Picking up a prescription at a pharmacy is often “sort of like going into a McDonald’s and ordering a Big Mac–you pay for it and you walk away 15 minutes later,” the Chicago Tribune reporter Sam Roe recently told ProPublica’s Breakthrough podcast. “There’s not a lot of chit-chat,” Roe said. “But the silence is [the pharmacists] breaking the law.”
Roe was talking about an investigation that he and his colleagues Ray Long and Karisa King ran into the failure of drugstore pharmacists to warn customers of dangerous, sometimes fatal, interactions between prescription drugs. The Chicago Tribune ran the results of the two-year investigation in December; in the largest and most comprehensive study of this aspect of the industry, the reporters found that pharmacists missed dangerous interactions 52% of the time.
This is significant, Roe said when speaking to ProPublica, because collecting a prescription is nowhere near as straightforward as grabbing a fast-food meal. Many commonly prescribed drugs–for instance, an antibiotic and an anti-cholesterol drug–though perfectly safe when taken alone, can be disastrous when combined. But when reporters from the Tribune went up to the counter to get them filled simultaneously, they were, more often than not, not even questioned, let alone warned. The investigation, the Chicago Tribune wrote, is “striking evidence of an industrywide failure that places millions of consumers at risk.”
Over the course of the study period, a team of 15 Tribune reporters visited 255 pharmacies in the greater Chicago area. The reporters consulted with two leading experts on drug interactions to decide which to test. One combination, of the muscle relaxant Tizanidine and the antibiotic Ciprofloxacin, could result in loss of consciousness; the interaction of the gout treatment Colchine and high-blood-pressure medication Verapamil causes multiple-organ failure and can potentially be fatal. A Chicago physician who treats elderly patients and knows the risks of drug interactions agreed to write the conflicting prescriptions for the reporters to present to the pharmacists.
Independent pharmacies fared the worst, failing 72% of the time. But national chains were not far behind: CVS missed interactions 63% of the time, Target 62% of the time, and Kmart 60% of the time. As Americans lean more heavily on prescriptions drugs to treat health concerns—one in 10 people are on five or more drugs at a given time—the Tribune’s findings are alarming.
By law, pharmacists are supposed to know and warn customers of dangerous interactions, Long told ProPublica’s Breakthrough podcast. “Pharmacies are supposed to be this important cog in the health care system, but they’re behaving, in many ways, as glorified vending machines,” he added.
But the Tribune investigation shook the industry. Though speed is frequently cited as a reason pharmacists miss interactions–one Walmart employee told the Tribune that she fills one prescription every 2.7 minutes–both national chains and independent pharmacies are now pledging to overhaul their systems to better protect customers. CVS will revamp its computer warning system, which should automatically flag dangerous interactions when prescriptions are filled, and Walgreens, among other changes, has pledged to bolster pharmacist training. Independent pharmacies will implement similar strategies.
Long told ProPublica that customers should already be noticing the effects of the investigation when they go to pick up a prescription, though the full computer-system upgrades may not yet be implemented. Customers should expect–and when not offered, demand–more robust and informed consultations before walking away with prescriptions. And the Tribune will keep its finger on the effects of its investigation. “We’ll have to periodically check in on the industry to makes sure they’re doing what they promised to do,” Long said.