Advocating for Change: A Pharmacist's Journey to Improve Maternal Health with Dr. Danielle R. Plummer

[00:00:00] .

[00:00:02] Welcome to the Chalk Talk Jim podcast, where we explore insights into healthcare that help

[00:00:08] uncover new opportunities for growth and success.

[00:00:11] I'm your host, Jim Jordan.

[00:00:19] Our guest today is Dr. Danielle Plummer.

[00:00:21] She's a third generation pharmacist and she's a passionate advocate for women's health.

[00:00:26] Today she joins us to share her unique perspective on the challenges and opportunities in today's

[00:00:31] healthcare landscape.

[00:00:32] She has a diverse background spanning retail pharmacy, hospital pharmacy and medical affairs,

[00:00:38] and Danielle leverages her expertise to support women navigating the complexities

[00:00:42] of maternal health.

[00:00:44] Through her innovative blog-turned consulting business, she empowers women worldwide by

[00:00:48] providing personalized medication guidance during pregnancy.

[00:00:53] Danielle's journey has led her to identify gaps in the healthcare system and fueled her

[00:00:57] determination to drive positive change.

[00:01:00] In this episode, we explore the evolving role of the pharmacist, the power of the

[00:01:05] patient in terms of advocacy and the potential for collaboration and technology

[00:01:11] to transform healthcare delivery.

[00:01:13] Danielle's insights shed light on the importance of interdisciplinary care teams,

[00:01:17] health equity and the need for systemic improvements to better serve our patients.

[00:01:23] So Danielle, tell me in the audience a little bit more about yourself.

[00:01:26] Yeah, hi, I'm Dr. Danielle Plummer.

[00:01:28] I'm a pharmacist, but I have my hands in many different pots as we like to say in

[00:01:34] healthcare where many practitioners then have one.

[00:01:38] We are trained to be jack of all trades and then some do go on to specialties,

[00:01:42] but I found many trades that I work with and it's led me to this interesting place.

[00:01:48] How I got here though, a little bit about myself.

[00:01:50] I'm a third generation pharmacist and a mom of three now adult daughters and a lovely stepdaughter.

[00:01:58] So, Jimmy and I were just chatting before this.

[00:02:00] You have four adult daughters.

[00:02:02] I'd say I'm in the same boat as well.

[00:02:05] But through my pregnancy that was very ill and it was in pharmacy school that I went to after

[00:02:10] I had my three pregnancies that I learned how we can treat patients and pregnant women who had

[00:02:15] that disease state, which is called hyperemesis gravidarum.

[00:02:18] And I was wondering why nobody spoke to me about nutrition through my pregnancies or

[00:02:24] options we have, trial and error, how to decide what medications are safe in pregnancy.

[00:02:28] And started a blog and the blog grew into consulting business.

[00:02:32] And here I am today working with women around the world to help them decide on

[00:02:37] medication safety in their pregnancies using a science called pharmacogenetics.

[00:02:43] I also though have a background in retail pharmacy and hospital pharmacy and do work full time

[00:02:50] in medical affairs.

[00:02:52] So, I just want to put a disclaimer out that anything I talk about today is just my own

[00:02:56] experience and opinions and not related to any organization for which I work or volunteer.

[00:03:02] But all of this has brought me to a place where I've seen our broken health care system

[00:03:07] and am doing my share to fix these pieces and bring it all together for the best of patient safety.

[00:03:15] So we were talking earlier, I have my side hustle is I have a health care data center

[00:03:21] where I track business models and it's a nonprofit that's been my side passion,

[00:03:25] which is what led to this podcast.

[00:03:27] But I came from a similar background as yourself.

[00:03:29] You've been in these big bigger companies where you're trained on the system and how it works.

[00:03:34] So we have the advantage of actually understanding those components of it and then having a very personal experience.

[00:03:40] So how long you've been doing this consulting?

[00:03:43] Started with a blog in 2019.

[00:03:46] I actually when I went to leave retail pharmacy, I love retail pharmacies in my blood.

[00:03:51] I love that. I love working with my patients.

[00:03:53] There's a change happening, a huge change.

[00:03:56] And I am grateful I left before the pandemic hit.

[00:03:59] But while that change is going on, I knew I had to be in other spaces.

[00:04:03] So I actually wanted to go to work in medical affairs, which I do now and I do love.

[00:04:08] But I hired a pharmacist that specializes in resumes.

[00:04:11] So look at my resume and help me update it.

[00:04:14] And she said, oh, you're an entrepreneur.

[00:04:16] And I actually have since found my happiest basis as an entrepreneur.

[00:04:19] I like being with a big corporation where I have the freedom to really just work my heart off

[00:04:25] and accomplish on my own time and my own pace and rhythm,

[00:04:28] which obviously matches the company's goals, but without being micromanaged.

[00:04:33] So I started this blog in 2019 after going to a conference for pharmacist entrepreneurs.

[00:04:38] I went with a dozen ideas and walked going, I have to do this because I have this knowledge.

[00:04:44] Pregnancy. Yeah, I don't know if Jim or any of your listeners know,

[00:04:47] but in the United States, we have a very serious problem right now

[00:04:51] where we have the highest maternal mortality rates of any developed country.

[00:04:56] So we have more women dying because of pregnancy.

[00:05:00] And the government considers that either the year or the nine months they're pregnant

[00:05:04] or the year following, depending which study or statistics,

[00:05:08] some will say up to three months following giving birth.

[00:05:11] And in fact, just a week and a half ago, there was a Kansas City cheerleader

[00:05:16] who passed away after having a stillborn baby and then having sepsis.

[00:05:21] And every day we read about this on a newspaper.

[00:05:24] And you have to think, why is this happening in the United States?

[00:05:28] And a lot of it is because of this broken health care system that we have.

