmacist there feels like doing his job. I'd call that an emergency.

I suspect that most hospitals have the stuff in their rape kits.

They don't. They may have access to them, but they don't form part of a rape kit.

If she has her wing ding on Christmas eve does she expect her family doctor to write her a perscription on Christmas day?

If he's open, why shouldn't she?

Second, some people have moral scruples that disqualify them from some jobs.

Which is a really good reason not to take those jobs.

 

[Lovejoy]

It still doesn't seem right for them to be able to push their morals on other people. If someone was prescribed a certain medication by a doctor, than that's their business. The only time a pharmacist should be able to refuse the medication is if it is in conflict with another medication that the patient is taking. If the doctor prescribed the medication to the patient, they should be able to get it. Pharmacists should remain professional when they are at work. If they are so opposed to certain drugs than they should either 1. work at a pharmacy where these drugs are not available or 2. not work in a pharmacy at all. If I go to buy cigarettes and the person says "You know these are bad for you?" that's one thing, but if I go to buy cigarettes and the person says "these are bad for you and people around you and I refuse to sell them to you". That person would get fired. Why is it any different with pharmacists? It's not up to them to decide what a patient should and should not take as far as medications go unless two of their medications will conflict and cause medical problems.

A person selling cigarettes is not licensed and does have to carry malpractice insurance, and therefore is not legally responsible for the outcome of your smoking. A pharmacist is responsible for the outcome of your meds. If you are not properly informed about the results of taking a drug, your doctor is not as likely to catch trouble over it as the pharmacist is. How many women really understand that "Plan B" is a teratogen? Your pharmacist does. He even knows that most progesterone only birth control pills are actually increasing the rate of spontaneous abortions in women. What is he/she supposed to do with that knowledge. Tell you, and learn to live with the outcome. Or just refuse to provide a drug that is being prescribed irresponsibly? To be honest, there is a shortage of pharmacists. If the ones that objected to handing out hormonal birth control and emergency contraceptives just left practice, they would not be there to hand out Lanoxin and nitroglycerin, and people would die. There has to be a better way.

 

[Pepper]

A pharmacist is responsible for the outcome of your meds. If you are not properly informed about the results of taking a drug, your doctor is not as likely to catch trouble over it as the pharmacist is.

Which is exactly why the pharmacist should inform you of this, not refuse giving it to you.

The doctor is well informed enough to tell you the risks of any drug, if it will cause a problem with any prescriptions you are currently taking and you fail to mention these to your doctor, he may not know of a potentially harmful interaction. Which is where the pharmacist should step up and say, these two drugs interact in a way that is unsafe, you should talk to your doctor about taking something else. But for a pharmacist to just say, no you can't have that drug it goes against my morals, for no reason of your health and wellbeing, but because of their morals, that's just not right. The reasons for prescription are between you and your doctor, the pharmacist should be there to catch any harmful interactions with other drugs and answer any questions you have about your prescriptions, that's it. That's where it ends. If the pharmacy provides a drug, and your doctor prescribes it to you, and it won't cause any interaction with another drug, the pharmacist should give it to you. I wouldn't want to walk into a store to buy condoms and have the cashier say "no, sorry, I'm catholic and I don't believe in contraception, you can't buy those from me". And don't say it's not the same thing, because it is. Some pharmacys may chose not to carry certain things, in which case they can state that they don't carry it. But if someone refused to give me a perscription and said "That's just morally wrong, I can't give that to you", after my doctor had prescribed it to me. I would be appalled, that's not their business.

 

[billwald]

If a person isn't willing to perform all the obligations and duties of an occupation then he isn't qualified for the occupation.

 

[Free-Agent Smith]

I have been on several threads about "birth control" and all the Christians usually take the perspective on how it (birth control pills) deals with the subject of :shocked: birth control :noway: not hormonal balance substitutes.

Why must we think the two different things must be equal in our perspectives?

 

[jeremiah]

I have been on several threads about "birth control" and all the Christians usually take the perspective on how it (birth control pills) deals with the subject of :shocked: birth control :noway: hormonal balance substitutes.

Why must we think the two different things must be equal in our perspectives?

:dizzy: What did he say? Is this secret agent, spy talk?

 

[beanieboy]

That article makes a lot of sense.

Can you imagine a pharmacist not giving you brith control pills, because they are Catholic, even though the pills are legal, you are married, and Protestant?

