Pharmacists practicing integrative medicine do not transition from the role of the pharmacist but rather expand it. Dr. Pam Tarlow and Dr. Swathi Varanasi highlight the importance of other modalities of health and even touch on the business implications of integrative medicine in the future!

Lynn [00:00:00] Here with the Nontraditional pharmacist part of the Pharmacy Podcast Network, here today to talk about an area of pharmacy that’s definitely becoming more mainstream, and that’s integrative medicine. We have two guests with us today. First, Dr. Pam Tarlo is a clinical, integrative pharmacist. Pam is currently practicing at Santa Monica Homeopathic Pharmacy, where she works with providers and patients on the safe use of pharmaceuticals, botanicals, homeopathic nutritional agents, therapeutic essential oils and lifestyle strategies. Additionally, she’s an educator and lecturer at several pharmacy programs, including the University of Southern California, where she went to pharmacy school. She also serves on the United States Pharmacopeia Dietary Supplement Quality Collaboration and is also a director of the PGY1 Integrative Health Pharmacy Residency.

[00:01:00] Also joined with us is Dr. Swathi, who graduated from the Medical University of South Carolina with her PharmD. She is currently a PGY1 Integrative Health Pharmacy resident. Both Pam and Swathi have co-founded PharmSupplement. This is a natural medicine educational platform for health care professionals and students where they provide pharmacist designed resources, online courses and drug information services. So thanks both for being on the show here with us today.

[00:01:50] So let’s jump right in and start with an overview of integrative medicine, because I think a lot of us aren’t that familiar with the term, including homeopathic medicine.

Swathi [00:02:09] So the way I see integrative health and integrative medicine is a multi-modality approach. It’s conventional pharmacotherapy, so prescription medications that you’d normally think of, but plus other modalities of health. So that could be through natural products, dietary supplements, meditation, homeopath homeopathy, all those different possibilities to help the patient. And the way that we have talked about it also is that it really centers around a patient centered, shared decision making model. And so that’s working one on one with the patient to make a decision that’s best for them.

Lynn [00:02:46] OK. So it sounds it almost sounds like it’s a branch of functional medicine, would you say that’s correct?

Pam [00:02:53] The terms tend to overlap in functional medicine, it has some other characteristics but integrative may be more of a broad umbrella term.

Lynn [00:03:03] OK, so that includes the homeopathic. And like you said, there’s a bunch of areas that’s included in integrative medicine. Tell me a little bit about your specific role, your current role that you’re in now.

Pam [00:03:14] Both of us are in some shared roles and some different roles. But I think the way Swathi explained it before is really that we have embraced and learned and utilize other strategies other than just pharmacotherapeutics. And so some of our work is one on one with patients at a pharmacy. Sometimes it’s direct consultation with people outside of the pharmacy. There’s educational different components clinic or we’re both involved in some clinic, lots of education. So it really varies, but it kind of boils down to the question, what can I use with my medications or what would be harmful if I took it with my medications? Do I choose this or that or can I take them both? And then also when a situation comes up that a particular patient either can’t or won’t take a certain kind of medication. We see both. Sometimes they can’t because of risk factors or other factors, availability factors, or sometimes they just don’t want to. And their doctor has told them as long as they get symptom relief or their biomarkers improve, then they can try things outside the box a little. And so we’re there for that. Not saying that this is the one way to do it, but hearing the patient’s story or in some cases the clinicians talking about the patients to us and then providing certain options, showing advantages, disadvantages, etc.

Lynn [00:05:05] So I’m trying to get an idea of what its like to be an integrative pharmacist. Are you in a stand alone pharmacy?

Pam [00:05:11] I am, yes. And the residency is it’s at a very unique pharmacy and one that does prescriptions and has a lot of natural products. And we’ve developed a way of talking to people about those and we have them available. Also checking for drug interactions.

Lynn [00:05:29] Oh, okay. So then you also do dispensing of conventional therapies such as medications in addition to supplements?

Pam [00:05:36] Yes, we are a licensed pharmacy. That’s the place we feel it is most effective!

Lynn [00:05:40] Excellent. Okay. That is very, very cool. Absolutely. Because that’s we are able to get the full history of the patient. You can see what medications they’re on and the interactions. I know when I was in pharmacy school, I learned a lot from on the job training (that necessarily wasn’t taught in my curriculum) that people would be on several or at least one supplement, which a lot of people don’t think of, and how important it is to know the interactions with that. So that’s very cool. You’re able to incorporate that into into community pharmacy.

Pam [00:06:22] And community pharmacy, that’s just one setting! Everywhere we go now we are integrative pharmacists because we’ve integrated it within ourselves also.

Lynn [00:06:30] So that includes the consulting that you were saying?

Pam [00:06:34] Yeah, and yet if somebody is consulting with us and they want strictly medications, we can talk about that, too.