[00:05:32] There's many reasons, but almost all of it is preventable and should not be happening.

[00:05:37] So this blog turns into a consulting business.

[00:05:40] So now I'm on year five, I would say, for this.

[00:05:43] And it's my side business, right?

[00:05:46] Because I'm really fortunate to be in a space where I have medical knowledge.

[00:05:50] I understand our health care system better than most.

[00:05:52] I don't think anyone understands it completely.

[00:05:55] And women from around the world are reaching out to me going,

[00:05:58] my doctor doesn't understand or they're telling me this is normal.

[00:06:01] And a lot of it's old wives tales, even from the time of Freud saying,

[00:06:04] oh, you're supposed to be sick when you're pregnant.

[00:06:06] It's fine. It'll go away until weeks.

[00:06:07] And unfortunately for many women, that doesn't happen.

[00:06:11] And now when you look at our maternal health, more women having difficulty

[00:06:14] becoming pregnant, more women with postpartum depression than before,

[00:06:18] or other what we call comorbid disease states.

[00:06:21] So all these women that if you are told to take medications when you're pregnant,

[00:06:25] it's scary.

[00:06:26] And we think back to the philatomide disaster in Europe in the 1950s and 60s,

[00:06:31] where women were told, hey, go ahead and take this meds, help your nausea.

[00:06:35] And then their babies were born very deformed.

[00:06:38] If anyone of the younger generation now doesn't know that story,

[00:06:41] do Google it because it's a lesson to learn from.

[00:06:44] Because of that, though, pregnant women have been excluded from clinical trials.

[00:06:48] And it's a lot of retrospective data that we look at.

[00:06:51] And it's a very scary and overwhelming feeling.

[00:06:53] My I guess my big plug is to have a pharmacist on your maternal health team

[00:06:57] to help decide proves versus cons, risk versus benefit

[00:07:01] and decide which medications are safest for you.

[00:07:03] If you are going to take medications while you're pregnant

[00:07:07] or preparing for pregnancy or recovering from pregnancy.

[00:07:10] But that's the consulting.

[00:07:12] So we were joking before we didn't know where this would go.

[00:07:14] I'm actually working with a client who is self-funding.

[00:07:18] She's a physician, a clamp for C-sections.

[00:07:21] And the data in the United States is we are ranked right with Nigeria.

[00:07:26] We're way down there.

[00:07:27] And it's just terribly sad.

[00:07:29] And my daughter, my youngest daughter, is a nurse and she's worked in the baby unit.

[00:07:34] And she's shocked by the lack of education that people in certain communities

[00:07:38] don't have and it's an access issue. Right.

[00:07:40] And so literacy is one of the biggest challenges.

[00:07:43] And lastly, I'll quote my wife who says that this was a man's issue

[00:07:47] would be solved by now.

[00:07:48] So it's 100 percent.

[00:07:49] So I'd say you're going to have to say it.

[00:07:52] So a lot of disparity that it just takes literally the village.

[00:07:55] It's going to take all of us to fix that health equity issue,

[00:07:59] the access issue and even women with and families.

[00:08:03] Right. With great health care providers.

[00:08:06] There's just a broken system with insurance companies

[00:08:09] dictating a lot of care.

[00:08:11] Would you see for care what how far close you are?

[00:08:16] In this case of this specific disease,

[00:08:18] say it's safer to go to an infusion clinic to get IV nutrition

[00:08:23] with electrolytes and vitamins on at least three times a week.

[00:08:28] But insurance companies are saying, hey, we're not going to pay for that.

[00:08:32] Or some families have maybe an HSA or an FSA account where other families don't.

[00:08:37] And unfortunately, even with good insurance, our deductibles, our claims,

[00:08:41] our copays are unaffordable.

[00:08:44] Even for most, I want to say what, maybe middle class Americans.

[00:08:47] So it's everybody. It's affecting everybody.

[00:08:50] So what moment did you realize that this blog, which was a passion,

[00:08:55] was going to actually turn into something bigger?

[00:08:57] What was the event that happened?

[00:09:00] When I started getting emails from women literally around the world

[00:09:04] going help and so it's not just the US issue.

[00:09:06] We talked about these maternal mortality rates, but women around the world.

[00:09:11] It goes back to a time where we had family members,

[00:09:15] we had a community to support and we don't have that anymore.

[00:09:19] In fact, I just got back from a conference for oncology research.

[00:09:22] So when you look at the cancer space of research, it's phenomenal.

[00:09:29] I felt like I was walking almost through a science fiction movie.

[00:09:31] This research is brilliant and it's very targeted therapies.

[00:09:35] And we can look at the DNA.

[00:09:37] It's a science called translation where they're looking at

[00:09:40] how to take the DNA of maybe the tumor you have and then go,

[00:09:45] OK, this is the best treatment for you or we're going to create a treatment

[00:09:48] to target that specific coding.

[00:09:51] And with women's health, we don't have that quite there yet.

[00:09:55] It's a doctor here at the School of Medicine had told me

[00:09:58] that we're decades behind oncology.

[00:10:00] But one of the sessions I went to on health equity

[00:10:04] looked at patients from university in Virginia, not of Virginia.

[00:10:09] I think it was Commonwealth in Virginia and looked at patients in that area

[00:10:15] that saw doctors in the area.

[00:10:17] But the study was out of that Commonwealth, Virginia University,

[00:10:20] and then looked at patients in Puerto Rico and even found that

[00:10:24] their results showed of this health equity study that the patients

[00:10:27] in Puerto Rico were potentially less educated and lower income.

[00:10:33] However, they felt better supported because they had that community

[00:10:37] throughout their cancer treatment and their cancer care.

[00:10:40] And I would bet it's the same thing for pregnant women as well.

