The Legend of Stingy Jack and the Halloween Lantern

I realize I should be living up to the promise I made last week to write about medicinal marijuana, but it’s Halloween! After carving pumpkins, making spider cupcakes and eating Tootsie Rolls I find it impossible to be serious. And speaking of pumpkins, it’s rather odd that once a year we carve scary faces in them, light them up and put them on our front porches. Whose goofy idea was this, anyway?

Actually, the jack-o’-lantern has been around for centuries. I should have figured out from the “o” in o’-lantern that the custom originated in Ireland. You see, there once was a man, a miserable old drunk by the name of Stingy Jack, who loved to play tricks on his neighbors. No one was safe from his pranks – not his neighbors, his friends, nor his dear old mother. He was such a jokester, the story goes, that he bragged he could fool anyone – even the Devil himself. One day Jack went down to the corner pub for a pint when he spied the Devil at a table with a tall glass of bitter ale in front of him. Stingy Jack looked at the glass and licked his lips. “I’ll have me pint,” he thought to himself, “but I won’t leave this establishment a single shilling lighter.” Taking a seat at the Devil’s table he said, “You’re a man of some reputation! Certainly your money is too good for a working man’s tavern. What if I told you I have a way we could drink the evening away and pay nary a pence?” The Devil motioned Jack to continue. “Turn yourself into coin,” Jack said with a smile, “and I’ll pay for our drink. Once the barman has been paid, turn yourself back again!” The Devil agreed and turned himself into a gold piece. Jack took the coin but instead of buying more ale he put the gold next to a silver cross he carried in his pocket. Now it was impossible for the Devil to exercise his own free will. “Give me what I ask,” Jack whispered to the coin, “and I’ll set you free.” Then Jack told the Devil he had to promise that he would not bother him for a year and that if he were to die in that time he would not take his soul. Reluctantly, the Devil agreed. Jack removed the coin from his pocket and put it down on the table, whereupon the Devil returned to his former self. “Good day to you now,” Jack said with a sly smile. “And remember our bargain.” Whistling a tune, he tipped his hat to the Devil and left the pub, proud that he, Stingy Jack, had put one over on Lucifer himself. The Devil, content with the knowledge that time was on his side, sat down and ordered another drink.

It was a lovely summer day when Jack was wandering through the countryside and came upon the Devil sitting under an apple tree. “Now’s my chance,” Jack thought, “to buy myself a bit more time.” Jack doffed his hat to the Devil and bowed low. “I’ve had a few months to think,” said Jack. “I took advantage of you that day in the pub and I’d like to make amends. We could have a meal together. I have bread, cheese and a few turnips in me rucksack – even a jug of wine! The gorgeous apples in this tree would make our lunch a beautiful thing. Ah, but this bad leg of mine! I’ll never be able to reach that delicious fruit. Would you be so kind as to climb the tree and pick us an apple or two?” The Devil thought for a moment and decided that climbing the tree would only be to his advantage, since it would put him above Jack. He began to climb. Then Jack reached into his rucksack for his knife and quickly carved a cross into the bark of the tree. “I’m too clever for you!” cried Jack. “Now you’ll agree to leave me in peace for the rest of my days. And when my time is over, you’ll not make my soul your own.” The Devil, faced with the prospect of sitting on a branch for the next ten or twenty years, reluctantly agreed. Jack chipped the cross away with his knife and the Devil came down from the tree.

A few years later, Jack died and met St. Peter at the gates of Heaven. “You’ve lived the life of a blaggard and a drunkard,” boomed St. Peter. “You’ll not be entering here. Your fate lies that way.” Peter pointed to a path that wound down a mountainside into the darkness below. Jack started down the path and after walking for days through inhospitable and treacherous country, he came once more upon the Evil One. “Jack, my boy!” said the Devil. “I can’t say I’m surprised to see you here. You look like you could use a bit of hospitality but I made you a promise and a promise I shall keep so I’ll stick to my word and not take your soul. You won’t be entering here, either. Off with you now!” Jack turned to go. “Please, Devil,” said Jack. “I know my fate is my own. But there’s nothing but the darkness out there. How will I know where to go?” Lucifer laughed the laugh of the triumphant and tossed Jack an ember from the flames of Hell. Jack sighed, sat down and pulled a turnip and his knife from his rucksack. “I’ve no idea where I’m going,” said Jack, “but I’ll surely be able to see my way there.” He hollowed out the turnip, placed the glowing ember inside it and started on his way. And the poor beggar wanders still, lighting the path ahead with his Jack-o’-Lantern.

