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    Pharmacists and cognitive dissonance

    When diametrically opposed views are the framework of daily reality


    What I tell myself vs. what I do

    Cognitive dissonance often arises when there is conflict between a pharmacist’s positive concept of himself/herself (The drugs that I dispense are safe and effective), and the reality (Some drugs do more harm than good).

    How do pharmacists handle this disconnect? Do we react with hostility and denial toward customers who sometimes question the safety of the drugs we dispense? Or do we confront the possibility that there may be some truth in the fears customers express?

    The academic viewpoint vs. the line of fire

    Another example of cognitive dissonance is illustrated by the difference in perspective between pharmacists in the trenches and academics in their ivory towers.

    When practical circumstances prevent pharmacists from doing what we know we have to do, what we should do, and what we want to do, it creates a terrible conflict. This sort of cognitive dissonance hugely compromises anyone who has to endure it.

    While the academics are commenting from a philosophical standpoint, the pharmacists in the trenches are getting stomped on all day long, every day. These are two entirely different realities. When the attitudes arising in one reality are used against the truth of the other, it causes a huge conflict among pharmacists.

    Behavioral change vs. pharmaceutical intervention

    On the one hand, our instincts tell us that human health is primarily the result of basic factors such as good nutrition, healthy lifestyles, maintaining a healthy weight, avoiding a sedentary lifestyle, avoiding the use of tobacco and alcohol, etc.

    On the other hand, our healthcare system is based on the manipulation of molecules and cells with powerful synthetic chemicals called pharmaceuticals.

    How does one reconcile these opposing views of human health?

    Dennis Miller, RPh
    Dennis Miller is a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at [email protected] His books ...


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    • Anonymous
      You continue to amaze me, Dennis. I can't believe you can read my mind so perfectly! The cognitive dissonance you speak of is as familiar to me as getting out of bed in the morning, and much less palatable. How DO you reconcile what you know to be true with what you must tolerate to survive. For many years, I have felt "two-faced" or phony in my practice of pharmacy. What I really want to do is tell my customers to flush the medication and start taking care of their bodies. What I have to tell them is how the medication will "help" them, and how they should take it faithfully. I've played the part as long as I can - I'm getting out. I can't in good conscience keep shoveling this stuff out. Keep up the good work! Tired Pharmacist.
    • MarkBurger
      Dennis, You're right on the money again! Good job. Another way to ask the question: When did pharmacology and epidemiology trump Physiology and Biochemistry? I saw a cartoon last week: It was of a Scientist looking through a microscope (presumably an immunologist). God, from above, sarcastically said, "What a blunder! I forgot to complete the Immune System! I count on you to address this." We forget, I think, that enzymatic reactions defy the Laws of Thermodynamics and occur in a quantum physics manner. And, finally, there's this from the New England Journal of Medicine :: "Lifestyle intervention reduced incidence of diabetes by 58% and metormin by 31% as compared with placebo; •“The lifestyle intervention was more effective than metformin." ~ REFERENCE Diabetes Prevention Program Research Group, New Engl J Med 2002;346(6): 393-403