There were several "ah ha" moments that I am really fortunate this class gave me. The first was while talking about the global healthcare and viewpoints on our own system. I loved hearing about all of the other countries, and honestly I found myself being too critical of our own healthcare system at times. That being said, I in no way believe our healthcare system is close to perfect, especially not for the majority, but it's important to recognize that we do have some strengths, such as thorough care for those who can afford/reach care. Additionally, I thought it was also important to remember that what works for other countries, might not work here (population differences, geographical differences, general lifestyle differences), which I believe commonly gets forgotten. Long story short, I think we should all remain critical for improvements and equity to happen, but still remember of the good in our system.
Going off of the above "ah ha", something that I really appreciate, like Iceland (and Brendan) do is the importance of preventative care. I believe that the lack of affordable preventative care is one that really slows our country down in metrics. I think in the long run it will save money and help not only the health of our citizens but also significantly increase quality of life. Moving forward, I would like to see the US try and continue to improve, and expanding preventative care is a must for that!
Another "ah ha" moment was discussing the financial spending of pharmaceutical companies. I always knew that there was such an up-charge with lots of newly approved medications, but I never thought much of what it was for. I was always told about how the price is increased for future lawsuits that are guaranteed to happen, which is part of it, but I never thought about how much went into lobbying and with marketing the drugs. I don't have an opinion (yet) on the companies doing what they want to lobby and for advertising, but I found it very interesting that it was such a huge piece of their financial pie. I do have an opinion that their financial pie should be smaller though, and I'll leave it at that (mainly because I have no solutions at this time). This was very beneficial for me to remember about how multifaceted our problems can be within our healthcare and pharmaceutical systems.
Overall looking back I really appreciate so much of what we learned, starting with some history of pharmacy, some SDOH, the drug pipeline etc. But what I am most thankful was the class was always so supportive and a safe space to learn and share ideas + experiences. Because of the class environment, I feel like I was able to get a lot from the class, including several "ah ha" moments! Go Blue!
Prior to starting pharmacy school, I worked as a technician at an independent compounding pharmacy. In addition to the variety of medications and dosage forms that the pharmacy was able to offer, a huge selection of herbal and dietary supplements was made available for the patients to purchase. The pharmacy was located in the same office space as a few functional medicine providers. If you are like me, I had no idea what functional medicine was. From my experience and understanding, functional medicine can be defined as a holistic, patient-centered approach to care utilizing traditional Western medicine practices as well as practices from around the world. Given that many of the patients at the pharmacy were seeing a functional medicine provider in the office, many of them used a variety of supplements as well as medications for non-FDA approved uses. An example of this is low dose naltrexone. While many of us know this medication as an opioid antagonist, many patients were using this medication to help with regulating the immune system in a variety of conditions. My experience working in this pharmacy setting gave me a unique perspective into the world of complementary and herbal medicine. Before starting pharmacy school, given that my only pharmacy experience was in this setting, I was under the impression that herbal products and dietary supplements was an expertise of most pharmacist. However, my experience in pharmacy school thus far has led me to believe just the opposite. I have been surprised how little the pharmacy curriculum focuses on this type of medicine. According to the CDC, 57.6% of U.S. adults have used a dietary supplement in the past 30 years. This a huge portion of our population consuming products likely purchased at a pharmacy. While these products are often controversial in terms of their efficacy, safety, and purity, given lack of regulation, I believe that more research and funding should go into learning about these products. Personally, one of the most interesting things about dietary supplements is the extreme, opposing views that individuals can have regarding their use. Even among healthcare providers some are so in support of their use while others are not. Much of our knowledge is rooted from evidence-based medicine. However, in the case of supplements not much research is conducted in terms of their safety and efficacy, likely due to financial incentives. While it may be likely that the placebo effect could play a role in specific patient’s experiences, I believe we as pharmacist should support this as long as no known safety risks are present. A role of the pharmacist is to take into considerations of patient preference in terms of treatment options. If a patient preference is the use of supplements, we as pharmacist should have more knowledge on this topic to help provide more patient specific care. While dietary supplements is a quite broad topic and it would be impossible to cover all of them in a course, I believe that more time should be built into the curriculum to at least understand the potential use of the medications. I find it slightly embarrassing as a future pharmacist that if I were asked the potential use of many common herbal products/supplements, I likely will not have an answer for all of them. No matter the setting of pharmacy, the understanding of supplements will be important. While the role in community pharmacy is more clear, where many patients are purchasing these agents, clinical pharmacist must also have some knowledge. Given that many patients are consuming a variety of different supplements and they have the ability to interact with other drugs, pharmacist should have this knowledge to help best manage a patient’s medications.