(The Irish in America, of course, found the native pumpkin much easier to carve and so the custom was born!)

Happy Halloween to all of you from all of us here at Apex Medical Placements!

 

 

 

Up in Smoke II: The Banning of Cannabis – 30’s Style

“Was it marijuana, the new Mexican drug, that nerved the murderous arm of Clara Phillips when she hammered out her victim’s life in Los Angeles? . . . THREE-FOURTHS OF THE CRIMES of violence in this country today are committed by DOPE SLAVES – that is a matter of cold record.”

                                                                Annie Laurie, columnist – Hearst Newspapers

William Randolph Hearst was the best known newspaper publisher of his day and the originator of yellow journalism. His “sensationalized stories of dubious veracity”, as Wikipedia puts it, shocked and inflamed his readers and whipped up popular support for his favorite causes, the criminalization of cannabis being one. Making the weed illegal was a goal that spoke not only to Hearst’s political and racial biases – it would also make him wealthier, and he wasted no time putting his considerable journalistic weight behind it.

In the early 20th century agriculture and industry in America had a show-down. Rudolph Diesel’s brainchild, an engine patented in 1898, ran on peanut oil. When he took the engine to the 1900 Paris World’s Fair a scarcity of peanut oil made him turn to hemp oil to power it. Both the fuel and the engine were a success and Diesel’s name was made. At the time hemp was one of the largest agricultural crops in the world. Strong, soft and durable, its fibers stood up to salt water better than cotton when made into rope and sails. In addition to fuel, pressed oil from hemp seeds was used in paints and varnishes and hemp could be used to make better paper than wood for less money and without the polluting chemicals used for processing wood pulp. By 1938 the magazine Popular Mechanics called hemp the “Billion Dollar Crop”. G.W. Schlichten’s “decordicating machine” (hemp’s equivalent of the cotton gin) allowed cellulose to be processed from the “hurds”, or material left over once the fibers were removed. The cellulose was then used to manufacture literally thousands of products, from cellophane to explosives.

Motivated by a desire to find uses for agricultural surpluses, Henry Ford experimented with different crops to make a resin that could be used in the manufacture of automobiles. His “special interest”, according to hempplastic.com, was converting soy meal into plastics. When the first resin car was unveiled, the only steel used was for its tubular frame. Ford eventually abandoned soy for a resin recipe of cellulose fibers of wheat, hemp and sisal. Then he added binders and molded it all under hydraulic pressure to create body panels, steering wheels, gearshift knobs, dashboards, trim – even windows. This was Ford’s vision of an automobile “grown from the soil”. It weighed a ton less than a comparable steel car and impact tests showed it to be ten times stronger, as well. By 1941 Popular Mechanics featured Ford in the hemp fields on his large estate and his “plastic car” was introduced with great fanfare. There is no doubt that manufacturing and powering cars with plant sources would have been a great boon for the agricultural industry. “The fuel of the future is going to come from fruit like that sumach out by the road, or from apples, weeds, sawdust — almost anything,” Ford said. “There is fuel in every bit of vegetable matter that can be fermented. There’s enough alcohol in one year’s yield of an acre of potatoes to drive the machinery necessary to cultivate the fields for a hundred years.” But by late 1941, Henry Ford, the master of publicity, no longer advertised his car. Petroleum-based products were about to steal the show.