[00:10:44] You are going to work every day.

[00:10:46] You are trying to take care of maybe other family members, a house.

[00:10:50] It's a rat race. A lot of us live in.

[00:10:52] And while it's wonderful, women have a choice now

[00:10:55] whether we want to stay home, not all women, but some women, right?

[00:10:58] To stay home, whether we want to work.

[00:11:00] We have opportunities, but it's also very isolating.

[00:11:04] And it takes that community to really support.

[00:11:06] And we need everyone in our health care team to work cohesively

[00:11:11] to take care of that pregnant women so that they're not falling

[00:11:14] through those gaps in our system.

[00:11:17] It strikes me the similarity between a conversation

[00:11:20] I had with a person who's running long term care nursing homes.

[00:11:24] The challenge is that no one lives near their parents anymore.

[00:11:27] And it struck me in my neighborhood, this little baby boom going on.

[00:11:31] And I was out walking the dog and started talking to one of the women

[00:11:34] that is a child and she has no family here.

[00:11:37] And we just have this conversation like that must be hard.

[00:11:40] And I think what you're seeing in that community in Puerto Rico

[00:11:43] is that I used to say that everyone says it's quality time,

[00:11:46] but in the quantity, you find the quality, right?

[00:11:48] That little question that comes out of that little inference

[00:11:51] that comes out when you're with people for a long time.

[00:11:53] And if you're just visiting, it's not the same.

[00:11:56] It really isn't so good for you.

[00:11:58] So you've become that family source in a sense.

[00:12:01] I love that perspective because it's not just pregnant women.

[00:12:04] You talk about living near parents and it's a joke with me and my mom.

[00:12:08] Because when I was a teenager, I left home, I literally moved to Japan.

[00:12:12] I was an ice skater at the time.

[00:12:13] I went to do a show there as a dancer in an ice skater.

[00:12:16] And I said, oh, my gosh, I want to be as far away as my for my mom.

[00:12:20] As possible, the teenager in me and here I am decades later.

[00:12:23] I literally six years ago, six years ago, bought a house,

[00:12:27] five minutes from my parents.

[00:12:28] And I think we take care of each other as much.

[00:12:31] And fortunately, my dad and my mom are still going strong.

[00:12:34] In fact, I have to go to my mother's dance recitals.

[00:12:36] But because of that's where I stepped into this unofficial

[00:12:39] patient advocacy space for my parents and their whole community.

[00:12:43] So they live in Sun City.

[00:12:45] Everyone I used to think 55 and up sounded old.

[00:12:47] It's now young to me.

[00:12:49] But my mom jokes every time I have a birthday.

[00:12:51] I'm a year closer to moving into Sun City.

[00:12:54] But it's amazing like all the time she's going to her friend's

[00:12:57] 90th birthday parties or 100th birthday parties.

[00:13:00] I found like they found the fountain of youth,

[00:13:02] but it's because of that community.

[00:13:03] And then when they get stuck in this health care system going,

[00:13:06] I can't get an appointment with my cardiologist.

[00:13:08] I can't get an appointment with my neurologist.

[00:13:11] You know, who do you know who my friend could see?

[00:13:14] Or can you help me decipher this bill?

[00:13:16] Or who do we talk to about billing from that hospital?

[00:13:19] I'm their go to person.

[00:13:21] So it's it's a struggle and actually just reached out

[00:13:24] to another friend of mine after I had a personal issue.

[00:13:27] Fortunately, it was nothing was important.

[00:13:29] And really in the big picture was preventative.

[00:13:31] And I was like, hey, I just want to see what's going on with this.

[00:13:33] And I ended up I thought it was a copay and it ended up going

[00:13:36] toward the deductible.

[00:13:37] And four months later, I got this $300 bill in the mail.

[00:13:40] And I said, I understand our health care system better than most.

[00:13:43] Why did I not see this coming?

[00:13:45] And it's going to just take all of us to support each other

[00:13:49] and make it through those health issue that we may encounter through our life.

[00:13:53] So what strikes me is that when you start getting that sort of scale

[00:13:57] that you're getting people reaching out, you start realizing

[00:14:01] there's not enough of you and you actually need to invest in technology.

[00:14:06] The generation newsletters,

[00:14:08] customer relation management systems, tell me about that part of your journey,

[00:14:12] because that's something that when you start getting that success

[00:14:15] and it starts moving, you don't really think much about it.

[00:14:18] Because I'm sure like you, we just opened our WordPress

[00:14:20] and started blogging. Right. That's how we started.

[00:14:23] It is exactly what I did.

[00:14:25] And it's interesting because my undergraduate degree is in hospitality.

[00:14:29] So I have that business background.

[00:14:32] Didn't stay in it too long because I was married to the military

[00:14:35] and we moved all the time.

[00:14:36] And it was later than I went back to school to get my doctor

[00:14:40] pharmacy degree.

[00:14:41] But I thought I understood a little bit of business,

[00:14:44] and that was definitely a big challenge.

[00:14:45] So when you talk about the moving pieces, I still struggle with that.

[00:14:49] I definitely need a virtual assistant.

[00:14:50] I do have a full time job.

[00:14:52] I absolutely love spending my days talking to doctors about a specific

[00:14:58] disease state and what's available to help their patients with that disease.

[00:15:02] They I spent the last two years working in biomarkers,

[00:15:05] and now I'm with a different product.

[00:15:07] But because of that, I really do need strong systems in place

[00:15:11] for my other consulting work that I do.

[00:15:15] So, yeah, I changed CRM's a couple of times.

[00:15:20] I actually hired one of my daughter's friends to help me.

[00:15:22] Social media is not my strength.

[00:15:24] It doesn't come naturally to me.

[00:15:26] And but the information is so important.

