Earlier this month, I was deeply honored to receive the University of Florida College of Pharmacy’s Distinguished Service to the Pharmacy Profession Award. My sincere thanks to Dean Peter Swann and all those involved in the selection process. What follows are my reflections on where our profession has been and where it must go next.
Nearly 30 years ago, when I was President of the American Pharmacists Association, many of us embraced patient counseling and encouraged adherence. But soon we realized something critical:
Adherence to a non-optimized regimen often leads to medication misadventures—namely, predictable and preventable adverse drug events (ADEs), which remain the third leading cause of death in the U.S. today.
And it’s more than mortality, it’s also morbidity. ADE-related falls, cognitive decline, and even suicidal ideation seriously affect quality of life and drive significant financial waste.
That realization pivoted my purpose from adherence to optimization of medication regimens, based on science. For the past two decades, I have worked to transform a 75-year-old paradigm of preference-based, “trial and error” prescribing into science-based medication regimens.
Adverse drug events are not just common; they are a pandemic. According to the Lown Institute:
Why is this? It wasn’t that way 25 years ago. Why do we have a mindset of a pill for every ill — and sometimes even an invented ill? At least three reasons:
Even with this “pill-for-every-ill” momentum, since the 1970s, electronic health records and pharmacy systems have been limited to analyzing one drug against one drug—not entire regimens simultaneously using modern science.
It’s time to move on to multi-drug, prospective, simultaneous analytics and mitigation.
No one is talking about the current pandemic caused by unoptimized medication regimens. The prevailing strategy remains: just add another pill. It’s time to change that through three science-based action points.
Pharmacists are the only profession uniquely positioned to identify, mitigate, and reverse the worldwide harms of polypharmacy: predictable and preventable falls, ER visits, hospitalizations, premature mortality, and the enormous waste of financial resources. We must lead the movement to ensure that pharmacotherapy science replaces today’s trial-and-error prescribing.
We are the only profession that fully understands drug disposition sciences, and can apply them through collaborative practice with care teams, and deliver this unique, value-based care across the globe.
We are the only profession that can perform simultaneous, multi-drug and drug-disease analytics—through our current bottom-up approaches, and increasingly, through top-down innovation as AI evolves.
I am thankful for the opportunity to continue this purposeful journey together, working with PACE and hospice care teams across the U.S.