In the 1920’s the DuPont Company, originally an explosives manufacturer, began to branch out. After World War I ended the company found greater profit in the manufacture of artificial fibers and began making cellophane. Next DuPont acquired General Motors and joined with Standard Oil (now Exxon) to produce the lead additive in gasoline known as ethyl. In 1935 the company made its most important discovery – Nylon, with many synthetic products, such as Lucite and Teflon, to follow. Andrew Mellon, banker and business magnate, was DuPont’s largest investor. In 1921 Mellon resigned as president of the Mellon National Bank to become the U.S. Secretary of the Treasury, a post he held under three presidents until 1932. He appointed Harry J. Anslinger (who would later marry his niece) to head the Federal Bureau of Narcotics and Dangerous Drugs. Anslinger was an ambitious sort and he knew the Bureau was a great career opportunity. The problem was that the depression was threatening to defund his organization. He needed to find a new threat to justify the Bureau and his role within it – opiates and cocaine weren’t enough, so he latched on to cannabis and began his work to make it illegal.

Anslinger’s style was well-suited to Hearst’s. Anslinger got busy stirring up racial fears to turn cannabis into a national threat. He ordered his field agents to compile the most horrendous and depraved crimes in the nation into “The Gore File” which he then promoted and read from frequently: “There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos, and entertainers. Their Satanic music, jazz, and swing, result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers, and any others.” Likewise, Hearst hated minorities and he used his newspapers to stir up racial tensions at every opportunity. Hearst papers portrayed Mexicans as lazy, degenerate, violent, job-stealing marijuana smokers. Hearst’s father, U.S. Senator George Hearst, had acquired hundreds of thousands of acres of land in Mexico for 20 cents apiece following the surrender of Geronimo. The loss of 800,000 acres of that prime timberland to Pancho Villa during the Mexican Revolution may have had something to do with the younger Hearst’s point of view.

While DuPont developed and patented fuel additives, synthetics and plastics, other companies were developing products from renewable plant sources. The hemp decorticator promised to help hemp dominate the paper market, eliminating the need for wood pulp paper. The Hearst news business and wood pulp paper were a marriage made in heaven. Hearst still owned vast amounts of timber and hemp was a threat to its value. For every product made from petroleum sources, Henry Ford and other companies promised better and cheaper alternatives made from cannabis hemp. Something had to be done. Meeting in secret, Hearst and the DuPont’s decided that hemp was too much of a threat to their billion dollar dynasties. Cannabis had to go. The tycoons, assisted by an eager Anslinger, took the little known Spanish slang term “marihuana” and pushed it into the public’s awareness. For two years, from 1935-1937, DuPont lobbied Herman Oliphant, chief counsel of the Treasury Department, for the prohibition of cannabis. Petroleum-based synthetics, DuPont assured him, could take the place of hemp in the marketplace.

It’s surely no coincidence that the Marihuana Tax Act made the possession or transfer of cannabis illegal throughout the U.S. in 1937. Cannabis used for medical and industrial uses had an expensive excise tax applied to it, making it more expensive for manufacturing than petroleum sources. In fact, other bills introduced to Congress proposing a national energy program based on the country’s vast agricultural resources were killed by the petroleum industry. Gasoline was clearly inferior to Cannabis hemp fuel. It had a lower octane rating, was more toxic, dangerous and polluting. No matter. Sensationalist smear campaigns paid for by petro-dollars slashed the hemp industry down to the ground and gasoline emerged as the twentieth century’s dominant fuel.

If you were born in the 50’s or before, you may have been shown the 1936 film “Reefer Madness” in school. We all love to look back at the stern, straight-faced 1930’s anti-marijuana propaganda and laugh at the level of ignorance that was once taken as Gospel. Yet there is virtually no history of concern about the evils of marijuana use in America until the passage of the Volstead Act in 1919, which prohibited the use of alcohol. Hysteria over cannabis use was easy to cultivate because of the divisions and corruption caused by prohibition. Hearst and the DuPont’s, in conjunction with corrupt or misguided officials like Anslinger, popularized dozens of movies, books, pamphlets and newspaper articles condemning cannabis. By 1930 many states had not only criminalized it but had labeled it as a narcotic. The FBI’s annual Uniform Crime Report estimated that some 723,627 people were arrested for cannabis violations in 2001 – nearly half the drug arrests in the country. Of those, 88.6% were charged with possession only, including those whose cannabis was grown for medical use. Since 1992, approximately six million Americans have been arrested on cannabis charges, illustrating the fact that the lunacy of the Reefer Madness days is not gone, but haunts us still. Little wonder, then, that the research and development of cannabis for medicinal use is just a distant dream.

