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    What I wish I had learned in pharmacy school

    Dennis MillerI’ve always had an interest in the social sciences, so perhaps the tech-heavy pharmacy curriculum was not a good match for me. I probably would have been much happier with a sociology degree, if the employment prospects hadn’t looked so dismal.

    Where pharmacy is concerned, I don’t think my interest in the social sciences is misplaced. Social sciences ought to receive greater emphasis in pharmacy school. They would help pharmacists-in-training to understand the social, cultural, psychological, political, and economic factors that are important in the causation of human illness. The current mechanistic and reductionistic focus of pharmacy school benefits the pill-for-every-ill attitude of corporate America far more than it benefits the general public.

    So what would a curriculum with an expanded public-health perspective look like?

    First, consider these questions.

    Do you believe that human health is significantly connected to lifestyle choices? Or do you believe it has more to do with the technical manipulation of molecules and cells with potent pharmaceuticals? To put it another way, do you believe that human health is directly proportional to the per capita consumption of pharmaceuticals?

    If you believe that human health has more to do with lifestyle choices, perhaps you too would prefer a college curriculum that pays more attention to culture and society. Here are a few thoughts, pro and con.

    Sociology, anthropology, psychology

    During my college years I would have loved to attend classes in medical sociology, medical anthropology, and psychology. A semester of medical anthropology could teach pharmacy students about many of the cultural myths and misconceptions surrounding the causes of human illness. A semester of psychology might help pharmacists understand the behavior exhibited by nonpharmacist store managers and by techs, clerks, and customers. 

    Political science

    A semester of political science might give pharmacists a better understanding of prevailing issues, such as the debate over Obamacare vs. the simplicity of a single-payer (Medicare for all) model. Insight into political science might also help pharmacists see how Big Pharma uses lobbyists to influence Congress into pressuring the FDA to expedite the approval of drugs that critics say should not be approved. 

    Public health

    Although many large universities have schools of public health, the university I attended did not. Courses in public health could give pharmacists a macro (epidemiological) view of health rather than the micro (molecular/cellular) view that we are force-fed in pharmacy school. 

    Calculus, physics, English literature

    This was my experience: I took calculus as an elective during the pre-pharmacy segment of my studies, but I never used any of my knowledge of that subject throughout my entire career as a chain pharmacist. Similarly, I have used nothing from two pre-pharmacy semesters of physics. My semester of English literature was a waste of time (I’ve read zero fiction since graduation in 1975), even though I absolutely understand the need for well-rounded graduates. 

