Semantics and the pharmaceutical industry
I’ve written letters of complaint before. If memory serves, they mostly fell on deaf ears.
Still, on this occasion, compelled to complain.
I was angry. In part, I was angry with myself because in retrospect I really could have said no. But there were other issues at play—economic and environmental, that went beyond a petty pique.
The story is this: on March 14, I underwent hip replacement surgery at a Montreal clinic. On March 15, while I was in the clinic’s recovery ward, I was contacted, as expected, by a nearby pharmacy. I knew I’d be taking an antiinflammatory and a blood thinner for two weeks or more, and I knew there would be other drugs as well.
The pharmacy had what seemed like a rather long list of medications to recommend. I was told what each was for. I questioned whether all were necessary, since several of the pharmaceuticals were for pain relief and two of them were to be taken only if earlier painkillers were ineffective.
My gut reaction was that there were far too many items on the pharmacy’s list. Medication had been explained to me by a nurse. The drugs were control mechanisms: one to reduce swelling, another to prevent blood clots, a couple to cope with pain, and one— taken half an hour before breakfast—to coat the stomach lining to protect it from all the poisons that were about to be ingested. So, I knew there were going to be a lot of pills, but the list seemed too long.
I asked if I needed them all immediately. Would I be able to get the same medication from my local pharmacy, if and when I found it necessary?
I was told yes, but that the wisest course of action was to order everything now as I would have the medication at hand if I needed it.
And if I didn’t need it?
Medication that is not used can be returned to the pharmacy, she said.
This is where I should have noticed a red flag. I didn’t.
There were contributing factors to this lapse. We were talking on the phone, which is never as clear a conversation as in person. As well,
Ifelt neither of us was conversing in our respective customary languages. I sensed I was up against a well-trained salesperson and the longer I was on the phone, the more I wanted to get off. In the end, I didn’t take everything on the pharmacy’s list but still took too much.
The pharmacy delivered the medication on the evening of the 15th. The following morning, the 16th, I left the clinic at 7a.m., before breakfast, with the bag of pharmaceuticals still unopened.
Once home, I took the pill to coat my stomach, and shortly after, with my late breakfast, the antiinflammatory, the anti-coagulant, and the Tylenol that the surgeon specifically recommended. Within a few days, I knew that there were vials of pills that would remain unopened and untouched. With the vials was the cashier’s slip with this notice at the bottom, “Aucun remboursement sans ce coupon. Après 15 jours.”
I recalled the conversation when I was in the clinic’s recovery ward. I knew that the slip should have had a further clarification: no reimbursement on any medication. Nevertheless, I phoned the pharmacy to ask if the medication that I now knew I would not need could be returned on May 3, when I next have to visit the orthopedic clinic, or if I had to find a way to return it before the 15 days mentioned on the cashier’s slip. I asked the question innocently even though I knew the answer.
I was told, by someone who spoke English as a first language, that the medication could not be returned. If I did not use the medication, it could be brought to any pharmacy and it would be disposed of there. I pointed out that I’d been told something different. The person on the line suggested that there had been a misunderstanding and that I was lucky to have a high pain threshold. And, she pointed out, there was another medication on the prescribed list that the pharmacy had not sold me.
I should have felt good about my pain threshold—although I’d been told that recovery from a hip operation is generally straightforward and problem-free—and glad that I didn’t have yet one more unopened vial.
Somehow, the conversation did nothing for my anger. I dashed off a letter to the pharmacy that read, in part:
“I am writing because I should not have been given contradictory information.
If medication cannot be returned, I should not have been encouraged so strongly to immediately buy pharmaceuticals that I might never need. I should have been told very clearly that, once bought, the medication could not be returned for reimbursement.
I am all the more disturbed by the fact that “disposing” of that unused medication almost certainly means that, sooner or later, those pharmaceuticals will end up as contaminants in the environment without doing anyone any good at all. It is the worst form of waste.
I am writing to ask that I be allowed to return the untouched medication for full reimbursement and that, in the future, the pharmacy be very clear with clients about the conditions of sale and not say one thing one day and the opposite thing the next.”
I sent the letter to the pharmacy but, as I indicated at the end of my letter, I also sent a copy to the Quebec Order of Pharmacists.
That was on a Tuesday. On Friday, I got a phone call from the pharmacy, from the same person who had spoken to me on the 15th when I was in the recovery ward. She apologized for the misunderstanding. There is a difference between returning medication to the pharmacy and returning medication to the pharmacy for reimbursement. Medication that is not used can be returned to the pharmacy where it will be disposed of.
On the following Monday, I got a phone call from the Order of Pharmacists of Québec. The call lasted half an hour or more. It began in English and later switch to French and then flipped back and forth according to which language had the most apt phrase. The woman who called patiently listened to my story. She asked twice if I wanted to make a formal complaint against the pharmacy. I didn’t.
I explained that I was most upset by the waste involved, by the fact that medication had been sold that would benefit no one before ending up in the environment.
The money involved in my case was less than $100. But, however small the sum, it will inevitably represent more to the client, whatever his annual income, than it does to the pharmacy and the drug companies that are exponentially richer than any client. Do they really need to follow a policy of aggressively promoting drug sales?
And when those pharmaceuticals go directly from the drug store to the disposal bin, doesn’t that just put more strain on the environment? Our rivers already flow with measurable quantities of a wide range of pharmaceuticals. Shouldn’t the protocol be to minimize rather than maximize the sale of potent poisons?
I got the impression that the Order of Pharmacists was already aware of my concerns. I was told that the quantities of old pills that are returned to pharmacies for disposal are eventually shipped to an incinerator near Gatineau where they are burnt to ash, arguably less harmful to the environment than being buried or dumped into a waterway.
In the end, the money I gave to the pharmacy for a product I’ll never use will stay in the pharmacy’s till. On the plus side, I have at least a little hope that the Order of Pharmacists might nudge the pharmaceutical industry towards a more patientcentred protocol.