Pennsylvania Pharmacist, December 1997

NATURAL PHARMACY - THE GREEN SCENE

By Daniel T. Wagner

Pharmacists have a powerful historical image. The pharmacist, often recognized as America's most accessible health professional, is associated with an image of trust, competency, and advocacy. But the diverse and dynamic profession of pharmacy is such that new specialization has emerged that responds to the evolving process of health care. Nothing acknowledges this multifactorial role of health alternative and complementary medicines.

The facts are in. . . herbal medicines, vitamins, nutritionals, and other dietary supplements are big business. Over 37% of Americans are taking an alternative medicine, and drug stores are cashing in at a tune of at 57% increase in sales from 1995-1996. Consumers spent a whopping $11 billion dollars out-of-pocket for natural treatments, herbs and dietary supplements in 1994, and the figures will easily eclipse $25 billion this year. There is little doubt that the consumer demand for "natural remedies" will continue to grow.

It is the prudent and innovative pharmacist who will be in the forefront of this natural revolution and sharpen his or her skills and knowledge to better serve the patient who is "reaching out" for this information. What many consumers are looking for are natural remedies for many disease states and minor ailments that use to lead them to choose a prescription or O.T.C. legend medicine. What the pharmacist should provide is the professional intervention to fulfill their desires, albeit it may be a bit contrary to what they have learned to do in the past. But, truth is, many alternative products are efficacious and effective. Plus, these products are selling at a tremendous rate, and since health food stores and supermarkets are leading the way in retail sales, it is imperative that the independent and chain pharmacist garner these sales from a eager "cash paying" customer.

Following A Passion
After seventeen years as an independent, retail pharmacist, I decided to follow my passion and open a pharmacy devoted to natural remedies, herbs, vitamins, minerals, and other complementary products. So, on January 1, 1997, I sold my retail pharmacy business to a chain drug store that had moved in the neighborhood a year earlier. It was a big decision. Since I had absolutely no intention working for my former competitor, I had to have extreme self-confidence, an iron will, and a good business plan to open up "Nutri-Farmacy" a few months later. The name I chose was characteristic of the business I planned to operate. "Nutri" for nutritional, with information not only on alternatives, but just as much on diet, prescription and OTC drug use (in synergy with complementary medicines and therapies), healthy lifestyles, and true facts about supplementation. "Farmacy" with an "F" because I was not selling pharmaceuticals, but a more natural approach to products that are primarily derived from plants and other natural sources. All this wrapped in a total concept of wellness, nutrition and health care, and I believed that the public would come flocking.

And they have. After being opened for only five months, Nutri-Farmacy has been a very successful and professionally satisfying experience that has fulfilled all my expectations of practicing as a health professional and truly feeling as through I can make a positive change in the overall health of so many people. Pharmacists are in an enviable position to meet the nutritional needs of the public, mainly because they are so accessible, have a very high degree of respectability and trust, and are educated about drugs and the effects and side-effects that can elicit. Thus, the pharmacists' ability to bring synergy to allopathic and the complementary worlds of medicine are inestimable. But pharmacists, like allopathic physicians, are trained with a mindset and a professional bias that must be overcome if they are to succeed in this exciting new pharmacy niche. First of all, it should not be called "alternative" medicine, for that implicates something different and possible nonconforming. (In actuality, since 70% of the world's people use primarily plant medicines, one could naturally deduce that western medicine is indeed an "alternative" to historic medicine. It was easy for me to accept that "complementary" medicine is just that - something that complements our existing health model and does not "compete" with it. There is truly no reason why it can not complement allopathic medicine in a very worthwhile and meaningful manner. I see no competition here - only synergy.

Finding My Niche
I've always had a deep-down, inherent fascination for the natural world for as long as I can remember. When I chose pharmacy as a career, I never once doubted that my affection for the environment and nature could somehow be connected to my profession. Surely, I was aware that many of the drugs I had learned about as a student and an intern where "derived" from natural sources, mainly rain forest plants. Still today, almost 25% of all the prescription drugs behind the Rx counter come from natural or semi-natural sources. This has always intrigued me. I look at the rain forests and other natural biomes of the world not only as a place for the proliferation of life, but as a huge chemical and pharmacy factory - from which the precious gift of medicine was first derived eons ago. In fact, the rudimentary beginnings of our noble professional where first undertaken by the alchemists. They were the first pharmacists who knew the plants well, and by using the roots, herbs, leaves, bark, flowers and fruits found in their environment, they concocted the medicines and drugs of their day to heal and treat the masses.

