Letter to the editor: Checks,balances: Where should the pharmacist's loyalty lie?

December 1, 2008
Gary N. Fox, M.D.

Norman Levine, M.D., as evidenced in his Sep. 1, 2008, Dermatology Times Commentary (Commentary: Pharmacists, insurers limit scope of practice, prescription choices) is an articulate, caring and excellent physician, and I commend him for taking care of patients with delusions of parasitosis, a disease many of his colleagues elect to refer.

Key Points

Dear Editor:

Norman Levine, M.D., as evidenced in his Sep. 1, 2008, Dermatology Times Commentary (Commentary: Pharmacists, insurers limit scope of practice, prescription choices) is an articulate, caring and excellent physician, and I commend him for taking care of patients with delusions of parasitosis, a disease many of his colleagues elect to refer.

I also agree with Dr. Levine that it is frustrating to have pharmacists and insurers question our prescriptions and limit our choices.

In fact, "the development of atypical antipsychotics, with a marked lower incidence of extrapiramidal [sic] syndrome (EPS), has modified the therapy of psychosis and mostly replaced the use of classic antipsychotics."[1]

With regard to psychiatrist-recommended drug treatment for delusions of parasitosis, Dr. Levine's assertion was posted to the psychiatric forum on a physicians-only Web discussion site, Sermo. Responding psychiatrists all indicated that antipsychotic agents should be chosen the same as for any delusional or psychotic disorder, and that atypical antipsychotics were the drugs of choice.[2]

Pharmacists have the same professional duties to patients that we as physicians do and face the same legal conundrums. Thus, as a patient, when a pharmacist suspects that the medication being prescribed is not the optimum medication per current practice, I would want my pharmacist's loyalty, even if just the "druggist at the neighborhood Safeway supermarket," to be to me - not to my physician - when considering whether to honor a prescription.

So, although I agree with Dr. Levine's basic premise, I understand the pharmacist's refusal in the case as presented by Dr. Levine.

- Gary N. Fox, M.D.
Defiance Clinic
Defiance, Ohio

References:

1. Sandoz A, LoPiccolo M, Kusnir D, Tausk FA. A clinical paradigm of delusions of parasitosis. J Am Acad Dermatol. 2008 Oct;59(4):698-704. PMID: 18793939

2. http://https://md.sermo.com/medical/ticket/details?nav=on&id=27167/

Related Content:

News