People need to stay within the law, and be employed in a way that is in line with their morals.

(oops. someone beat me to it )

 

[Lovejoy]

That article makes a lot of sense.

Can you imagine a pharmacist not giving you brith control pills, because they are Catholic, even though the pills are legal, you are married, and Protestant?

People need to stay within the law, and be employed in a way that is in line with their morals.

(oops. someone beat me to it )

The law, however, is still being interpreted. Conscience clauses are popping up all over, which means in some places the law will side with the objecting pharmacists. Mostly, however, I am speaking to the use of "emergency contraceptives." And that is quickly going to bypass the pharmacists anyway.

 

[Lovejoy]

Which is exactly why the pharmacist should inform you of this, not refuse giving it to you.

The doctor is well informed enough to tell you the risks of any drug,

That is assuming a great deal. There are a number of meds that docs do not understand entirely, and they rely on the vast biochemical background of the pharmacist to help them out.

if it will cause a problem with any prescriptions you are currently taking and you fail to mention these to your doctor, he may not know of a potentially harmful interaction. Which is where the pharmacist should step up and say, these two drugs interact in a way that is unsafe, you should talk to your doctor about taking something else.

The knowledge of pharmacists goes far beyond drug interactions. They are the ones that actually explain the use of a drug to you, and often are the prime source of information (well, after nurses) on expected outcomes of the use of a med. For goodness sakes, pharmacologists are at the heart of the creation of these meds.

But for a pharmacist to just say, no you can't have that drug it goes against my morals, for no reason of your health and wellbeing, but because of their morals, that's just not right. The reasons for prescription are between you and your doctor, the pharmacist should be there to catch any harmful interactions with other drugs and answer any questions you have about your prescriptions, that's it. That's where it ends. If the pharmacy provides a drug, and your doctor prescribes it to you, and it won't cause any interaction with another drug, the pharmacist should give it to you.

If you are pregnant, and the drug is not indicated for use during pregnancy, the pharmacist is required to hold the drug. "Plan B" will cause vast damage to a developing embryo, and should not be used during pregnancy. For some reason, parts of the medical field disagree with this assessment. If, in his or her professional assessment, the pharmacist sees a poor outcome with the use of that drug, they should hold it. The embryo is in danger! I would not give it, anymore than I would participate in an abortion.

I wouldn't want to walk into a store to buy condoms and have the cashier say "no, sorry, I'm catholic and I don't believe in contraception, you can't buy those from me". And don't say it's not the same thing, because it is.

It is the same because you say it is? Condoms do not cause spontaneous abortions. They are not teratogens. It is not the same.

Some pharmacys may chose not to carry certain things, in which case they can state that they don't carry it. But if someone refused to give me a perscription and said "That's just morally wrong, I can't give that to you", after my doctor had prescribed it to me. I would be appalled, that's not their business.

As far as traditional birth control goes, I am beginning to agree. But "Plan B" (and its cousins) is another story. It is used irresponsibly, and a good case can be made for this.

 

[firechyld]

"Plan B" will cause vast damage to a developing embryo, and should not be used during pregnancy.

We may not be thinking of the same drug. What are you referring to when you say "Plan B"?

 

[Lovejoy]

We may not be thinking of the same drug. What are you referring to when you say "Plan B"?

Levonorgestrel is what I am specifically talking about. The discussion seems oriented on what a pharmacist should and should not be able to decide to do within their practice, and I am mostly trying to muddy the waters. Plan B is the most common form of emergency contraceptive, and is the form that comprises a massive dose of hormones all at once. In many states, including mine, you can get it from the pharmacist without having to go through your doc at all. That means the pharmacist is left to give it without any other health provider to shove the responsibility off on to. And if the person receiving the med is already pregnant, or if the drug fails to prevent the pregnancy, the dose of hormones is so high that the (embryo or fetus) will be damaged extensively. This is a very real moral crisis for some pharmacists. In fact, RU486 (Mifepristone) and Cytotec may be the follow up to Plan B, as they are recommending a "true" abortion for any fetus that survives Plan B. No health provider in the States can be compelled to participate in a surgical abortion, yet these sorts of chemical abortion procedures remain outside those protections (for some reason).

As to normal hormonal birth controls, well, that pharmacist should have to make special arrangements to not have to provide those (if they have a problem with it). My point, assuming I have one, is that pharmacists have the same privileges and responsibilities that all licensed health providers have. They are not just drug fetching monkeys for the docs.