    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
      I agree wholeheartedly with increasing the public health in the curriculum and perhaps nutrition (where do we address clinical nutrition?). Spanish might be useful in Del Ray Beach. Texas A&M is requiring Medical Spanish of all of its students because it is preparing them to serve a large Hispanic population. But is it really necessary in the corn fields of the Midwest? I simply cannot agree with removing science and math from the curriculum, and especially medicinal chemistry. We are the only health professional that studies medicinal chemistry and pharmaceutics. We are the one member of the health care team that has that specialized knowledge. My understanding of the chemistry and kinetics of warfarin are part of what makes me a better anticoagulation provider than, say, an nurse practitioner or PA-C (and my wife who is a PA-C agrees with me). Remove the science that is unique to our profession and we become pharmacy technicians with public health or nutrition degrees. And if he thinks the presence of a sulfur atom is what triggers a sulfa allergy then maybe he needed to pay more attention in med chem. Sheez. The thing that we always have to remember is that we are educating entry-level practitioners for a broad variety of practices. That means giving a very broad education. Mr. Miller is speaking from a very narrow perspective.
    • Anonymous
      I respectfully disagree. Most pharmacy schools right now have admission classes with majority having had a bachelor's degree or higher prior to pharmacy school. I had started taking college classes while in 10th grade of high school such that pre-pharmacy school, I had 6 years' worth of undergraduate credit (for my B.S. degree with chem major, math minor) prior to the 4 years of pharmacy school and then 2 years of residency. I had plenty of psychology, anthropology, sociology, economics, political science, and business undergraduate coursework and would have loathed any more heaped upon me in pharmacy school. Several of my classmates had M.S. and PhD degrees prior to pharmacy school. My school (UCSF) at the time allowed testing out of chemistry and other science classes if you could pass a (difficult) exam plus showed upper-level undergraduate coursework that was deemed equivalent. I hope other schools consider adopting that to spare those of us who already took a ton of undergraduate chemistry the need to sit through introductory biochem, o-chem, etc. I do agree that those classes you mentioned are useful, such that any school that doesn't already require them SHOULD require them as prerequisites.
    • Anonymous
      Dennis, with the 6-7 year programs that exist now there's plenty of opportunity to pick up a social sciences background (if the student doesn't already have a degree in the field). We had a couple of social science courses in my pharmacy curriculum which, because they were poorly placed in the second professional year, were attended by 5 designated note takers while everyone else was studying med chem/pharmacology/and clinical pharmacy. The classes weren't meeting anyone's needs at the time (early 1980s). I think you would have had plenty of opportunity to audit the social sciences if your college/university had been on a quarter system instead of a semester system. The semester system significantly reduces a student's options for additional courses giving that degree less "bang for the buck."
    • DerekBorkowski
      As a first-year pharmacy student (Class of 2018) at the University of Minnesota, Duluth and someone who has read your book "Pharmacy Exposed", I, in no means am trying to challenge your expertise, but I must say that many of these issues that you bring up about what pharmacy school needs implemented are already in our curriculum. In my experience, I must completely disagree with your labeling of pharmacy school as currently having a "mechanistic and reductionistic focus...(that)... benefits the pill-for-every-ill attitude of corporate America far more than it benefits the general public." First, in most if not all of pharmacy schools, at least 2 courses in social sciences are required prerequisites and sociology, psychology and economics are among the most common taken. Also these days, English writing is a much more common prerequisite than English literature for pharmacy programs and I'm sure you'd agree with the importance that written communication has in every aspect of professional life. Additionally, I know programs, especially in areas highly populated with Spanish speakers, have begun implementing Pharmacy Spanish into their curriculum. I've only been in the PharmD program for one complete semester and already we have had courses that include both the history of and contemporary state of the US Healthcare system (Obamacare, and a wide range of payer models included) as well as have looked at healthcare systems internationally. Additionally, our entire curriculum has a focus on public health, and the interpretation of evidence-based medicine when making decisions. On my fourth day of class we were bussed, along with the first-year medical students, out to a rural community for a day and spent time at various establishments in the town talking to people and gathering information of how the community works. We then went on to perform complete presentations about the rural communities we visited including information on eight different domains that made up the community. After this we had a similar semester long project examining our hometowns by similar standards. Also in my first semester we have begun to study herbal medications and supplements with focus on the potential dangers these may have versus the potential benefits. Further along in our curriculum we have courses that tie cellular metabolism and nutrition together as well as have nutrition electives. Lastly, in our first-semester pharmaceutical care course we began assessing both real patients and patient cases. The focus of these assessments were identifying and resolving both drug therapy problems and any problem the patient may have by considering all options, including non-pharmacological and referral alternatives, and did not just focus on drug therapy as the only alternative. My experience in this course is the basis of my disagreement with your statement that pharmacy school benefits the pill-for-every-ill attitude. In conclusion, I think its great that you wrote this article detailing the troubles that the pharmacy education of the 20th century, as you put it, may have dealing with contemporary healthcare practice and healthcare systems, but I think it's even better to know that the pharmacy education of the 21st century has already begun to make these changes and advance the practice of the pharmacist as a leading health professional in today's healthcare landscape. P.S. I agree we may still be way overloaded with chemistry!
    • Anonymous
      I truly enjoyed this article. You are so correct in that Pharmacy Schools teach so much unnecessary chemistry and would do well to subtract from that and add usable classes such as nutrition. Many people that I come in contact with know and understand foods and natural products much better than I, which makes me feel like I should go back to school to learn about nutrition to be of more help to the patients I serve. Business and psychology/sociology classes would also be extremely beneficial.
    • Anonymous
      Dennis, I enjoyed your article and would like to add a few courses in business/management would be essential for a more well rounded graduate. We should be cognizant of the fact that healthcare is a business yet many practitioners are clueless of modern business practices.
    • AnthonyGesualdo
      Dennis I'm a pharmacy graduate class of 68. You are absolutely correct. Most new retail pharmacists come into the profession with much of what they learned to be of no use, especially in retail pharmacy . Bright eyed and bushy tailed over educated in subjects with no value. Much of pharmacy today , especially in big chains, isn't about pharmacy anymore but how much and how fast Rxs can be dispensed. How many vaccinations can be given, doing MTMs, counseling and on and on and on. All about money not about patient care. All of this with no help. They should teach fortune telling because in addition to every other chore expected, consumers think we should have their scripts ready even though they have been sent elsewhere, expecting us to know where, and drop everything with 20 people at the drop off and pickup window . They should add a course on how to be a Magician. It's a rapidly changing profession turning into a run away train. Nothing like you should have been trained to do.
    • Mr. JBlossom
      I can certainly attest to the usefulness of a psychology background, and not just a semester. I got a degree in psychology before pharmacy school (as well as a few years working on a psych unit). I can honestly say I use it every day of my life.
    • Anonymous
      I have to agree especially about all calculus, literature and physics classes! When I did pharmacy there was a program where you could get a food science degree dual with pharmacy! I actually think some more nutrition classes may be valid as well!