Next week: searching for the truth about cannabis as medicine

 

Up in Smoke: California’s War on Medicinal Marijuana

In a complete about-face of Obama’s promise not to target medical marijuana users in states that allow it, the Feds are threatening to shut down pot dispensaries throughout California. Earlier this month Federal prosecutors began sending out letters to dispensary landlords threatening to bring charges and seize property unless they close down the businesses within 45 days. In an interview with the LA Times, Joe Elford, chief counsel for Americans for Safe Access (an advocate group for medical marijuana) said the move is “coming out of left field as far as we’re concerned.” The article goes on to say that only certain dispensaries have received letters and that the Feds have refused to comment on the criteria used to target them. I guess you could say this is the part where Obama takes resources away from serious crime-fighting and puts them into snatching doobies out of the hands of cancer patients. Whoa. Heavy, man.

Cheap drug humor aside, the medical marijuana issue is as confused as a narc after eating a plate of Alice B. Toklas brownies. Sorry. But seriously, marijuana’s history in America is crucial to understanding the resistance to its use as a medicine today. Many assume that it is a nothing more than a dangerous “gateway” drug, made illegal after years of Congressional hearings based on testimony from scientific and medical experts. But that would be over-simplifying things a bit. Actually, marijuana use goes back some 7,000 years and was legal in this country as recently as when Ronald Reagan wore short pants. That means it has been illegal for only 1% of the time man has been gathering or growing it. Makes you wonder, doesn’t it? I mean, what do we think we know now that 70 centuries of marijuana use didn’t teach us? Or is the move behind criminalizing it, like so many other things in this culture, based on politics, race and economics?

It would probably blow your mind (OK – I’ll stop) to know that the first law in the U.S. regarding cannabis actually supported it (and from here on I’ll refrain from calling the weed “marijuana” because of its negative associations with recreational use). In 1619 the Jamestown Colony in Virginia began requiring farmers to grow hemp, the non-intoxicating relative of the plant everybody is getting so excited about. Hemp is an amazingly useful plant that was eaten, made into paper, cloth, rope and sails. The military found it so valuable that someone could be jailed for not growing it in times of shortage. In those days hemp was even used as legal tender and was accepted as payment for taxes. According to Jack Herer’s classic book, The Emperor Wears No Clothes”, even in 18th century England “the much-sought-after prize of full British citizenship was bestowed by a decree of the crown on foreigners who would grow cannabis, and fines were often levied against those who refused.” Its popularity did not wane; in 1850 the U.S. Census counted 8,327 hemp farms.

You know, it never ceases to amaze – aside from its indigenous people, America is a country of immigrants, yet one group of them or another is always in disfavor. The Chinese, Germans, Irish, Southern and Eastern Europeans, Catholics and Jews (no matter where they were from), Middle Easterners – all have fought bigotry and discriminatory legislation to settle here. The history of the use, abuse and criminalization of cannabis and other substances is all tangled up with our attitudes toward these newcomers. Anti-Chinese sentiment led to the very first anti-narcotics law in the country – an 1875 ordinance in San Francisco against opium dens. It was the California Board of Pharmacy that created many modern techniques of drug enforcement, like undercover agents, informants, criminalization of users, anti-paraphernalia laws and drug raids. Henry J. Finger, a prominent member of the Board, was a rabid drug prohibitionist who, in addition to the scourge of Chinese opium, pushed to have cannabis included in federal drug legislation. This time he blamed East Indian immigrants that had arrived in San Francisco in 1910: “Within the last year we in California have been getting a large influx of Hindoos and they have in turn started quite a demand for cannabis indica; they are a very undesirable lot and the habit is growing in California very fast…the fear is that now they are initiating our whites into this habit…”. The “Hindoos”, according to Dale Gieringer’s The Forgotten Origins of Cannabis Prohibition in California, “sparked an uproar of protest from Asian exclusionists, who pronounced them to be even more unfit for American civilization than the Chinese.” They were “widely denounced for their outlandish customs, dirty clothes, strange food, suspect morals, and especially their propensity to work for low wages.” Apparently, Finger was the only one to complain of their cannabis use. Others saw them as hard-working and sober.