I am thankful that my colleague was brave enough to share her experience as a woman who sought for treatment while being in the ER, and yet whoever was supposed to be taken of her called her out, for a lack of better term, a “Drama Queen.” As America is becoming increasingly diverse, discrimination against minority groups persists and contributes to the negative outcomes for patients and healthcare professionals. Healthcare professionals have a responsibility to address inequity in the medical system. Healthcare professionals like pharmacists, doctors, just to name a couple, must take an oath to treat all patients equally, and yet not all patients are treated equally well. People within minority or otherwise socially disadvantaged groups are confronted with a multilevel web of challenges that negatively impact their health and wellbeing. And guess what? Perhaps as a defense mechanism, individuals who have experienced discrimination in the past may be more reluctant to seek health care, as they may perceive it as a setting of increased risk for discrimination (refusal of service or lower quality of care). This surely will create a negative effect on individuals’ trust in and satisfaction with the healthcare system, increasing the likelihood of delaying or foregoing seeking care.
I genuinely believe that it is important to have a firm foundation on the social determinants of health and how they can negatively impact a patient’s healthcare status and thus further understanding about problems and concerns that my patients are facing. But I can’t do this alone – I also need to your help, my colleagues’ class of 2024. I have no doubts that you will be like one of those who will cross their arms and walk away when they see that someone is being mistreated, whether it be your workplace or in the classroom. I know that you will have their back as you always have mine. Thanks for always being so supportive and creating a safe space for new ideas and challenges. Keep up with the good work and wear your “big M” pride to wherever you will end up – show them who we are! Now I can say this without feeling cringy – Go Blue!
We had a really nice discussion in class about personal morality and professional ethics. I think some of the examples that came up in class revolved around the provider having a personal issue with treating a patient due to their race or sexuality or refusing to dispense abortion drugs. In my opinion these were stark examples of personal morality vs professional ethics that helped to teach the difference to us. The conclusion I came up with during class, however, was that professional ethics is an objective gold standard and one’s subjective personal morality needs to conform to it. But after thinking about it, I think at any health institution there will be all kinds of cases where personal morality will enter a moral gray area with professional ethics. For example, in class we gave an example of a P&T committee including a new “biotech” drug into the formulary, which was the best medication for its indication, but expensive. We had a scenario where an elderly patient on Medicare couldn’t afford the medication. If I wanted to create a policy to help make this drug cheaper, I would also have to consider if a rich, young person comes into the pharmacy seeking a discount. Personally, I would only want this policy to help poor people first, but professional ethics tell me I shouldn’t compromise for different demographics. We all can agree the overall goal is to help as many patients as possible, but this conflict exists because there is disagreement about how accomplish it.
While mulling over this I found more examples of personal morality vs professional ethics in drug discovery and research. If you had to do a study on a low-cost drug to help the indigent, which requires homeless people to take a full medical exam and subject their bodies and paid them $10,000 to incentivize them to join the study, that would be unethical according to the institutional review board. Because paying $10,000 is almost coercive because they can’t say no but paying $100 would give them more of a choice. But for me it’s more moral to give a homeless person more money especially since I know finance is huge disparity for them and to justify the risk of joining a study. Another issue is when you’re doing a study on drug effect, you will subject one of the treatment arms with placebo, which means you know that there are people with the disease that aren’t getting help. This goes against personal morality because you want to help anyone that is suffering at any point in time including in a clinicaly study. Sure, you can get into an argument that if we start treating the control group the study results will have less validity. My takeaway here is that I think recognizing that a gray area exists is enough. We shouldn’t try to prove that personal morality is superior to professional ethics and vice versa. I think if you are in an area where your personal morals are in constant conflict with your professional ethics you won’t be very productive. So it’s important to do introspection and know where you stand so that you can be the best you.
