Pennsylvania Pharmacist, November 1998

NUTRI-FARMACY . . .
A NEW CONCEPT IN RETAIL NATURAL PHARMACY

By Daniel T. Wagner

It has been nearly one and a half years since I opened my new concept farmacy (not ph-armacy, because I no longer sell pharmaceuticals) in Wildwood, PA, a small town about 15 miles north of Pittsburgh. It has truly been an exercise in joy and fulfillment of my professional and personal goals.

There are many reasons why I chose to sell my retail, community pharmacy that I had successfully operated for 17 years. One was a longing to synergize my love of pharmacy with my passion for the environment. What better way to do this than to pursue a natural approach to pharmacy - utilizing herbs, vitamins, minerals, homeopathy, phytomedicinals, and other nutrients, in compliment with conventional (allopathic) medicines - not in competition with. Second was a desire to create a practice in which I scheduled patients (like a doctor's office), and consulted them on the proper use/misuse of conventional drugs with alternative medicines and therapies. And last of all, to further utilize the experience I gained in eight trips to the world's tropical rain forests during the last four years into a worthy, practical, and unique retail business that would ultimately do one thing: help the patient improve hi/her own health. Now in the undertaking, I did not wish to "leave" pharmacy, so I still operate a closed, non-retail pharmacy (Med-Pharm) in which I only service nursing homes, and I still own a medical supply business (Wildwood Medical) that is also located in an old building I bought two years ago and renovated into a large health-based business. But primarily I am the consultant for Nutri-Farmacy.

I admit that my move to open Nutri-Farmacy (April of 1997) was timely and fortunate. The responsiveness of the American people to the whole natural phenomena is unbelievable. According to a recent article from The Los Angeles Times, a recent survey found that 40 percent of Americans regularly use herbal products, up from 16 percent two years ago. Herbs have also gained credibility in U.S. scientific and medical circles. I knew the time was right for me to follow this passion. Was it luck? Some wise man says that luck is nothing more than timeliness coupled with preparedness.

Who better, I often thought, to consult a patient on when and when not to use an herbal or natural supplement with a prescription drug than a pharmacist? For me believing in the concept was easy, but there was more to it than that. There's the basic reason we are pharmacists to begin with - serving our patient's needs. Whatever you believe regarding the efficacy, safety or effectiveness of alternative medicines, a relevant question that many consumers ask today is: "I'm on Coumadin, and an antihypertensive medicine. I also take Synthroid - can I take Echinacea, or Ginko? Is there an interaction if I take Co-enzyme Q-10 or Milk Thistle with these medicines?" There is a huge contingent of our patients walking into your pharmacies with similar questions on their minds. They want a professional answer, but, unfortunately, they usually settle for self-medicating on information they read in a health magazine. I knew that this was an important niche, and it was one I was eager to fulfill. Let's face it, pharmacists and doctors aren't taught about vitamins, herbs and nutrition in school. Chiropractors, acupuncturists, and other alternative practitioners may know something about alternative medicines, but they haven't learned about pharmaceuticals. Who is left to advise the patient on the use of these products? Unfortunately it's been GNC, or some vitamin/herbal distributor salesperson from some direct-marketing company, who has no health professional background at all. I feel it is professionally incumbent that every pharmacist learn enough about alternative medicine so that they can intelligently consult their patients on the benefits and risks. One caveat: for retail pharmacists this stuff can also be uncommonly profitable.

The Retail End of Things
Let's face it, no one in retail pharmacy is breaking records on profit margins these days. Even if your volume has increased, your bottom line keeps shrinking. You don't have to look any further than around the corner to see the proof of this - community pharmacies are closing and selling out to chains at an alarming rate. What's a retailer to do? How about adding more profitable lines! I am amazed at the 40-60% profit margins of most vitamin and herbal products. These are products that seem to be without price bias, that just about all prescription items were tagged with in recent years. With all the prescription price gouging, prescription price advertising, and deep-discounters, it became almost impossible to not complain about the price of vitamins and herbs. Oh, sure you can't sell calcium, Vitamin C and E at high markups, but in most cases these natural products seem almost immune to price discounters. I even noticed that most people getting a prescription these days will loudly complain about the exorbitant prices that these drug companies are charging. In fact, people often complain about paying their $10 or $6 co-pay on prescriptions. I rarely get a person telling me my herbs/ vitamin prices are too high.

It certainly helps to have a line or lines of herbs and nutritionals that are both priced right and have quality reputation. Think about it ... what is the answer that you have given over the years for the most frequently asked question that any pharmacists receives. The question is: "Is a generic as good as a brand-name drug?" What answer have you given in the past? In my opinion it is the same answer I give when someone asks me today if one brand of vitamins or herbs is as good as another. My reply: TRUST THE MANUFACTURER. I don't know what else to tell these people in all honesty. Think about it. You certainly trust Mylan for generics over ABC Generics out of Texas (these places seem to call you at least three times a week). You certainly would trust Apothecon (same stuff as Bristol-Myers) over XYZ Generics that you never heard of. Price would be a less important issue to you than trust of quality, consistency, and a fair price.

