When you go to your local CVS and Walgreens – and other big pharmacy chains – are you getting the highest standard of care? Or do they care more about the billions of dollars in profits they make each year and how to increase those profits? Have these pharmacies gone rogue? Millions of medication errors have caused illness and death in America – and this problem has recently come into greater focus as pharmacists increasingly blow the whistle on their employers.

Yet the National Association of Boards of Pharmacy (NABP) doesn’t seem to be paying much attention to medication errors at U.S. pharmacies. Instead, they choose to spend their time “educating” the public about the dangers of prescription drug importation, warning Americans that it’s not safe to buy lower-cost medicines from other countries over the Internet. They have even included PharmacyChecker.com and this very blog (!) on a list of over 12,000 “Not Recommended Sites” – websites that they have categorized as safety threats from importation that put people and their families at risk. We have sued them for defamation and antitrust violations. 

Here’s proof that the NABP are paying relatively little attention to medication errors compared to internet pharmacies. On the NABP’s website, under the category of Medication Errors, you’ll see seven posts and nothing since 2015. Under the category Internet Pharmacies, you’ll find 122 posts.

Here’s the truth about who governs U.S. pharmacies and how they are represented:

The National Association of Boards of Pharmacy (NABP) represents the “interests of the 50 U.S. state pharmacy boards,” according to its website in 1999 (click “who we are” and I’ll explain below why I look back to 1999). These boards of pharmacy, the ones that make and enforce the rules of pharmacy practice and pharmacies in their respective states, consist of many members who own pharmacies, work for pharmacies, or who otherwise make a living on the success of the U.S. pharmacy industry. It is not uncommon for board members to include executives from the largest pharmacy corporations, such as CVS and Walgreens. Therefore, it should come as no surprise that, with the fox guarding the hen house in this manner, cost-containing business practices have ended up killing Americans due to medication errors.

The New York Times exposé was scathing: How Chaos at Chain Pharmacies Is Putting Patients at Risk

The subtitle of that article is bone-chilling:

“Pharmacists across the U.S. warn that the push to do more with less has made medication errors more likely. ‘I am a danger to the public,’ one wrote to a regulator.”

That’s right. Brave pharmacists are starting to blow the whistle. They are revealing the unspeakable work environments in which patients are receiving the wrong drugs or dosages and getting killed. Pharmacists in the U.S. are incentivized to move faster, maximize sales, and meet corporate targets. One CVS customer with a prescription for depression ended up with a powerful cancer drug that killed her. A baby was supposed to be taking anti-reflux medicine and instead was given a steroid, which the child ended up taking for two months. Another pharmacist dispensed ear drops instead of eye drops. That man ended up in the ER with burning, swollen eyes. One woman was given the right drug – Adderall, a powerful amphetamine – but the wrong dose and ended up going to the emergency room incurring a $900 bill.

According to a study by the Institute of Medicine, 1.5 million Americans are harmed each year by medication errors. That’s a dated study from 2006. A new one is definitely needed.

This post is not some pitch to get people to stop going to local pharmacies and to buy medicine cheaper – and potentially more safely – from PharmacyChecker-accredited international online pharmacies. In fact, we’re excited about our lower U.S. pharmacy discount prices these days, and we need to support our pharmacists and the good work they do in our communities. But I am shouting from the rooftops that the system of pharmacy board governance is not protecting the public health. How do we know? The pharmacists themselves say so. And many other others fear losing their jobs and keep silent.

For a paper that I wrote, called Online Pharmacies, Personal Drug Importation and Public Health, PharmacyChecker staff researched the entire membership of all U.S. pharmacy boards in 2014. We found that 50% of board members owned or worked for a pharmacy. Other medical professionals, such as doctors and nurses, have state boards, too, ones that help regulate their professions. But pharmacy is unique in that the boards also license and regulate pharmacies, which are generally for-profit businesses. Think about the prospects for patient safety if drug companies were able to regulate their own drug approvals.

I brought up the NABP because medication errors and fear among pharmacists to keep silent or lose their jobs seems to me the exact type of pharmacy practice issues that they should focus on. Instead, the NABP, which has spent drug company-provided money on “public education” to protect Americans from dangerous, “so-called” Canadian pharmacies, rogue pharmacies, — PharmacyCheckerBlog  — and opposing drug importation, is relatively silent on medication errors! We know these domestic pharmacy mistakes have harmed millions. When it comes to personal imports from licensed pharmacies in Canada or other countries that require valid prescriptions, the FDA hasn’t reported any deaths or even serious adverse events – and that’s after 20 years of such orders being placed.

Back in 1999 in the “Who We Are” section of the NABP’s website, the organization at least told the truth by stating that they represent the interests of the pharmacy boards in the U.S. For fuller disclosure, the NABP stated that it also represents the pharmacy boards in “New Zealand, nine Canadian Provinces, and four Australian states.” That was then. It seems that New Zealand and Australia dropped out. The NABP appears to no longer state on its website that it represents the U.S. pharmacy boards. They should put it back.

The NABP has consistently stated, since 1999, that its mission is to protect the public health. As the reference to the IOM study indicated, however, medication errors are nothing new. The NABP, protecting the public health? Today, with pharmacists calling themselves a “threat to the public,” it makes you wonder just what the NABP thinks about that. Where are they?  

The NABP, like the boards they represent, would apparently rather talk about the dangers of drug importation and the Internet than medication errors. Why? As I see it, competition from Canadian and other foreign pharmacies with lower drug prices are bad for U.S. pharmacies. Whereas medication errors truly appear to be a cost of doing business.