I’ve always been passionate about easy and affordable access to healthcare in the United States, or rather, the lack of it. I always knew our healthcare system wasn’t the best, but I didn’t know just how bad it was until a few years ago. I used to work with patients that spoke little to no English, and that was the start of me noticing the everyday struggles patients go through just to receive care. They had to deal with lack of interpreters, minimal cultural competence, and simply not being able to call off work for an appointment. Throughout pharmacy school, it seems those hoops are only increasing in number for both patients and providers. Prior authorizations, lack of coverage for certain medications and treatments, and gaps in transitions of care are only the tip of the iceberg. The overwhelming number of challenges demonstrates that the system was never meant to be easy for patients and providers. I’ve also always been a supporter of the Medicare for all movement, also known as the single payer healthcare system and I believe it is the solution to many of these problems. Our class discussions paired with the global healthcare presentations solidified my support for it. I noticed that many of the countries we discussed had some sort of universal, free healthcare component. The care or execution may not have been the best for one reason or another, but there was a general belief that healthcare should mostly come from the government and at a low cost. The United States, however, is ruled by wealthy people that continue to profit off the current healthcare system, so they keep resisting the Medicare for all movement. However, the movement is there, and it is gaining momentum. The United States is one of the wealthiest countries and has vast resources. What country is more fit to make the switch? Not only do we have the resources, but we have good and bad examples from all over the world. With a greater demand from the public and careful planning and execution, our healthcare system can give people the healthcare they have the right to.
There were several "ah ha" moments that I am really fortunate this class gave me. The first was while talking about the global healthcare and viewpoints on our own system. I loved hearing about all of the other countries, and honestly I found myself being too critical of our own healthcare system at times. That being said, I in no way believe our healthcare system is close to perfect, especially not for the majority, but it's important to recognize that we do have some strengths, such as thorough care for those who can afford/reach care. Additionally, I thought it was also important to remember that what works for other countries, might not work here (population differences, geographical differences, general lifestyle differences), which I believe commonly gets forgotten. Long story short, I think we should all remain critical for improvements and equity to happen, but still remember of the good in our system.
ReplyDeleteGoing off of the above "ah ha", something that I really appreciate, like Iceland (and Brendan) do is the importance of preventative care. I believe that the lack of affordable preventative care is one that really slows our country down in metrics. I think in the long run it will save money and help not only the health of our citizens but also significantly increase quality of life. Moving forward, I would like to see the US try and continue to improve, and expanding preventative care is a must for that!
Another "ah ha" moment was discussing the financial spending of pharmaceutical companies. I always knew that there was such an up-charge with lots of newly approved medications, but I never thought much of what it was for. I was always told about how the price is increased for future lawsuits that are guaranteed to happen, which is part of it, but I never thought about how much went into lobbying and with marketing the drugs. I don't have an opinion (yet) on the companies doing what they want to lobby and for advertising, but I found it very interesting that it was such a huge piece of their financial pie. I do have an opinion that their financial pie should be smaller though, and I'll leave it at that (mainly because I have no solutions at this time). This was very beneficial for me to remember about how multifaceted our problems can be within our healthcare and pharmaceutical systems.
Overall looking back I really appreciate so much of what we learned, starting with some history of pharmacy, some SDOH, the drug pipeline etc. But what I am most thankful was the class was always so supportive and a safe space to learn and share ideas + experiences. Because of the class environment, I feel like I was able to get a lot from the class, including several "ah ha" moments! Go Blue!