Lynn [00:06:43] How did you how did you find that this is a need in pharmacy? So I know you guys started this residency program that you both co-founded. Pam, you’ve been a pharmacist and then you were in this right away is that correct?

Pam [00:07:00] No actually, it took me about fifteen years before the need came up! I saw the unmet need in patients. I was working for an independent pharmacist and got a lot of questions that I couldn’t answer and became interested in being able to round out my education so that I could provide complete consultations with patients. So I’ve only been doing this about twenty five years out of the 40 years of my pharmacist career.

Lynn [00:07:28] Yeah. Wow. I mean, that’s that’s so great that you’re able to find a void in pharmacy and do something about it.

Pam [00:07:36] And that’s only increase the need for health care professionals to be a place for patients to ask questions has only increased, including today. I think with what’s going on in the world today and what people are asking and the availability of products. Back at twenty five years ago, there wasn’t social media and internet sales that we have now, and so people are using those as resources rather than us as pharmacies.

Lynn [00:08:06] And that can be misleading because, I mean, we use if you rely on the Internet, then you don’t know who’s saying what on there. And we need the resources and the studies that show what’s safe and what’s not. And that’s where I think pharmacists can come into play and really incorporate that into everyday practices across the board of pharmacy, whether it’s community, whether it’s clinical, whether it’s consulting.

Pam [00:08:32] Yes, even in the emergency room! You hear Swathi’s story as a recent grad and how she got involved with this!

Swathi [00:08:46] Well, I’ve always been interested in nutrition and holistic health and wellness. I didn’t know anyone in the health care field that was doing anything integrative health related. But this all changed when I found that Dr. Tarlow was doing an APPE rotation at her site. And so I had an opportunity to come out and do a four week APPE rotation with her. And at the end, I really found that this was my place in pharmacy. And I was so like, overjoyed and excited! I talked to Dr. Tarlow about potentially starting a residency or having me trained for a year and what that would look like. And then it kind of just blossomed from there. And we started in July. And I can’t believe it’s already April!

Lynn [00:09:40] So you found it on when you are on rotation and that’s how you got here. This is actually a good question for you then Swathi – What advice would you give to somebody looking to pursue a similar role? That’s going to be different for a student versus a pharmacist that’s looking to transition into it, so what advice would you recommend or give to a pharmacy student right now that’s interested? Whether they’re early in their career or they’re looking to pick rotations?

Swathi [00:10:12] Yeah, definitely. So I would say there’s so many great resources, whether we’re talking about podcasts, whether we’re talking about various free newsletters that you can get from different websites that we can link for you if you’d like or put them in your caption. There’s so many there’s so many great opportunities to learn. So I think just even starting there with just like trying to feed your interest in that way.

[00:10:37] But then the other thing that I think is so important is networking. And so I would say, like anyone, no matter if they’re like a first-year pharmacy student or a pharmacist that’s been working for however many years. Everyone should have like a LinkedIn or some sort of method to network with other people, because I think when you speak to other people about what they’re doing and anything that they’re interested in, you can feel that passion and actually really get a better understanding of what that field is. So I think that if people connected with us, for example, we could talk about our experience more. But there are plenty of other people doing amazing things and you just have to find them through networking.

Lynn [00:11:18] Oh, absolutely. Networking is definitely one of the most important ways to get an idea of what’s involved in the job. I love that. Definitely networking. So I’ll be sure to include those links underneath the post. And for pharmacists looking at transition, whether you’re in the field- for example, a community pharmacist looking to transition into integrative medicine, what advice would you give to a currently practicing pharmacist?

Pam [00:11:47] I’d like to speak to that for a minute. This is part of my view of it, and I’ve been thinking about this for for many, many years. This is not a new subject for me, it’s that it is more of an expansion rather than a transition, because I don’t leave anything behind that I learned in pharmacy school or in a conventional practice. I just add on to it and look to see what my patients are taking. So I’m listening to my patients always, always listening to my patients. And when they ask about supplement A,or homeopathic medicine B, or nutritional strategy C, I’m always thinking about that in the way I think about anything. Who would be harmed by it? Who might be helped by it? What’s the benefit to the risk? Is there solid evidence? This is straight pharmacy, so there’s no transition out of that. It’s just opening up to really the way the body is able to maintain its own resilience and its own homeostasis. And that’s what nutritional products and homeopathic medicines can offer, that pharmaceutical medicines can’t really. As wonderful as they are for certain conditions once they’ve gotten to a certain point. That’s what the message I would really like to to say. It also depends on why a pharmacist or traditional pharmacist might want to make this expansion. There could be business reasons. They could want to expand into the cannabis medicine market so that patients can come to them for certain products depending on what state they’re in. And that’s really blossomed in this year, and what Swathi and I have been working together on.

Lynn [00:13:45] Yeah, I love that. I love that. You said it’s an expansion and thanks for clarifying that because it’s true. You go to pharmacy school, you have all this education and great knowledge on conventional medicine. So to add on to that with a further knowledge of supplements and integrative medicine, I really like how you phrased that.