There is no doubt in my mind that the consumer would highly trust YOUR judgement on the reputation of any vitamin or herbal manufacturer or packager, along with your personal estimation of the efficacy of their products. But be careful and do your homework. There are plenty of low-lives in the alternative (dietary supplement) industry. I like to call it "pan-herbalism," which is all the bull about the wondrous effects that many herbal manufacturers claim, i.e., lost 50 pounds, reverse aging, bum off fat, increase brain power. There are increasing problems of safety and efficacy simply because the FDA cannot and will not police these products to the same rigors as ethical drugs. There is an increasing danger of adulteration of products because certain herbs (like Echinacea and St. John's Wort) are becoming so popular. Good manufacturers are actually running out of the plant. So use your best judgement and look for the companies that best exemplify your personal reputation for good manufacturing practices.

My main company is called SiSu Enterprises out of Vancouver, Canada. I am extremely high on this company and have recently become an American distributor for its products. I have traveled three times and was overly impressed with their standardization process, their high quality ingredients, and the professional demeanor of the people running the company. SiSu is my main line of herbs and vitamins (of which I probably sell 40-50% of all products). It is extremely important to me that I recommend (especially during consultations) a product that I would take myself. I completely guarantee all these products, and they can bring them back for a full refund if they take one capsule or 99 capsules and have any side-effects or are not completely satisfied. If you are in a quandary about what natural products to carry and sell, I invite you to call or contact me regarding this line (412-486-8595). Some of these unique products have mark-ups of 100-200%. It is because they are unique formulas that should be recommended by a health practitioner who can easily be trained to know when and where to advise a patient on its use.

Classes Available
One of the exciting aspects of my new practice is the community classes that I hold four days a week in the classroom that I built in the basement of my building. Since last fall, I have had hundreds of people sign up for various sessions. I instruct "Beginner's Yoga" three days a week and "Introduction to Herbs, Vitamins, Minerals, and Nutrition (Level One)" twice weekly. The classes are one hour in length and run for five or six weeks. The charge is $40 per session.

Because of public demand, I have established new classes for the Fall, 1998, and Winter, 1999 sessions. I will teach an "Accent on Nutrition, Herbs, Vitamins, and Vitality (Level Two)" course. I have invited other instructors to use the classroom when time is available, so that I can expand my educational choices to the public, and I can garner extra rental fees. Some of the new classes include: "Stress Reduction," "ChiGong," and "Learning to Control Your Brain, Thoughts and Life."

The classes are a great way to foster community acceptance on the health concept that I am trying to exude at Nutri-Farmacy. The response has been very positive, and, in most cases, friends tell friends about all they learn and experience, which ends up being the best advertising tool of all.

Consulting Patients
Probably the single most rewarding and relevant aspect of my natural pharmacy business is the consultation I provide. I encourage people to call and make an appointment if they want to set up a consultation. When they phone, I ask them to supply me (ahead of time) with three bits of infonuation: First, list all prescription medicines that they are currently on; secondly, list all supplements that they are taking or have recently taken; and lastly, let me know what disease state(s) they would like to discuss predicated on a diagnosis from a physician. I emphasize that I am not a physician or M.D. I do not and cannot diagnose or prescribe. I mainly serve to provide relevant information and education on their health, and make recommendation on supplements that may enhance their condition or may interact adversely because of the medication they are on. This approach works extremely well, and most people are impressed and happy to talk with a health professional like a pharmacist. I do have a separate consultation room that I take the people into. We sit down for 20-50 minutes - whatever it takes to advise the patient and answer all of his/her questions and concerns. The personal interaction with a patient is priceless. So many people are so glad that someone cares about their health. We know of the increasing problem with managed care health service. It is not only unprofitable, it is extremely impersonal, and most people are having very mixed feelings about the whole medical community and their hands-off approach to health care.

For all intents and purposes, this may be the major reason so many Americans are "reaching-out" for alternative ways to health care. They are enticed by something natural, and whether it is good for their health is almost a secondary issue, the fact is - people are using this stuff and getting no or little professional intervention.

I carefully and methodically go over the prescription medicine they are on, do my homework on looking for possible interactions or contraindications, and then discuss complimentary products that may enhance their health in lieu of the disease state they are suffering from. Frequently, my recommendations are received with enthusiasm and a sense of well-being.