Prior to starting pharmacy school, I worked as a technician at an independent compounding pharmacy. In addition to the variety of medications and dosage forms that the pharmacy was able to offer, a huge selection of herbal and dietary supplements was made available for the patients to purchase. The pharmacy was located in the same office space as a few functional medicine providers. If you are like me, I had no idea what functional medicine was. From my experience and understanding, functional medicine can be defined as a holistic, patient-centered approach to care utilizing traditional Western medicine practices as well as practices from around the world. Given that many of the patients at the pharmacy were seeing a functional medicine provider in the office, many of them used a variety of supplements as well as medications for non-FDA approved uses. An example of this is low dose naltrexone. While many of us know this medication as an opioid antagonist, many patients were using this medication to help with regulating the immune system in a variety of conditions. My experience working in this pharmacy setting gave me a unique perspective into the world of complementary and herbal medicine.
ReplyDeleteBefore starting pharmacy school, given that my only pharmacy experience was in this setting, I was under the impression that herbal products and dietary supplements was an expertise of most pharmacist. However, my experience in pharmacy school thus far has led me to believe just the opposite. I have been surprised how little the pharmacy curriculum focuses on this type of medicine. According to the CDC, 57.6% of U.S. adults have used a dietary supplement in the past 30 years. This a huge portion of our population consuming products likely purchased at a pharmacy. While these products are often controversial in terms of their efficacy, safety, and purity, given lack of regulation, I believe that more research and funding should go into learning about these products.
Personally, one of the most interesting things about dietary supplements is the extreme, opposing views that individuals can have regarding their use. Even among healthcare providers some are so in support of their use while others are not. Much of our knowledge is rooted from evidence-based medicine. However, in the case of supplements not much research is conducted in terms of their safety and efficacy, likely due to financial incentives. While it may be likely that the placebo effect could play a role in specific patient’s experiences, I believe we as pharmacist should support this as long as no known safety risks are present. A role of the pharmacist is to take into considerations of patient preference in terms of treatment options. If a patient preference is the use of supplements, we as pharmacist should have more knowledge on this topic to help provide more patient specific care.
While dietary supplements is a quite broad topic and it would be impossible to cover all of them in a course, I believe that more time should be built into the curriculum to at least understand the potential use of the medications. I find it slightly embarrassing as a future pharmacist that if I were asked the potential use of many common herbal products/supplements, I likely will not have an answer for all of them. No matter the setting of pharmacy, the understanding of supplements will be important. While the role in community pharmacy is more clear, where many patients are purchasing these agents, clinical pharmacist must also have some knowledge. Given that many patients are consuming a variety of different supplements and they have the ability to interact with other drugs, pharmacist should have this knowledge to help best manage a patient’s medications.
Source: https://www.cdc.gov/nchs/products/databriefs/db399.htm#:~:text=%2C%202017%E2%80%932018.-,Summary,men%20in%20all%20age%20groups.
I am thankful that my colleague was brave enough to share her experience as a woman who sought for treatment while being in the ER, and yet whoever was supposed to be taken of her called her out, for a lack of better term, a “Drama Queen.” As America is becoming increasingly diverse, discrimination against minority groups persists and contributes to the negative outcomes for patients and healthcare professionals. Healthcare professionals have a responsibility to address inequity in the medical system. Healthcare professionals like pharmacists, doctors, just to name a couple, must take an oath to treat all patients equally, and yet not all patients are treated equally well. People within minority or otherwise socially disadvantaged groups are confronted with a multilevel web of challenges that negatively impact their health and wellbeing. And guess what? Perhaps as a defense mechanism, individuals who have experienced discrimination in the past may be more reluctant to seek health care, as they may perceive it as a setting of increased risk for discrimination (refusal of service or lower quality of care). This surely will create a negative effect on individuals’ trust in and satisfaction with the healthcare system, increasing the likelihood of delaying or foregoing seeking care.
ReplyDeleteI genuinely believe that it is important to have a firm foundation on the social determinants of health and how they can negatively impact a patient’s healthcare status and thus further understanding about problems and concerns that my patients are facing. But I can’t do this alone – I also need to your help, my colleagues’ class of 2024. I have no doubts that you will be like one of those who will cross their arms and walk away when they see that someone is being mistreated, whether it be your workplace or in the classroom. I know that you will have their back as you always have mine. Thanks for always being so supportive and creating a safe space for new ideas and challenges. Keep up with the good work and wear your “big M” pride to wherever you will end up – show them who we are! Now I can say this without feeling cringy – Go Blue!