[00:15:29] And I was actually just talking to another.

[00:15:31] He's actually a podcaster consultant that was like, oh, Jim,

[00:15:35] you and I just talked about that we should have this on YouTube, right?

[00:15:37] We should be videoing this.

[00:15:39] And how do we feel like the editing who handles those systems?

[00:15:42] So a lot of when I went to that,

[00:15:45] when I went to the conference for pharmacist entrepreneurs,

[00:15:48] that was the one thing like one.

[00:15:50] What you have to say is more important than how you look.

[00:15:53] That was one of my big takeaways.

[00:15:55] But the other is hire people for those that I am great at medication

[00:16:00] consultations, understanding your meds.

[00:16:02] I can look at a list of a dozen meds and see which ones are going

[00:16:06] to interact with each other, contra indicate with each other,

[00:16:09] right, synergistically work together, which will be covered from your insurance

[00:16:14] or not how to afford medications if they're not covered on your insurance.

[00:16:17] Like I have that eye for that.

[00:16:19] But when it comes to sending out weekly newsletters or posting my blogs

[00:16:23] or creating taglines or Google SEO, social media, any of that,

[00:16:28] I definitely need to outsource that.

[00:16:30] And that's been a journey in itself, trying different platforms,

[00:16:33] different, like I said, daughters and friends

[00:16:36] and different methods to make it work.

[00:16:38] It's a journey.

[00:16:39] And then you realize that when you first start out,

[00:16:41] you're spending a thousand months on this and you're making a hundred dollars.

[00:16:45] So it's really is a passionate gradually.

[00:16:47] I appreciate you for that.

[00:16:48] Something in the news recently,

[00:16:50] I was going to look through times this week about ozempic

[00:16:53] and increase in pregnancy.

[00:16:55] Did you read that?

[00:16:55] And I'm just curious.

[00:16:56] I'm sure the audience would love to get your take on that.

[00:16:59] I did not read.

[00:17:00] Oh, actually, no, I did read this one.

[00:17:03] And if I, and I apologize because I did not prepare this

[00:17:06] and I didn't have this actual study, but I did what I got out of it,

[00:17:10] if my memory serves me correctly here, is that because

[00:17:14] difficult to become pregnant if you are overweight or diabetic.

[00:17:19] And that's not a black and white blanket statement.

[00:17:21] But when that weight comes off, depending how overweight the woman is,

[00:17:27] that weight comes off, then it becomes easier to become pregnant.

[00:17:31] And that is my takeaway from that.

[00:17:33] So inadvertently, I saw something on the what's POS,

[00:17:37] PCOS, there was also some improvement in that.

[00:17:40] I thought I saw which was striking to me.

[00:17:43] Again, it's related to the hormones that are being secreted

[00:17:47] through these being overweight.

[00:17:50] When you get that weight off.

[00:17:51] But you know what?

[00:17:52] I wouldn't even say it's just overweight.

[00:17:54] It's a hormone imbalance and it's all correlated together.

[00:17:58] Not necessarily causation, but there is a correlation.

[00:18:01] So when you can get those hormones balanced.

[00:18:03] And I'm not just talking estrogen or progesterone.

[00:18:05] There's a lot of other hormones that are even cortisol levels,

[00:18:10] insulin levels, women who are at risk for diabetes.

[00:18:16] We test glucose where we should be also testing insulin.

[00:18:20] So there's a lot of balancing that needs to be going on.

[00:18:23] When that comes into balance, then it's easier to become pregnant.

[00:18:28] I think what we're discovering and I was telling you before,

[00:18:31] I'm working on a grant with some really brilliant professors

[00:18:34] where they're taking immunology, neuroscience, biology, AI,

[00:18:38] and the microbiome and trying to learn about learning systems.

[00:18:42] And it started with cancer research as you were talking about.

[00:18:45] And I think what we're learning is we are complex systems.

[00:18:49] And sharing earlier that I have a wellness doctor.

[00:18:51] And when I had started seeing him, I just couldn't lose some weight.

[00:18:55] And so he gave me an estrogen pill.

[00:18:58] And apparently when you get over a certain percent body fat,

[00:19:03] testosterone starts converting to estrogen.

[00:19:05] And so I remember going to the pharmacist and he pulled me aside

[00:19:09] and said, this is breast cancer.

[00:19:10] Like what's going on here?

[00:19:11] And I explained it.

[00:19:12] And literally after taking it for 90 days, I started shedding weight

[00:19:16] and really just took it for that 90 day period.

[00:19:19] So I think that we were talking earlier, our doctors are so specialized,

[00:19:24] right?

[00:19:25] And the two groups that I find really interesting to me, the

[00:19:29] pharmacies and the nephrologists because you're chemists, right?

[00:19:34] And you're looking at its systems.

[00:19:37] So how do you keep track of all the rapid changes that are going on in this market?

[00:19:42] It's a great question.

[00:19:44] There are different subscription services that can send you even Google

[00:19:49] scholar alerts.

[00:19:50] If there's a disease state you're following, put that in there and then

[00:19:54] they're going to email you through my main work.

[00:19:57] I always have a resource library, PubMed search.

[00:20:00] And what's crazy now with social media, we can use it to the good side

[00:20:04] of social media in LinkedIn, because I have a network of pharmacists that are

[00:20:08] working in maternal health.

[00:20:09] They're posting the latest data as well in the publications.

[00:20:14] And I also go to a lot of conferences.

[00:20:17] So I get to see scientific updates even before they've been published

[00:20:21] in the big sources.

[00:20:23] This conference I just returned from yesterday literally had a, I think about

[00:20:26] a thousand posters on cancer research.

[00:20:29] It was almost overwhelming.

[00:20:30] So it's okay, which type of cancer am I looking into?