But of all the hysteria wrought by other nationalities upon our shores, perhaps none have moved us to plain, old-fashioned irrationality like the Mexicans. In the early 1900’s western states were anxious because of the numbers of Mexicans coming over the borders. In 1916 the Mexican Revolution spilled into the U.S. when Pancho Villa raided Columbus, New Mexico and Uncle Sam chased him back. Some years later tensions developed between small farmers and the large farms that used cheap Mexican labor. Much was made of the fact that the Mexicans smoked cannabis and had brought the plant with them. “Marihuana” was soon noticed by the pharmacy journals and was written up as a relative of Indian hemp or possibly jimsonweed. Because it was associated with criminals in Mexico, it became linked to violence and insanity. The Mexican connection pushed the California Board of Pharmacy over the edge. They felt duty-bound to legislate against “loco-weed” in 1913.

The racial divisions that have plagued our society since its inception have led us to discount or dismiss much of what immigrants have brought with them. The United States is one of the only industrialized nations on the planet that does not grow hemp. Instead, we import $96,000,000 worth of hemp products each year. The medicinal properties of Cannabis have a long track record – the earliest written reference goes back to China in the fifteenth century B.C. If America would only take the blinders off it would see that the implications of the legalization of cannabis for both industry and medicine are huge. In 1975, the National Institute on Drug Abuse issued its Fifth Annual Report to Congress on Marijuana and Health in which it recognized cannabis as an ancient healing drug: “One should not summarily dismiss,” the report went on to say, “the possibility of therapeutic usefulness simply because the plant is the subject of current sociopolitical controversy.”

Next week: the economics of the criminalization of cannabis.

 

 

Is a New Golden Age on the Horizon for Pharmacy?

I once heard a pharmacist remark that they are in a losing battle because the nature of business conflicts with the nature of the profession of pharmacy. The nature of business is making profits. In retail pharmacy profits are made by filling as many prescriptions as possible with as little help as possible. But the nature of the profession is health care. Health care practitioners promote health and well-being. Pharmacists make clinical decisions and judgment about medication therapy – which drugs are appropriate for an individual and which are not, how to take medication properly and how to recognize the side effects. In fact, the principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication which improves patients’ quality of life. Ah, there’s the rub: the provision of conscientious clinical care and the business of retail pharmacy, in its current incarnation anyway, do not mix.

The complaints of retail pharmacists are fairly universal. After spending six years and thousands of dollars earning a doctorate in pharmacy, pharmacists use their extensive knowledge of pharmacology and their clinical training to stand on their feet twelve hours a day arguing with insurance companies on the phone. Oh, and directing customers to the cereal aisle. In between phone calls and customer interruptions they find the time to input, fill and check prescriptions, make sure techs aren’t making medication errors, giving patients the wrong information or escalating a situation with an irritated customer. Meanwhile, the market forces are closing in on them. Endless mergers mean that pharmacy chains are consolidating power within a short list of companies who decide how business is conducted. Mergers amongst pharmacy benefit managers and insurance companies give them an ever-growing influence over the direction of the profession. Pharmacists are nervous over the move towards automation, the increasing role of technicians, the mushrooming of pharmacy programs and the influx of foreign pharmacy grads flooding the market with hungry newcomers willing to work longer and harder for less. All in all, the picture for retail pharmacists is not a pretty one.

Some say the golden age of pharmacy is over. The squeeze is on for pharmacists to crank out the prescriptions, sacrifice quality to quantity, bend over for management and insurance companies and de-emphasize their skills as drug counselors and educators. But as blogger Pharmacy Mike wrote, “Maybe big box stores are not the best future for all of us highly educated drug experts.” Maybe not, indeed. Costco, Walgreen’s Wal-Mart and CVS will continue to push pharmacists out of the equation because increased use of automation and mail-order mean less labor and less labor equals higher profits. The hope for pharmacists is not to rail against the pressures of the retail business model but to expand their considerable skills and knowledge into a completely new direction.