My first taste of my personal pursuit of a "green" adventure came in 1994, when I participated in the first "Pharmacy from the Rain Forest" field trip and work study that went to the Amazon rain forest of Northeastern Peru, South America. It was an overwhelming experience that I knew would change my life and my professional pursuits in the future. You would think that just experiencing the fauna and flora of the jungle would be fulfilling enough, but the true highlight of the journey was meeting and working with gifted shaman and medicine men and women who transformed simple plants into effective healing modalities that treated a whole host of ailments. "Here is knowledge that should be preserved," I thought, "here are secrets that western medicine can utilize."

In truth, the experience was too endearing for me to only let it happen one time. In successive years I have traveled to Costa Rica, Belize, Guatemala, Nigeria, and Kenya, to learn more about plant medicines, natural products, and phytomedicinals. The experience I gained in working with some of the leading herbalists, botanists, and ethnobotanists in the field was invaluable. It only reinforced my personal passion to pursue a more natural approach to my chosen profession. And my timing was right. These natural remedies are enjoying an incredible resurgence in popularity and practicality mainly in Asia and Europe, but now, Americans are also recognizing the worth of these products with growing enthusiasm.

So after all these years as an eco-pharmacist, after all the time and miles away from home, after all the knowledge I have gained about the potential synergy of these products with modem pharmaceuticals, and with the inestimable potential to help, many, many people improve their health, I believe I have found my niche.

A New Twist On Patient Consultation Upon first opening Nutri-Farmacy, I was naturally skeptical on the overall response I would receive from the media, my fellow colleagues, and of course, the public. I fully realized that the public's interest in nutritional support products was escalating each year, but how would they react to a natural pharmacist? The evidence was encouraging for a number of reasons: the stock of natural health and foods stores was skyrocketing, use of alternative medicines in Europe was mushrooming, and the impersonal and trite service that many HMOs and managed care organizations were offering to many patients was discordant, and people were truly "reaching out" for a more natural way. Who could offer the people what they want - service, products, consultation, education, information and time - better than a pharmacist? No one, I was sure.

The first few days I was in business I had the curious, the price shoppers, and some old friends, as the mainstay of business. The new store was attractively laid out, it was brightly lit, the colors and decor were pleasing to the eye, and it was well stocked with merchandise. My idea to incorporate a fair-sized book selection with many nutritional, diet, cooking, alternative and health selection was a good fit to my business philosophy. I even provided two large "easy" chairs in the book section so that people could sit and browse any selection that caught their interest. In the background was soft, mellow music from a CD and cassette musicbox display that featured easy listening, nature sound titles that seemed to create just the right mood for the farmacy.

The inquiries from many patients interested in setting up a "consult" to discuss complementary therapies was overwhelming. I scheduled many consults in the first few weeks to review the prescription medication, OTC drugs, supplements, and other criteria, provide educational and information support, and recommend products that may enhance their overall health and wellness. I make it certain, by signing a consent form, that I am not diagnosing or prescribing. I do not have a license to do either, but only wish to help the patient help themselves through professional interventions. Thus, I would help them make better choices to improve their own health. In truth, people are quite impressed that a natural pharmacist would provide such a service. In fact, they seem over eager to partake in such a consulting arrangement, for most people feel totally comfortable with the concept and are very pleased with the results.

It has been extremely rewarding for me to serve my patients in this capacity. There is a growing bevy of information that every patient deserves to know regarding the relevance of allopathic and complementary medicine. I have absolutely no hesitations or qualms about recognizing the value of each, and imparting my professional judgment to the patient to help them decide what course of health care they can best pursue. Never at any time would I tell or lead a patient to go off their prescribed prescription medicine. This would be contrary to my education and career choice, rather I freely afford valuable information and education to help people make better choices for themselves or their loved ones. This, I believe, is an important service, especially considering most people are self medicating themselves with complementary medicines because of the lack of reliable knowledge. It only makes sense that the intervention of a trained health professional can only be an asset to the perplexed patient, who frequently is too embarrassed to tell their doctor that they are taking supplements, or are ambivalent about the current state of the medical profession and refuse to see physicians at all. I believe many of these people can be helped by providing sound, non-judgmental, professional advice, for in most cases your opinion carries a lot of weight and you can sway the reluctant patient to seek professional medical help when indicated.