[00:20:33] And you talk about the gut biome, colorectal cancer, anything we do with our GI

[00:20:38] tract just really plays into the whole body system.

[00:20:43] I work with a lot of pharmacists who have stepped out of, I like to say

[00:20:48] the box, figuratively and literally.

[00:20:50] And they now work in functional medicine pharmacy and they talk about how oral

[00:20:54] birth controls affect the bacteria balance in our guts.

[00:20:59] And that plays into so many other roles, even headaches and anxiety.

[00:21:04] If we can balance that natural flora, the good healthy flora with probiotic

[00:21:10] and prebiotic foods, then it's amazing what else can happen in the body.

[00:21:15] I think that we're learning that there's when people say that you used

[00:21:20] your gut, you had a feeling in your gut, they're actually discovering that

[00:21:23] this is many cells there represent your brain as is what's in your brain.

[00:21:28] So I think that again, we were at the point where one of the purposes of this grant

[00:21:34] is that if we think of any scientific specialty, you have the tail of the

[00:21:38] distribution and all the really cool stuff is on the outside.

[00:21:41] And if you're a biologist looking at this data out there, but you're not

[00:21:44] using it for what you're using it for.

[00:21:46] And so what AI is going to allow us to do is take all those tails

[00:21:49] and start moving them around, but it's actually shaking up

[00:21:53] the science of research.

[00:21:55] You've brought a good point to the table because through these past couple of

[00:21:59] years, and I've been working in so many different areas of maternal health

[00:22:03] and with pharmacy, I've met amazing clinicians and I've met amazing business

[00:22:09] people who have started apps that can really help women throughout their

[00:22:13] pregnancy.

[00:22:14] A lot of them as well to help with that health equity.

[00:22:17] But again, they're individual, they're silos.

[00:22:20] And how do we get all of that to work together?

[00:22:23] The technology in a lot of cases is there, but it's not in the hands of

[00:22:27] the patients and the practitioners and the support team, the family members,

[00:22:32] the case managers, the respiratory therapist, the nurse practitioners or

[00:22:37] physicians assistants, or even the case, I just say case management.

[00:22:42] Anyone who's helping that patient, as you were saying, your wife has

[00:22:46] helped other people with disease states that she has recovered from.

[00:22:51] And here I am with my parents and all their friends.

[00:22:55] So we have the technology there, but it's not in a cohesive, easy to access

[00:23:00] space with our EHRs, our radar, electronic health records, our systems

[00:23:05] where I live in Las Vegas.

[00:23:06] It's extremely broken.

[00:23:08] There is no cohesiveness from your primary care doctor to your specialty

[00:23:13] doctor, to your insurance.

[00:23:16] And even like I mentioned already in my own case, I just want to say,

[00:23:19] Hey, what's up with this?

[00:23:20] Why am I?

[00:23:20] In my case, it was snoring.

[00:23:21] I go, why am I snoring?

[00:23:22] And I wanted to say, when it sent me in this crazy journey where four months

[00:23:25] later I get the $300 bill in the mail and I say, wait a minute.

[00:23:28] I thought this was a copay for $40.

[00:23:31] So again, if I'm working with this, imagine those who have serious disease

[00:23:36] states who don't have that funding like you had briefly mentioned to get

[00:23:41] to the right care or get to the right people.

[00:23:43] When pregnant women reach out to me and they say, I am not being taken

[00:23:47] seriously, I'm not being heard.

[00:23:49] I tell them always bring a patient advocate with you and we do have

[00:23:53] paid patient advocates.

[00:23:54] There are hospitals that you can ask to speak to their case manager or just

[00:23:59] bring your significant other, just having that person there and then write

[00:24:03] down if they deny you a treatment or they say something that doesn't sit right

[00:24:07] or you feel like you're not getting that response, tell them, I want that

[00:24:10] written in my electronic health record.

[00:24:12] And unfortunately that's, you have to stand up for yourself.

[00:24:15] It was actually my third pregnancy.

[00:24:17] I was working at a WIC overseas office, so I was a military spouse at the time.

[00:24:22] I did not know much about our WIC program.

[00:24:24] It was absolutely fantastic.

[00:24:26] So somebody a few years prior said, Hey, our military family stationed

[00:24:30] overseas don't have this benefit that those stateside would have.

[00:24:34] And in, I think it was 2004, it was funded by the department of

[00:24:37] defense opposed to where stateside, it's the department of health and

[00:24:40] agriculture to get our pregnant women and our newborns and young

[00:24:45] children off to a healthy start.

[00:24:47] And it was my coworker who was running that office on this small

[00:24:49] overseas base with me, that first said you have to be your own advocate.

[00:24:53] And this was before I went to pharmacy school and her words, I am

[00:24:57] just so grateful for because that's just what stayed with me.

[00:25:00] And that's why I started the blog to pay this forward.

[00:25:04] You asked another question too.

[00:25:05] What systems are in place?

[00:25:07] What can we do?

[00:25:09] The government started a program called ARPA-H.

[00:25:12] It was based off our defense program from decades ago called DARPA.

[00:25:18] And I wanted to pursue this.

[00:25:20] I had the opportunity to work in our maternal health in the United States

[00:25:25] with this government funded program.

[00:25:27] I ended up in this other role that I absolutely love and I hope

[00:25:30] to stay in a long time, but if anybody is out there, that was one of the

[00:25:35] ideas, if you want to pursue this.

[00:25:37] Like I said, I know all these great business people and healthcare

[00:25:41] practitioners who have this technology, but we don't have anyone pacing it together.

[00:25:46] That is one of the programs I wanted to pitch to ARPA-H.

[00:25:49] So if anyone out there is interested in this space, please you can reach

[00:25:53] out to me and I will put you on the right contacts or just Google

[00:25:56] it because that need is there.