Last week I wrote about the turf war that’s heating up between physicians and non-physician providers like nurse practitioners, physician assistants, dentists and chiropractors. Due to the state of our healthcare system there are millions of neglected or underserved people in need of care. The time is ripe for the development of new methods of healthcare delivery. We don’t lack competent providers who can step up and meet the need. We lack leaders who can face up to the arrogant posturing of medicine. Pharmacy must take its proper place within the medical community and demand the right to diagnose and prescribe. By deferring to the American Medical Association, pharmacy has given up its only true professional responsibility related to pharmacotherapy. Pharmacists can’t be first-rate drug therapists until they practice drug therapy. And the job of dispensing drugs in a retail drug store has almost nothing to do with pharmacotherapy.

There’s a lot written in the pharmacy blogs about the dreadful situation retail pharmacists find themselves in and many say they are “stuck on the sidelines” with neither the will or the power to do anything about it. But the winds are beginning to blow in a different direction. The Pharmacy Manpower Project’s 2009 National Pharmacist Workforce Survey indicates shifts in the pharmacy profession toward more patient care. Despite the economic situation, the study results show that pharmacists are in high demand and that the profession has the “capacity for contributing to the reforming healthcare system to meet patient care needs”. The survey surely reflects the fact that as the Affordable Care Act is phased in, some 33 million people will have expanded access to insurance coverage. That, along with an aging population and increased incidence of chronic illness, which is almost always treated with medication, suggests we’re going to continue to need pharmacists. Maybe those increasing numbers of pharmacy graduates will have something to do, after all.

Speaking of pharmacy schools, the need for pharmacists to increase their clinical opportunities and influence is not wasted on administrators. Some pharmacy schools have blended a PA program with the PharmD program, the perfect stepping-stone to pharmacists being able to prescribe in their own right. This is the only sensible future for pharmacy and educators know it.

As the market forces the profession on to a new tack, pharmacists may breathe a little easier. All is not lost. But as the current business model dies, countless pharmacists will be affected. States have individual pharmacy associations and the national organization, the American Pharmacists Association (APhA), is the largest association of pharmacists in the United States; the structures exist for pharmacists to come together and influence legislatures, both state and federal, to make changes. But out of about 269,000 pharmacists in the country, only 60,000 belong to the APhA. Pharmacists often say they are the introverted type – not joiners, and they’re notorious for not organizing. But consider the Tea Party. No matter how you feel about them or their backers, Tea Party activists literally commandeered the machinery of the Republican Party on the local level in order to elect their representatives and enact their agenda. Their influence on the system, for better or for worse, is obvious. Real change comes from the bottom and it would serve pharmacists to take over their associations in numbers. Many may not be convinced of the need to get active or of its potential but the time is coming when more will find themselves compelled to go to a meeting, write an email or make a phone call. Change is in the air but things will likely get worse for the profession before it gets better. And nothing motivates a person to action like an empty pocketbook.

 

Just Call Me Doctor, Doctor.

After writing the first draft of a blog post a month or two ago, I read it out loud to my partner, who happens to be a nurse. The point of the blog (and it seemed perfectly sensible to me) was that pharmacists were the “sleeping giants” of the medical field and that their training qualified them to do a lot more than count pills, such as administer vaccinations, run cholesterol checks, conduct blood pressure  screenings…..suddenly I heard an emission of steam from my partner’s ears. “That is absolutely NOT within the purview of the pharmacist! Those are nursing duties. I don’t know why everyone thinks they can intrude on nursing territory and do our jobs better than we can!” I always thought that nurses had good relationships with pharmacists and saw them as invaluable resources of support and information but as the bullets flew overhead I found myself in the middle of a turf war I never knew existed.

