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Custom Cures

After years of suffering, a female patient came to pharmacist Karen Raehtz for another opinion. Doctors had been treating her for Lyme disease, but the medication wasn’t helping.

Raehtz came to a different conclusion. She devised a hormone replacement therapy that cleared up the woman’s symptoms.

“She feels better. She’s thinking clearly,” Raehtz says.

Such customized care is part of a growing trend aimed at making pharmacists, including pharmacy students, key front-line health care providers.

The field has evolved, according to pharmacy alumni and instructors at Wayne State University. Change is under way as pharmacists step out from behind the counter and inject themselves into patient health care.

“We see the pharmacist as being a major provider of public health information,” says Dr. David Edwards, chairman of pharmacy practice in the Eugene Applebaum College of Pharmacy and Health Sciences. Whether people want to learn more about a pill advertised on TV, an over-the-counter drug or herbal supplements, pharmacists are knowledgeable, trustworthy and approachable — and in most cases, patients don’t need an appointment.

“We consider ourselves as the most accessible health care profession. Pharmacists are there on every other corner,” Edwards says. “You can walk in and you can get health care advice.”

University Pharmacy, an independently owned business located on Wayne State University's campus, is a prime example. Maria Young opened University Pharmacy in 2007 after working for chain stores and in a hospital setting.

“I was unhappy in the dispensing role,” she says. “My vision was to step outside the prescriptions to a patient-centered model.”

Young counsels patients on lifestyle modifications and meal proportions, as well as how and when to take their medication so the body uses it properly. She meets with patients in a private consultation room, where they can discuss personal matters without fear of embarrassment for being overheard.

“We’re bringing it back to the old way of doing things by having face-to-face consultations,” she says, adding that the idea is to get patients more involved in their own care.

As the nation engages in a discussion about a health care overhaul, pharmacists see more opportunities to help. They point out that proper use of medication can lower health care costs and improve the quality of life. For example, a recent study published in the Journal of the American Pharmacists Association finds that when pharmacists and physicians collaborate on a diabetes patients’ care, the patients have an easier time controlling their blood sugar levels, saving up to $211 per month among those surveyed.

Ideally, pharmacists say, a 30- to 45-minute consultation at the outset of the patient-pharmacist relationship will help both parties. The pharmacist can get a sense of the patient’s medical history, and the patient has the opportunity to ask any questions and provide feedback.

Some patients find doctors intimidating. They don’t want to admit they can’t afford a medication, or that they have stopped taking it, which contributes to the problem.

Without knowing the whole picture, a physician may conclude one prescription is not working and prescribe something else. Pharmacists can work with patients to find the correct dosage of medicine and make sure it is being delivered in the right form (whether pill, a topical cream, liquid or suppository).

Pharmacists devote six years of study toward their degree and in return can expect excellent opportunities and above average job growth, according to the U.S. Bureau of Labor Statistics.

The American Pharmacists Association notes that this extensive training makes the pharmacist the most knowledgeable healthcare professional when it comes to medicines and their use.

Helping the public understand what pharmacists bring to the table is one of the challenges right now, pharmacists say. “We’re still trying to increase awareness,” says Jim Owen of the Washington D.C.-based American Pharmacists Association.

“Most people when they hear the term ‘pharmacist,’ they assume it’s a person counting pills.”

As prescription drug use escalates, so does demand for pharmacists.

More than 3.5 billion prescriptions were filled last year alone in the United States. A new Walgreens store opens every 18 hours. More than ever, drug companies also are marketing products directly to consumers — promising to cure an overactive bladder, or even helping to grow longer eyelashes.

While dispensing these medications still consumes more of a pharmacist’s time, opportunities abound for specialization within the field.

For someone tall and thin, like pharmacist Scott Popyk, buying clothes off the rack is not always an option.

A small percent of the population has the same problem with prescriptions — the medicine they need is not commercially available.

“I have to take my clothes to a tailor. That’s what we do with medicine,” says Popyk, who runs Health Dimensions Compounding Pharmacy in Farmington Hills.

Some people find they need a specific dose of medicine, which major drug manufacturers don’t offer. They may have trouble taking pills altogether and require a chewable medicine.

For these people, compounding is their only option. Pharmacists can create a medicine that is truly “just what the doctor ordered.”

Compounding involves mixing raw ingredients to prepare customized medications to meet each patient’s specific needs. Both the form (such as nasal spray, suppositories, oral rinses, creams or lozenges) and strength of medicine can be modified. The customization might be as basic as a flavoring to meet a child’s fickle palate.

“Sometimes you have to medicate creatively,” Popyk says.

Popyk’s career led him to open Health Dimensions in 1996.

There are only about 400 compounding pharmacies in the United States. Health Dimensions was one of the first in the Detroit area, and one of only 76 nationally that are accredited by the Pharmacy Compounding Accreditation Board. That ensures that the pharmacy subscribes to methodology, procedures and environmental controls that meet rigorous practice standards.

After spending nearly a decade working in a hospital pharmacy environment, Karen Raehtz desired a change of pace and philosophy.

Raehtz started looking for something more positive, and that led her to open a business, Physicians Compounding Pharmacy, in 2004.

“I saw a big shift in people taking care of themselves, beginning to challenge what doctors were saying,” she says.

Now, her focus is on functional medicine — working with doctors to discover and treat the root cause of medical issues rather than just the symptoms.

“We look at the whole picture. That’s where we need to be if we really want to make a difference,” Raehtz says.

This is an abridged version of an article published in the Spring 2010 issue of Wayne State magazine. It earned honorable mention honors in the Detroit chapter of the Society of Professional Journalists' annual contest. Click the link to read the entire article.