[00:25:58] It's interesting because one of the jobs I had prior to doing what I'm

[00:26:01] doing now was working for a nonprofit and for-profit venture fund.

[00:26:05] Our goal was to help university technology come out and form companies.

[00:26:10] And so one of the things that struck me on the healthcare IT front is

[00:26:16] the high failure rate that was occurring in our community.

[00:26:19] And so we were one incubator that was focused on healthcare and life

[00:26:23] sciences, and there was another general incubator part of the Ben Franklin

[00:26:26] system, which is really famous and really talented people.

[00:26:29] And they had success with IT.

[00:26:31] So what we realized is they were having a high failure rate on IT that

[00:26:36] was focused on healthcare IT, and we were having high failure rate.

[00:26:40] And what it came to be is that you need the IT people to be involved

[00:26:45] because they just know how to make things simple and healthcare, we

[00:26:48] tend to make things complex yet they have to work within today's rules.

[00:26:52] And so you almost need them to team up.

[00:26:54] But something you said struck me.

[00:26:56] My healthcare data site, I do these various research reports

[00:26:59] periodically, and one of the ones I did in the past several months was

[00:27:03] our physician shortage and all the associated activities.

[00:27:06] So we're going to be 130,000 physicians short.

[00:27:09] And the challenge is to change that timing.

[00:27:12] It takes 15 years to make one.

[00:27:15] And if you look at it on a health policy perspective, by the time

[00:27:19] you would turn that up, the baby boomers would all be expired

[00:27:22] and we would have too many doctors.

[00:27:24] But we can turn around nurse practitioners and physician assistants.

[00:27:27] And in that report, I had identified what their skill sets are legally,

[00:27:31] what they can do and what they are doing.

[00:27:34] And they're not really performing to the level of things that they've been

[00:27:39] trained on for whatever reason we're saying that's going to have to change.

[00:27:43] You said PharmDN functional medicine.

[00:27:45] I got a hint there that there's something going on in this space where perhaps

[00:27:48] you all aren't able to have the licensing height that you could for your

[00:27:53] training, which probably had something to do with physicians and holding

[00:27:57] control, but when you're just not going to have enough, we need to open this up.

[00:28:00] So tell me what you think about that.

[00:28:01] Is there a skill set there where you can contribute to this?

[00:28:04] Oh my gosh.

[00:28:04] Is there a skill set?

[00:28:06] You brought such an important point and it's not the physicians directly,

[00:28:10] but they're overseeing association that is just legally fought very hard.

[00:28:15] We'll leave it at that.

[00:28:16] Yes.

[00:28:17] And it's in one of the rotations I did when I was in pharmacy school.

[00:28:21] I think I went like many people, I went to pharmacy school going,

[00:28:24] I only know retail pharmacy.

[00:28:25] That's what my dad did.

[00:28:26] That's what my grandfathers did.

[00:28:28] That's what I thought I wanted to do decades ago as a teenager.

[00:28:30] I worked in retail pharmacy and my eyes were open.

[00:28:34] So I did this rotation in the intensive care unit at a small

[00:28:38] community hospital in Virginia, and it was amazing.

[00:28:41] So we had about 12 beds and we rounded as a team.

[00:28:44] We had the MDs and the PharmDs and like I said, nurse practitioner or the

[00:28:49] nurse, I'm sorry, the nurse would present the patient and then say,

[00:28:52] Hey, this is what's going on.

[00:28:53] And then the doctor would give us updates and then they would look to

[00:28:56] the registered dietitian and the case manager and the PharmD.

[00:29:00] And we would talk about, okay, this is what we're doing to this patient.

[00:29:03] And it was this whole health system.

[00:29:05] It was this care in that patient.

[00:29:06] The outcomes were fantastic because you had this team.

[00:29:10] I feel like the doctors going through med school now, they love

[00:29:13] having pharmacists on our team.

[00:29:15] And in my work when I was a pro-DM pharmacist, I worked in the

[00:29:18] emergency room, I've worked in PACU and pre-op and making sure those

[00:29:23] patients going in and out of surgery had the right meds on board and had

[00:29:27] the medication reconciliation done.

[00:29:29] And we have always have pharmacists now in the ICU or potentially INC,

[00:29:34] but it's that transition of care.

[00:29:36] You mentioned long-term care.

[00:29:38] Pharmacists are not trained to count pills and put them in a bottle.

[00:29:42] And I always joke that we need better public relations.

[00:29:46] We need a PR campaign so the whole world knows what pharmacists

[00:29:49] are trained for.

[00:29:50] We are clinically trained.

[00:29:52] Most pharmacists now are going on to do one or two year residencies.

[00:29:55] They're board certified in specialty disease states.

[00:29:58] We are clinician to the highest level that we have up to eight plus years

[00:30:04] of classes, including pharmacology and pharmaceuticalics and

[00:30:08] pharmacotherapeutics.

[00:30:10] And we understand how the body systems all work together.

[00:30:13] And what happens to that medication as you either ingest it or absorb it,

[00:30:18] or it's injected into you where these other specialties don't have that same

[00:30:23] training. But that's why it's so important for all of us to work together.

[00:30:27] And Bush has been a political battle where apparently pharmacists are the

[00:30:34] only health care practitioners not considered to be so by CMS.

[00:30:39] Say one more time, I'm not sure I processed that.

[00:30:41] So the Center for Medicare Medicaid Services do not consider pharmacists

[00:30:46] healthcare providers to where we can bill for our consultations.

[00:30:51] Really?

[00:30:51] And really, and again, eight to 10 years of university, doctorate

[00:30:58] degrees, board certifications, right?

[00:31:01] Residency trained.

[00:31:03] Why is that?

