Change is good, but with caution

Change is good, but with caution

One of my favorite proverbs is “Don’t throw the baby out with the bathwater.” It is a warning: When we make needed changes we should also make sure that certain positive elements from the old system are kept in place. This proverb came to mind when I read two stories.

According to Kathimerini, the Greek Association of Pharmacy Owners appealed to the Council of State, the country’s highest administrative court, claiming that a new law is unconstitutional. The law attempts to liberalize the profession by allowing non-pharmacists to own pharmacies. The new ownership will be possible only if a licensed pharmacist is the owner of at least 33% of the company.

The Council of State rejected the appeal, declaring the new law constitutional. I think this is a positive development, moving away from a type of system that more resembles that of medieval guilds than modern professional associations. However, my enthusiasm was muted because I had also read two articles in the New York Times on a similar issue.

In the US, consolidation of pharmacy ownership has resulted in big chains. According to the NYT, five giant pharmacy chains dominate the US market. In my home state of Minnesota, the market is dominated by two of those companies. To be sure, there are still many pharmacies belonging to a single owner-operator but they cannot compete with the big corporations and they service significantly fewer people than the giants. In general, I find the big corporations to be efficient, their stores well stocked with a variety of goods and reasonably priced.

A few times, while waiting for a prescription I noticed how busy those pharmacies were but I did not pay much attention. It turns out, according to the NYT, that pharmacies are not regulated properly nor are they inspected regularly. As a result, corporations maximize profits by various means; one is to save on salaries by understaffing their stores. Thus one or two pharmacists, assisted by clerks, can become overwhelmed by orders. Another way of maximizing profits is for the management to tie a pharmacist’s salary to the number of prescriptions filled per shift.

The base salary is augmented by bonuses in proportion to “production quotas.” The results are worrisome. Anonymous testimony by pharmacists employed at big chains (but also by their customers) reveals a system where mistakes, many of them serious, are routine. People receive the wrong medicine, or the wrong dosage, or even two different pills in the same bottle. Also, being under pressure to fill more prescriptions, pharmacists do not have the time to make sure that patients (many of them elderly) who take multiple medicines do not overmedicate or use medicines which cause problems if taken together.

It is clear from the above that a good idea, opening pharmacy ownership and allowing the market to work, is not working as it should due to lack of supervision and blind belief in the power of the market to regulate itself. I think the Greek government should keep the proverb in mind as it introduces needed changes to the Greek economy.

John A. Mazis is a history professor at Hamline University in Saint Paul, Minnesota.

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