 

[firechyld]

We are talking about the same drug, then. Problem being, it's quite simply unknown whether or not this treatment causes damage, extensive or otherwise, to a foetus. As far as I'm aware, no study has managed to prove that it causes any damage to a foetus if the pregnancy continues, or if the woman taking the treatment was already pregnant. There is some anecdotal evidence, and some potentially misapplied data relating to other hormonal treatments.

I'm not claiming that it's 100% risk free to an established embryo, but I think you may be a little off in claiming that the foetus will be damaged by a woman taking the "morning after pill". In fact, it sounds awfully like you're promoting an urban myth put forward by those who want to scare women away from using it.

 

[Lovejoy]

My intention is not scare people off from using it. I am simply making a case for the pharmacist to refuse to give it. And I should have been more clear, as it may not be harmful before organogensis is taking place (which would be the stage newly pregnant women would be in), but could be very dangerous to a fetus that is in that particular stage. Insufficient research has taken place to be sure (because no one is willing to expose their child to it), however, it is still contraindicated for use during pregnancy! No one disagrees with that. Strangely, some of my info comes from a source that should have been much more biased towards your position: http://www.sexhealth.org/birthcontrol/morningafter.shtml

Warning! This site may not be appropriate for some people! I used to make a point, not for general info!

 

[cattyfan]

As to normal hormonal birth controls, well, that pharmacist should have to make special arrangements to not have to provide those (if they have a problem with it). My point, assuming I have one, is that pharmacists have the same privileges and responsibilities that all licensed health providers have. They are not just drug fetching monkeys for the docs.

and what of the women who are given the prescription for "birth control" not for that purpose, but for one of the many other reasons it's prescribed? Why should they have to explain their situation to the pharmacist? (take for example, the nun who takes "the pill" because of a hormone imbalance.)

 

[Pepper]

My intention is not scare people off from using it. I am simply making a case for the pharmacist to refuse to give it. And I should have been more clear, as it may not be harmful before organogensis is taking place (which would be the stage newly pregnant women would be in), but could be very dangerous to a fetus that is in that particular stage. Insufficient research has taken place to be sure (because no one is willing to expose their child to it), however, it is still contraindicated for use during pregnancy! No one disagrees with that. Strangely, some of my info comes from a source that should have been much more biased towards your position: http://www.sexhealth.org/birthcontrol/morningafter.shtml

Warning! This site may not be appropriate for some people! I used to make a point, not for general info!

Many studies have found no effects on fetal development associated with long-term use of contraceptive doses of oral progestins (POPs). The few studies of infant growth and development that have been conducted with POPs have not demonstrated significant adverse effects.

 

[Lovejoy]

and what of the women who are given the prescription for "birth control" not for that purpose, but for one of the many other reasons it's prescribed? Why should they have to explain their situation to the pharmacist? (take for example, the nun who takes "the pill" because of a hormone imbalance.)

Frankly, I don't know. I am just not fond of the idea of a pharmacist being "compromised", insofar as their beliefs go. There has to be a "compromise" that does not involve a pharmacist engaging in an action they do not believe in.

 

[Lovejoy]

Many studies have found no effects on fetal development associated with long-term use of contraceptive doses of oral progestins (POPs). The few studies of infant growth and development that have been conducted with POPs have not demonstrated significant adverse effects.

Alright, you asked for it! Take this: you are correct. Actually, the only "study" is a meta-analysis of previous research of incidents of use of progestins (birth control) in pregnant women, and that one is ten years old. No one (to my knowledge) has dared to intentionally expose fetuses to high levels of hormones. However, the site that I posted above was my source of info. I assumed, stupidly, that a pro-choice site would be hesistant to post side effects of contraceptives, and would have looked into it quite thoroughly. I was wrong. According to the NEJM, the only reason "Plan B" in contraindicated in pregnancy is that it is useless if you are already pregnant, and there is no sense taking chances. So I quite concede the point. I have not changed my position, as "Plan B" still prevents implantation of fertillized eggs, but I certainly appreciate you and FC keeping me accountable on this teratogen issue. Good work!

 

[Lovejoy]

You know, somehow everyone should have access to the healthcare that they need, while still allowing a professional healthcare provider to practice within their conscience. Any suggestions?