The information I use to aid me in my consultations comes from a sophisticated computer database, my own extensive library of herb/nutrient articles and periodicals, and my own inherent knowledge of diet, nutrients, herbs, and other complimentary medicines and therapies that I have learned through experience, travel and self-teaching. I believe any pharmacist can grasp this field of knowledge, and with a little time and effort, can become an adequate counselor in this new and exciting alternative area of health care. I usually charge about $25 for a consult, but in most cases I see at least $60-$80 worth of needed supplements that will augment the health condition of the patient.

The positive interventions that you can make on behalf of a person's health should never be underestimated. As Pharmacists, we are trained to monitor patient's drug interactions and consult patients on compliance and proper use of their medications. However, today's highly trained pharmacists who are getting their Pharm.D. degrees at a rapid pace, are highly skilled clinicians. It is their job to participate in "disease state management." Is it not prudent to surmise that a pharmacist, or any health professional, involved in outcome-based disease state management would not do a more complete and thorough job if they also considered the ramifications of diet, nutrient supplementation, and exercise, along with their drug therapy? I believe this is so. I hope that the next giant leap of my business will be the opening of my "health clinic" next year, in which I hope to monitor patient's health functions via biochemical testing with machines that measure blood, urine, sputum, hair, and energetic fields. Now we see the nation's schools of pharmacy clambering to get more information to their students on herbs and other complimentary medicines and therapies. I am honored to be hired to co-instruct a course at Duquesne called "Alternative and Complimentary Therapies" in the Spring of 1999.

The opportunities for pharmacists to branch out in new and relevant fields of their chosen profession is limitless. Natural pharmacy is the current wave of customer demand, and most experts feel that it is going to be around a long time. In Europe, where most of our good information about herbs comes from, there has been a long and valued association between allopathic and complimentary medicine. Already some of the leading experts in the field are predicting some kind of mutual acceptance and cross integration of these two schools of healing as the new century approaches. It is my desire to see pharmacists become the forefront professionals in this huge field of interest. Yes, herbs are generally safer (nontoxic) than drugs, but they are not without their inherent dangers and interactions with foods, drugs, and other herbs. We owe it to ourselves and to our patients to learn more about plant and natural medicines - truly, the rudimentary foundation of our own modern pharmaceutical phenomena.

Sample Consultation
Patient: Mrs. C., 85 years old, with history of high cholesterol, hypertension, arteriosclerosis, GERD, depression, impaired vision and severe osteoarthritis.

Present Prescription Meds: Zocor, Prilosec, Trental, Claritin, Paxil, Furosemide.

Present Supplements: none

Complaints: NSAIDS upset her stomach, losing her vision in one eye, no energy, poor digestion, a lot of mucous (post-nasal drip), leg cramps.

Suggested Protocol:
1 . A good multi-vitamin with minerals and antioxidants to boost immune, boost energy and vitality. Most seniors need extra vitamins and minerals, mostly because of poorer absorption of these needed nutrients, and because of eating too much processed food.
2. One Vitamin E 400 IU daily to improve circulation and aid in heart and B.P.
3. One Phytovision twice a day (a combination of antioxidant herbal preps for the ocular integrity). This women's ocular capillary growth actually improved so much in two months that her eye surgeon could perform surgery, whereas, two months earlier he could not because of lack of capillary circulation.
4. Glucosamine/Chrondroitin 500 mg twice a day with meals for arthritis. This product has amazed me in effectiveness more than any other since I opened my natural farmacy. GS-CS is not an anti-inflammatory (like NSAIDS), but improves arthritis pain by building cartilage and preventing the further deterioration of existing cartilage. It may take 4-8 weeks to work, but is highly efficacious.
5. When asking her about her diet, she informed me that she is heavy on dairy products, especially milk and cheese. This is likely contributing to her post-nasal drip. I see many, many people with food allergies (especially from dairy), and eliminating these products from the diet can improve excess congestion and phlegm significantly. (In fact, in two weeks her nasal congestion was gone and she no longer had to take the Claritin.)
6. Take a pancreatic enzyme with acidophilus twice a day to aid in digestion and prevent Candida and yeast growth.
7. One teaspoonful of buffered vitamin C (1500 mg) with magnesium and calcium to improve muscle and bone function. Magnesium is my top recommendation and is critical for muscle involvement and relaxation. Most Americans are deficient in magnesium.

Prognosis After Six Weeks: The patient's eyes were significantly better (to the wonderment of her ophthalmologist). Her arthritis was relieved to the extent that her NSAID use was only on a PRN basis, not daily. Her digestion was significantly improved, which was helped by drinking more water and less milk. The enzymes helped relieve her gas and bloating. Her doctor took her off Prilosec. She was happy to report she had lost seven pounds during that period, had an improved memory, and a better overall feeling about herself and her improved health. She has remained a loyal customer for six months now, and calls frequently to have her supplements mailed to her home.



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2506 Wildwood Road, P.O. Box 238, Wildwood, PA 15091
Phone: 412-486-8595 or toll free 1-877-289-7478
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Email: info@nutrifarmacy.com