As most pharmacists know, 1987 marked the first time that they ranked No. 1 in the Gallup Poll survey in terms of "honesty and ethical standards." We were still No. 1 for the next several years. How, then, do we explain a steady decline-from 1986 to 1991-in the percentage of sales of nonprescription medications in pharmacies, that is, until food stores actually surpassed pharmacies in market share of nonprescription medications?
This is just one of several paradoxes that we wish to examine in this lesson. We hope that they will illustrate not only problems but also opportunities, although the life expectancy of these opportunities may be dwindling.
Paradox 1: Pharmacists in community have lost control over OTCs
More than a quarter of a century ago, sociologist Norman Denzin observed that pharmacy had not achieved full professional status because of "failure to maintain control over the 'social object' around which its activities are organized." He meant that the prescribing physician still controlled the choice, but, of course, that control was law.
Paradoxes abound on this issue. In the time since Denzin's paper was written, hospital pharmacists have gained virtual control over the use of legend drugs. Community pharmacists did have control over OTCs at one point, but they delegated that control first to clerks (see Paradox 2) and finally to the customer through self-service.
PROSPECT: Pharmacists have complete control over which OTC products they choose to stock and sell (not totally true in corporate practice). They can exercise that control by a program of critical clinical and business analysis of the merit of each product chosen for sale, combined with a careful program of communication with the clientele.
Paradox 2: Most-respected occupation loses market share in OTCs
As noted before, pharmacists have for several years topped the Gallup Poll as the most respected of any professional occupation. This has made annual pharmacy headlines, and pharmacists are-perhaps-justifiably proud. The proof of the pudding, however ...
During this same time period, pharmacists have experienced a steady decline in their OTC market share. How do we explain this-pharmacists most respected but continuing to lose market share?
Explanation 1. The Gallup Poll is wrong! In spite of its careful methods, it has for several years now reached the wrong conclusion.
Explanation 2. Gallup Poll didn't check the public faith in the checkers of supermarkets. Perhaps these people have become an important source of health information to the people of the United States.
Explanation 3. The American public no longer views overthe-counter medicines as "real" medicine. Therefore, the association between pharmacists and nonprescription medicine is no longer real and relevant. And how did the public reach such a conclusion?
Explanation 4. Supermarkets are convenient one-stop shops for consumers. It is, of course, probable that the convenience of buying OTCs in "one stop" at the grocery store plays a part in this.
Opting for the third explanation, we suggest that the public has been convinced that nonprescription medicines are just another commodity by the nature and scope of advertising. Further, we believe that pharmacy has allowed this to happen because the profession itself has for too long treated nonprescription medicines as a kind of annoying stepchild in the practice of pharmacy.
PROSPECT: While it is late, it is not too late for organized and individual pharmacists to change their ways. This will require, first of all, a change in attitude toward OTCs, to recognizing them as real medicines that deserve and require a pharmacist's professional attention to assure appropriate use. This change in attitude, if effected, must then be communicated to the public in a variety of both obvious and subtle ways.
Among the obvious ways by which we can alter the OTC future is to tell the public that we take OTCs seriously, professionally, and that we believe our services are necessary to their safe, effective, and economical use. …