Adle Joseph loves being a small-town pharmacist, and he's been
one for 37 years. He knows many of his customers by name and by face, and today
he fills prescriptions for children whose parents played Little League baseball
on teams that he coached in the 1970s and '80s. For Joseph, a stroll through
his hometown of Leesburg, Va., means greeting the customers who are also his
friends and neighbors.
"They call me at home to ask questions. I don't mind,"
he says. "I know a lot of my patients. I know their problems, if they've
been in the hospital or not. You have to know your people and they have to know
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But things have changed a lot since he started in the business
in the 1960s. In those days, there were fewer prescription drugs on the market
and few had health insurance that covered them. Prescription drugs weren't
advertised on television and managed care didn't exist. Back then, pharmacists
and doctors were highly trusted and customers didn't ask many questions.
"There was no insurance; everything was cash," Joseph remembers. It
was, to be sure, a simpler time.
Today, Joseph says, the pressure on pharmacists is greater than
it's ever been. "Everything is more time consuming. The phone is constantly
ringing, you're making calls to patients and doctors, you're trying to deal
with insurance. The conditions are horrendous at times."
Joseph's experience is shared by pharmacists across the
country. The number of prescriptions has doubled in the past decade, from 1.5
billion in 1989 to a projected 3 billion this year, according to the National
Association of Chain Drug Stores. But the number of pharmacists has not kept
pace; the association estimates the nationwide shortage at more than 7,000
pharmacists. At the same time, managed care requirements have further increased
the workload on pharmacists, who find themselves overwhelmed.
The result is an increasingly dangerous situation in our
nation's pharmacies. Although most states do not require drugstores to report
mistakes, serious medication errors are on the rise. A Feb. 28, 1998, study in
the medical journal the Lancet estimated that in a 10-year period
starting in 1983, the number of deaths caused by drug errors jumped 250%,
reaching more than 7,000 a year by 1993, the last year for which data are
available. According to the FDA, an estimated 1.3 million Americans are injured
each year from medication mistakes. For some people, these errors have tragic
Bryn Cabanillas was just 6 years old when her parents picked up
a prescription for an antiseizure medication at a Thrifty Payless drug store in
Costa Mesa, Calif. The order was mistakenly filled at nearly seven times the
correct dosage, leaving Bryn with serious brain damage, unable to speak or get
out of bed. In 1998, a California jury ordered Thrifty to pay damages of $30.6
million to her family.