The main war over territory, however, is not between pharmacy and nursing. That’s just a little skirmish compared to the battle between non-physician clinicians, such as nurse practitioners, nurse anesthetists, dentists, optometrists and chiropractors and the current kings of the hill – the MD’s. Now that the PharmD degree, with its emphasis on clinical training is the educational standard, you can add pharmacists to the list of those battling for a piece of ground to call their own. Some of the arguments seem little more than schoolyard bickering to someone outside the profession, like who deserves the title of “doctor”. Non-physicians are seeking a larger role in medical care and the physicians are digging in for a long siege. Some MD’s don’t just bristle when they hear a doctorate level nurse or pharmacist addressed as “doctor” – they believe patient confusion over titles is a real issue. Not that you will be surprised, but the American Medical Association (AMA) has conducted its own (!!) research and found that patients are mystified by the trails of initials which follow names on practitioners’ badges and has found that “ambiguous provider nomenclature” used to market health services is “exacerbating patient uncertainty”. Health services are being marketed to us, all right, and the current health care system is nothing if not confusing but is that really what docs are most concerned about? Or is the real conflict over  who will ultimately control health care services and the status and pay that come along with them?

The struggle over medical turf is nothing new. The physician assault on midwifery, for example, dates back to the 1700’s. Midwives have always believed that the process of childbirth is normal and that the move to “medicalize” it and turn it over to obstetricians did nothing for women except rob them of its potential for spiritual transformation. More recently the Western Australia news site Watoday.com posted a story that the Australian Medical Association had criticized a company’s plan to open 180 pharmacy-based clinics staffed by nurse practitioners. Patients would use these clinics for help with common illnesses like infections or flu. But the Association, predictably, does not think nurse practitioners are qualified and labeled the clinics “supermarket medicine”. Never mind the fact that countless studies, in Australia, Europe and the U.S. show that care provided by nurse practitioners is at least as good as that provided by MD’s. And now pharmacists are jumping into the fray – what’s a poor physician to do?

The healthcare system in America is a mess, pure and simple. Yes, we’ve got some cutting-edge machinery and knowledge available, if you can afford them. Losses of coverage swelled the ranks of the uninsured to 52 million in 2010, according to a study by a New York foundation, the Commonwealth Fund. Rural communities suffer the worst of it. HealthReform.gov says one of five of the uninsured lives in a rural area where accessing quality health care is not only difficult but costly. The number of uninsured is even higher for rural minorities, the poor and those with less than a high school education. The number of primary care physicians in the U.S. is dwindling because primary care doesn’t pay as well as most specialties. As a result, both rural and urban areas are underserved; 23% of all patients said they had to wait six or more days to see their doctor the last time they were sick.

If you’re elderly, things are even worse, especially if you’re on Medicare. Doctors who specialize in geriatrics are increasingly rare, with just one geriatrician for every 5,000 seniors, according to the American Geriatrics Society. Treating older patients with multiple, often complex problems is a terrible way for physicians to make money because Medicare just doesn’t compensate them for the time that’s required.

It doesn’t end there, either. 11.6% of all children in the U.S. are uninsured. Many adults who do have insurance don’t go to the doctor because their co-pays are too high or because they have gaps in their coverage. The system is inadequate, so alternative methods of delivering health care are popping up everywhere. In addition to the vaccination services in all the big chain pharmacies, MinuteClinic, a retail-based operation, is opening walk-in medical clinics in CVS stores. Pharmacists are partnering with patients and physicians to promote safe and effective use of medications through medication therapy management programs. Today I received a call from my Walgreen’s store inviting me to a conference call with two pharmacists and other customers to discuss medication questions and concerns. And although physicians may complain about other providers muscling in on their territory, they are increasingly staffing up with nurse practitioners and physician’s assistants to help them squeeze in more patients.

Like a piece of Swiss cheese, our for-profit healthcare system is shot full of holes and millions have fallen through. It’s no mystery – there are plenty of skilled, experienced health providers aside from doctors so wherever physicians don’t or won’t meet the need, non-physicians are simply stepping up to serve their communities. People in need don’t care much about titles or turf. They just want competent, accessible help with their health care. Today I read about a pharmacist who found himself providing grief counseling to a woman who showed up at his counter about her blood pressure medication. She had just lost her husband and God knows nobody has mental health coverage anymore. So he just filled in a bit of the hole, as best as he could. Nature, if you’ll remember back to your 9th grade science class, simply abhors a vacuum.