TOPIC OF CHOICE
ReplyDeleteWe had a really nice discussion in class about personal morality and professional ethics. I think some of the examples that came up in class revolved around the provider having a personal issue with treating a patient due to their race or sexuality or refusing to dispense abortion drugs. In my opinion these were stark examples of personal morality vs professional ethics that helped to teach the difference to us. The conclusion I came up with during class, however, was that professional ethics is an objective gold standard and one’s subjective personal morality needs to conform to it. But after thinking about it, I think at any health institution there will be all kinds of cases where personal morality will enter a moral gray area with professional ethics. For example, in class we gave an example of a P&T committee including a new “biotech” drug into the formulary, which was the best medication for its indication, but expensive. We had a scenario where an elderly patient on Medicare couldn’t afford the medication. If I wanted to create a policy to help make this drug cheaper, I would also have to consider if a rich, young person comes into the pharmacy seeking a discount. Personally, I would only want this policy to help poor people first, but professional ethics tell me I shouldn’t compromise for different demographics. We all can agree the overall goal is to help as many patients as possible, but this conflict exists because there is disagreement about how accomplish it.
While mulling over this I found more examples of personal morality vs professional ethics in drug discovery and research. If you had to do a study on a low-cost drug to help the indigent, which requires homeless people to take a full medical exam and subject their bodies and paid them $10,000 to incentivize them to join the study, that would be unethical according to the institutional review board. Because paying $10,000 is almost coercive because they can’t say no but paying $100 would give them more of a choice. But for me it’s more moral to give a homeless person more money especially since I know finance is huge disparity for them and to justify the risk of joining a study. Another issue is when you’re doing a study on drug effect, you will subject one of the treatment arms with placebo, which means you know that there are people with the disease that aren’t getting help. This goes against personal morality because you want to help anyone that is suffering at any point in time including in a clinicaly study. Sure, you can get into an argument that if we start treating the control group the study results will have less validity. My takeaway here is that I think recognizing that a gray area exists is enough. We shouldn’t try to prove that personal morality is superior to professional ethics and vice versa. I think if you are in an area where your personal morals are in constant conflict with your professional ethics you won’t be very productive. So it’s important to do introspection and know where you stand so that you can be the best you.
I’ve always been passionate about easy and affordable access to healthcare in the United States, or rather, the lack of it. I always knew our healthcare system wasn’t the best, but I didn’t know just how bad it was until a few years ago. I used to work with patients that spoke little to no English, and that was the start of me noticing the everyday struggles patients go through just to receive care. They had to deal with lack of interpreters, minimal cultural competence, and simply not being able to call off work for an appointment. Throughout pharmacy school, it seems those hoops are only increasing in number for both patients and providers. Prior authorizations, lack of coverage for certain medications and treatments, and gaps in transitions of care are only the tip of the iceberg. The overwhelming number of challenges demonstrates that the system was never meant to be easy for patients and providers.
ReplyDeleteI’ve also always been a supporter of the Medicare for all movement, also known as the single payer healthcare system and I believe it is the solution to many of these problems. Our class discussions paired with the global healthcare presentations solidified my support for it. I noticed that many of the countries we discussed had some sort of universal, free healthcare component. The care or execution may not have been the best for one reason or another, but there was a general belief that healthcare should mostly come from the government and at a low cost. The United States, however, is ruled by wealthy people that continue to profit off the current healthcare system, so they keep resisting the Medicare for all movement.
However, the movement is there, and it is gaining momentum. The United States is one of the wealthiest countries and has vast resources. What country is more fit to make the switch? Not only do we have the resources, but we have good and bad examples from all over the world. With a greater demand from the public and careful planning and execution, our healthcare system can give people the healthcare they have the right to.