Robert Caudle shifts in his chair, across the conference table from his inquisitor.
"Let's see if I can get this straight," says Linda Smith, leaning forward toward the burly 45-year-old. "You do your blood sugar reading and then you take your multivitamins and vitamin E and Garlique about an hour later. Then you take the lactulose in between. Then you're taking the Glucotrol XL, your diabetes medicine.
_____Drug Mix Dangers_____
The overall risk of an interaction rises sharply with the number of drugs taken: Take five drugs and it's 50 percent; take eight and it's nearly 100 percent, according to the American Society of Consultant Pharmacists (ASCP), a professional group for pharmacists in senior care.
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"Then do you also take your blood pressure medicine at that time -- the Vasotec or enalapril? And you take the Elavil in the evening for the pain in your heel?"
Caudle takes off his wire-rimmed glasses, rubs his eyes. Three years ago he stopped a 27-year smoking habit, but now he looks like he'd like to light up.
"I feel like I'm on so many medications. I feel like I'm on a pill for everything," Caudle says. He's concerned that he may end up like his father, who also had diabetes and died a few years ago of a heart attack. "I think that's one of the reasons my father passed away. . . . At the end he was taking 30 to 40 pills a day."
Just as any good physician would, Smith listens with empathy. But she's no doctor. She's a pharmacist who, after more than 25 years working for others, struck out on her own about two years ago.
She's reinvented herself as an independent pharmacy consultant -- a pharmacist who counsels patients for a fee. The job description is so new that Smith is one of only a few in the Washington area and perhaps 500 or so nationwide. That's the number in a database compiled by the American Society of Consultant Pharmacists (ASCP), a 35-year-old professional group for pharmacists in senior care, of members who say they are willing to do private consulting work. But only a fraction of that number derive the bulk of their income, as does Smith, from independent consulting.
Pharmacy consultants say their new calling fills a public health need that time-pressed doctors often can't meet: counseling older Americans and the chronically ill, whose several doctors often prescribe medications that may interact with each other or cause harmful side effects.
But another force behind the trend is increasing market pressures on retail pharmacists, who are forced to work harder and faster to compete with proliferating mail-order and Internet drug suppliers. Meanwhile, the administrative aspects of their jobs, such as verifying insurance coverage, take time away from counseling and other tasks for which they have been trained.
"In most of the places that pharmacists practice, it's really difficult to have the opportunity to use that [clinical] knowledge," said Carole Cranor, assistant professor in the School of Pharmacy at the University of North Carolina, Chapel Hill.