[00:31:04] And it's just, I, my mom used to say that maybe we should have

[00:31:07] unionized years ago.

[00:31:08] There are pharmacists now trying to unionize because we've just been

[00:31:13] pushed down as a profession.

[00:31:14] And, and now there's a resurgence going, wait, we have this knowledge.

[00:31:19] We're, we literally have doctorate degrees.

[00:31:21] We've spent years training in hospitals and specialty areas with

[00:31:26] disease states like pediatrics and oncology and geriatrics, and with

[00:31:31] a plethora of medications on the market now in the specialty medications

[00:31:34] we have, and everything's a monoclonal antibody or a IV infusion.

[00:31:39] Or as you're talking about with the weight loss medications like

[00:31:42] ozumthic now, as one of many that are out there, you have to have a really

[00:31:47] deep understanding of the science behind it to understand how it works.

[00:31:50] So yeah, tell me what we can do to get us practicing to the height of our license.

[00:31:56] I think that when you hear about lobbying and advocacy groups, it

[00:31:59] generally has a negative tone to it from most people's perspective.

[00:32:02] But the reality is that when you have people doing what they're doing

[00:32:05] every day, they need a group that can help articulate what they do and

[00:32:09] the impact of how they do it.

[00:32:11] And I think even the ability of having FOMDB functional medicine folks

[00:32:15] is actually relatively new to if I'm correct, right?

[00:32:18] Absolutely.

[00:32:19] And it's just, I want to say maybe 10 years that we've had.

[00:32:23] It's interesting timing of everything many years ago.

[00:32:27] And we've seen movies on this where they go, the robots are going to take over.

[00:32:30] Jim, you mentioned AI changing healthcare.

[00:32:32] And it's interesting when I started working for this big corporate retail

[00:32:36] chain and we have robots filling medications, and now we have pharmacy

[00:32:40] technicians giving immunizations.

[00:32:42] Pharmacists with these degrees and not every, I'll give you the caveat now,

[00:32:47] not every pharmacist has a doctorate degree.

[00:32:50] It changed, ooh, I don't have the exact year, I want to say maybe 20,

[00:32:54] so 25 years ago, but so we do have a lot of pharmacies out there that don't.

[00:32:58] But I'll give an example.

[00:33:00] My mom's dad was the last pharmacist in the state of Connecticut

[00:33:03] to be coined by apprenticeship.

[00:33:06] I love this story.

[00:33:07] I think it was the 1940s at the time.

[00:33:10] My dad, when he went to pharmacy school in the 1960s,

[00:33:13] it was a five year degree.

[00:33:14] It was a bachelor's plus one more year.

[00:33:17] The doctorate degree did exist at some point.

[00:33:20] I don't know when it came into fashion, but not everyone went ahead for that.

[00:33:23] And then I think maybe at this point, 25 years ago or so, and I'll have

[00:33:27] to check the exact year it happened, that there were no longer

[00:33:30] bachelor pharmacy college programs in the United States.

[00:33:34] It's only the doctorate degree.

[00:33:35] So when I attended, I said, why are we like, why do I need to know about EKGs?

[00:33:39] I remember being in my cardiology class, like, why do I have to learn an EKG?

[00:33:43] I'm going to go work for my retail store and boy, am I eating my words now.

[00:33:47] It's incredible when you understand how to read those EKGs

[00:33:50] and which anti-arrhythmic medications and how they work and what's best for you.

[00:33:54] And to give a personal story, my dad's been on Sotolol for decades.

[00:33:59] And one time he was in the hospital and they did a formulary change

[00:34:02] and he almost died because of it.

[00:34:03] Because it's just a therapeutic substitution because of what was

[00:34:06] on their formulary there.

[00:34:07] And he knows, no, I have to be on Sotolol.

[00:34:09] Now I can look at his DNA and go, yup, that's the one for you.

[00:34:13] But it's interesting.

[00:34:14] Like we have this training.

[00:34:15] It's time to work with AI and all this technology we have to really

[00:34:21] practice to the height of our license and our education.

[00:34:25] But it is going to take some changes in our government laws to get us there.

[00:34:29] And I think it's actually probably going to be the pressure

[00:34:31] of the rising cost of healthcare.

[00:34:33] I always track the annual national healthcare expenditure growth

[00:34:37] to gross domestic product, and it's always higher.

[00:34:40] We're approaching 20% and moving with the rest of the world's is 10 to 12%.

[00:34:45] And what people don't realize what that really means is the rest

[00:34:49] of the world is taking that extra 10% and investing it in innovation.

[00:34:55] So it's like an investment if you think about a startup or you

[00:34:57] think about a new technology, right?

[00:34:58] They're investing in that.

[00:34:59] Whereas we're burning it up in a healthcare setting and it impacts generations.

[00:35:04] I've told this story before that I met this woman who was, her son had

[00:35:08] to come home from college to take care of her and he was working at

[00:35:11] the Burger King and it's not that working at Burger King is there's

[00:35:15] nothing wrong with that, but he was in school for engineering and his

[00:35:18] potential, his ability to contribute to the economy might be less than what

[00:35:22] it was and it's all because of healthcare.

[00:35:25] So what's the biggest lesson you've learned on your journey?

[00:35:28] I said it once.

[00:35:29] I'll say again, you have to be your own advocate.

[00:35:32] Don't be afraid to ask for support, to ask questions.

[00:35:36] If something isn't making sense to you, don't wait to find out.

[00:35:40] Ask the questions ahead of time.

[00:35:42] For, I'd like to share for anyone who is on Medicare, one of things

[00:35:46] you can do during open enrollment every year, put your medications in to the

[00:35:51] website and your plans year to year.

[00:35:53] And it's going to be a difference of hundreds, if not thousands of dollars

[00:35:57] that is going to be your expense.