After adding a "classroom" to my new business, by the new year I will be expecting my services to include community educational classes in such areas as children's nutrition, yoga, stress management, vitamins and herbs, and disease state management.

Frequently Used Protocols
Some of the most commonly used vitamins/herbs that are currently hot sellers at the natural farmacy are: selenium, ginseng, ginger, bilberry, vitamins E and C, glucosamine sulfate, and coenzyme Q-10. Sales are taking off, especially on products like St. John's wort and ginkgo biloba, which have recently received such positive reviews from the national health news media.

There are a number of common health problems in which nutritional and/or supplement therapy can provide a major advantage to health and healing. Frequently, the information and education I can provide to the patient has a synergistic effect and a positive intervention in their overall wellness and health.

For example:
1) For hypercholesterolemia, a common occurrence in cardiovascular disease, a nutritional protocol would include a low-fat diet, elimination of sugar and refined carbohydrates, and dietary fiber such as psyllium or pectin. Supplements may include chromium, magnesium, vitamin E and vitamin C, along with lecithin and essential fatty acids.
2) Crohn's disease is a serious gastrointestinal disease that can nutritionally be treated by eliminating sugar, refined carbohydrates and high protein from the diet. In addition, the elimination/desensitization of food allergies could be of major benefit. Supplements of zinc, vitamin A, vitamin E, folic acid, vitamin B-12, and lactobacillus and acidophilus can be helpful.
3) Another problematic gastrointestinal disease is ulcerative colitis. Again, desensitization of food allergies can be a major factor. Vitamins E and C, PABA, zinc, fish-oil concentrate, and pancreatin can be of major benefit.
4) A common teenage skin problem, acne vulgaris, can be treated by avoiding too much sugar and refined carbohydrates. Zinc, copper, vitamin A, and selenium may be extremely helpful if supplemented for three to six months.
5) Asthma is one of the most common disease states today among old and young alike. Desensitization of food allergies is essential (especially in children), and sugars and sulfite preservatives should be minimized. Calcium citrate and magnesium are two important minerals to supplement with. Additionally, vitamins C, B-6, and B-12 are effective. DHEA may be added if levels are low.
6) Osteoporosis is the second most common ailment among seniors (next to heart disease) and can be helped by supplementing calcium citrate, magnesium, zinc, manganese, and boron. Vitamins C, B-6, D, and folic acid may be of benefit in treating this disease.

Recently, glucosamine sulfate has played a larger role in building cartilage and minimizing the over use of prescription non-steroidal anti-inflammatory drugs. Significantly subsidence of pain, especially in the knees, has been demonstrated with a twice daily regimen taken for four to eight weeks.

7) Many elderly who have compromised vision and are at risk for cataracts, macular degeneration, or simple loss of visual acuity may find bilberry and lutein two useful herbal supplements. Selenium, vitamins E, C, and A should also be supplemented along with ginkgo and a potent multi-mineral-antioxidant vitamin.
8) Hypertension occurs in over 40% of seniors in our country. Many interventions can be made for treating high blood pressure. First, a diet low in sugar, fat, caffeine, and alcohol, but high in fruits and vegetables is important. Add garlic and onions to your cooking. A vegetarian diet is associated with lower blood pressure. Minerals such as magnesium and calcium will help. Coenzyme Q- IO can be very effective in managing the overall integrity of the cardiovascular system. Potassium can be extremely important, so a blood level from the doctor should be checked, and if low, supplementation is crucial.

It is always safe to consult your physician to treat any and all disease states. However, it is a fact that more and more Americans are treating themselves with alternative medicines without the consultation of any health professional. This is unwise and can be dangerous. Most nutritional therapies should be undertaken in patients with one or more disease states with extreme caution. Patients with compromised liver, renal, or hepatic insufficiencies may be at increased risk for nutrient toxicity. Remember, most minerals, vitamins, and herbs can be toxic at high levels. It is recommended not to supersede package-suggested doses at any time without seeing a qualified health professional.

There is little doubt that the role of the pharmacist is expanding with the current rends in health care. The time is right for pharmacists to get more educated in the exciting field of nutritional and supplementation. Albert Einstein once said, "Chance favors the well prepared." And although he may have been referring to quantum physics, it is nonetheless just as true for the pharmacist business man or women whose focus is on the health of the patient with a gleaming eye toward profitability and self determine and fulfillment.



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