[00:35:59] If you don't keep up with those formula rate changes.

[00:36:01] So don't assume that just because one insurance plan is just for you

[00:36:04] one year, look, you might be a better off on a different

[00:36:08] plan the following year.

[00:36:10] So just continue to have that village, that support.

[00:36:14] You shared that story just now with a son having to quit college

[00:36:17] to come home to care of mom.

[00:36:19] I mentioned being back, I bought this house near my parents to help each other.

[00:36:23] And we have to support each other, whether you're in healthcare or not.

[00:36:27] And if you are that interdisciplinary care team makes all the difference.

[00:36:31] So put your support team together, both family friends and which

[00:36:36] healthcare providers you mentioned a shortage of doctors.

[00:36:39] When we look at the amount of urologists, the amount of neurologists,

[00:36:43] the amount of nephrologists in the United States, I'm not even going to

[00:36:46] begin to talk about obstetricians.

[00:36:48] It's very difficult to become an obstetrician.

[00:36:50] And then I learned in my last role in medical affairs that there's a

[00:36:54] specialty called maternal fetal medicine specialists.

[00:36:57] So not only do they go to med school, they then go on to do their

[00:37:01] four years of residency, then they go on to do another three to four

[00:37:04] years of a fellowship.

[00:37:05] They literally have as much education as a neurosurgeon.

[00:37:08] These are who a lot of our pregnant women with high risk pregnancy

[00:37:11] should be seeing.

[00:37:12] And there's just not enough of them.

[00:37:14] I think about 2,500 in the United States here, somewhere between

[00:37:18] two and 3000 of them.

[00:37:19] So the cost of going to med school, you mentioned the 15 years, right?

[00:37:24] So now they're putting off families, all these conferences I've gotten to

[00:37:28] attend, fortunately, there's always a session, unfortunately, about

[00:37:32] financial wellness for the soon to be or now doctor, and they're starting

[00:37:38] life now in their thirties, maybe even forties and it's difficult financially.

[00:37:44] So we're going to have less and less.

[00:37:46] And like you said, look to your caretaker, ask your pharmacist if

[00:37:49] you have questions and if that pharmacist doesn't have time, I'd

[00:37:51] say ask him for an appointment, pull him aside.

[00:37:54] Yeah.

[00:37:54] I'm curious if there's a correlation with what you just said that we

[00:37:57] have older mothers, I think in the past year we've seen postpartum

[00:38:01] being covered, which was not my sister Jennifer will tell this story too.

[00:38:05] So I'll tell it out loud.

[00:38:06] It's just the funniest story.

[00:38:07] She's four older brothers, so she's tough as nails and brother-in-law says

[00:38:12] beautiful and tough, it's just the greatest combination in a wife.

[00:38:15] And she had postpartum and that really didn't do anything, but

[00:38:18] she read online that if you run and so she's running down the street

[00:38:22] and her neighbor stops and says are you okay?

[00:38:24] Cause she's crying.

[00:38:25] She goes, I have postpartum and I'm just going to keep going.

[00:38:28] And three weeks later, she had taken herself out of it.

[00:38:31] So again, not a scientific study by any point, but it just shows how

[00:38:34] lonely and isolated women were 20 years ago when she was having children.

[00:38:39] And just the change today.

[00:38:41] And I wonder if these older women are being a little more

[00:38:43] confidence in their advocacy for themselves might've made this change.

[00:38:47] And I think that's really important.

[00:38:48] The concept of advocacy.

[00:38:49] So I'll add, can I add one more thing?

[00:38:52] Menopause is now a big buzzword at every conference I attend

[00:38:57] in industry and with women where it was once I just had this

[00:39:02] conversation with a lot of people where it's once nobody wanted to talk about it.

[00:39:06] And now we're like, wait a minute, why are we not talking about this?

[00:39:09] Perimenopause post menopause and one of the pharmacists I talked

[00:39:13] about that I met at this conference, I didn't talk one of the pharmacists

[00:39:17] at this pharmacist entrepreneur conference.

[00:39:20] She actually was one of the founders and her whole business now is

[00:39:24] helping women through menopause.

[00:39:25] And I just want to share a story like you're running.

[00:39:28] I've been told, I'm not there yet, but I've been told hot yoga helps

[00:39:31] when you do end up getting hot flashes.

[00:39:34] So again, not scientifically proven, but getting that oxygen flowing,

[00:39:39] the mental mindset in line, getting your hormones balanced.

[00:39:43] There's a lot we can do on a more natural holistic side and then go

[00:39:48] to medications when it's needed and make sure you're choosing the

[00:39:51] right medications for your body.

[00:39:53] Is there anything else you'd like to share with the audience?

[00:39:55] I do have a new blog I'm starting called pregnancy vomiting.com.

[00:39:59] So I've always I've been to guest blogs as well.

[00:40:02] There's so much information to share, to put to bed old wives'

[00:40:06] tales and reach out any time.

[00:40:09] I'm not doing a lot of one-on-one consulting anymore just because

[00:40:12] of my time limitations, but I do have a course coming out soon

[00:40:17] and I am always here to support anyone, especially pharmacists

[00:40:21] who feel very stuck in the box.

[00:40:24] I have an ebook on how I transitioned into the medical

[00:40:27] industry and I absolutely love what I do.

[00:40:29] So Jim, thank you for everything you do and for having me on.

[00:40:32] And let's work together as a whole, our country, our world

[00:40:37] and get the healthcare situation improved.

[00:40:40] Thank you so much.

[00:40:43] Thanks for tuning into the Chalk Talk Jim podcast.

[00:40:47] For resources, show notes and ways to get in touch,

[00:40:50] visit us at chalktalkjim.com.