Pam [00:14:05] That’s I think that’s the key. The key is for us to always be pharmacists. And then add on either due to our patients needs, so anyone who’s listening to this, patients and certain populations may have certain needs. And if you’re an oncology pharmacist, you might be interested in products that don’t interact with oncology drugs that may ease patients symptoms, and side effects so that they may complete their course of therapy. Something like that. If you’re an infectious disease pharmacist, there may be ways of repairing the gut once antibiotics have been given. I started with what I was interested in. And I believe that’s what Swathi has done too, from my observation as a residency director. She’s gone with what she’s interested in and what the needs of the people that she’s serving. And that is a fabulous way to start because you can start helping people pretty soon after doing that.

Lynn [00:15:09] Yeah, I mean, that’s that’s great. You guys are leaders in the pharmacy, you know, in the sense of, again, finding finding that problem and incorporating it into what you’re interested in. That’s a that’s definitely great that you guys are doing that.

Lynn [00:15:22] One of the major goals of the Nontraditional pharmacist is to give pharmacy students and pharmacists a true look into what’s involved in the job. Lets talk geographic location. So in terms of geographic location. You guys are in California which seems to be more on the front end of natural medicine. I practice in the Midwest and it’s not as common here. Would you say that you’re restricted by geographic location or do you think it’s something that if people are interested in should be kind of a pioneer or a leader in the field and try to to somehow incorporate it into their current practice?

Pam [00:16:05] I don’t think there’s much restriction. That is true where we practice it there’s a lot more conversation than acceptance. That is true. And there’s also a lot of physicians and other practitioners that practice integrative medicine around us. But in the day of social media and internet, I I think that everybody’s hearing about it. All patients are hearing about it. What really concerns me is, among other things, is that our patients that we’re filling prescriptions for are taking these products, but they’re not telling us because they don’t think we care or we don’t think we know about them or they. Even worse, a pharmacist may say, why are you taking that?You know, the patient is going to take it anyway, but not tell us.

Pam [00:16:49] Yeah, that’s a that’s a good point. They might not be able or willing to share that information. So that’s something to consider, too, as a pharmacist, to be able to have empathy and make patients feel comfortable with telling that. I’m sure that’s a whole part of it as well.

Pam [00:17:05] It’s a very important part, because without knowing anything about integrative strategies or products, dietary supplements, one might have misconceptions that could be conveyed verbally or nonverbally to a patient and make it so they don’t want to talk to us.

Lynn [00:17:25] So let’s transition over to hours in day to day activities. What is it like to work in your field? Is it 9 to five? Is it nights? Do you work weekends?

Pam [00:17:38] Oh, that really depends. Swathi and I have very different hours, sometimes in different tasks. If you’re doing it in a retail setting, then you have the retail hours that a consultation could be anything. Swati, do you have an opinion on that?

Swathi [00:17:58] Yeah, I think it really just depends on what’s going on if we have some projects coming up or some deadline or for preparing some slide deck. Sometimes we do meetings on Sunday nights. Sometimes we do meetings on Tuesday mornings. It really just depends.

Lynn [00:18:12] It’s a very variable that makes. Yeah. Yeah.

Pam [00:18:16] So it’s fairly unlimited. And I think many pharmacies can start right where they are. And many pharmacy students that have jobs can just start opening up to what people are saying and what’s on the OTC dietary supplement aisles of the places they work or if they’re doing transitions of care, they can find out what the patients are gonna go back to taking; doing medication reconciliation and finding out what vitamins they’re taking and who suggested it and whether their doctor knows. So really can start anywhere, I think.

Lynn [00:18:53] Would you say further training is necessary? I know the residency, I’m sure, helps open your eyes as well as the research and everything involved with integrative medicine. But would you say that, you know, is it enough to get a master’s degree or on the job experience?

Pam [00:19:16] I think I’ll have Swathi talk about that. I’ve learned this on my own because I had to since there weren’t programs available. Swathi you have been exploring some programs, havent you?

Swathi [00:19:29] Yeah, definitely, and I also to answer your question, I would say training, whether that formalized training or taking a course or a residency, or if it’s just informal and training yourself through other methods like podcasts and articles and things like that.

Pam [00:19:49] Well, that’s what we’re doing PharmSupplement. We’re trying to make this a very concise, practical informational and educational platform so that one would know what you need to discuss this with a physician or a patient, how to think about it. And then lots of resources for further in-depth study.

Lynn [00:20:23] Could you tell us a little bit about PharmSupplement?

Pam [00:20:24] Well there’s been a little interruption with current events; that changed everything. So we can provide a link so that listeners can be notified when that does go live. But we’re still working on it, refining it, trying to make it real applicable to contemporary pharmacy and lots of areas.

Lynn [00:20:45] And one last question to wrap up here. In terms of the future of pharmacy, where do you see pharmacy going, especially with what you’re doing and what you’re learning?

Pam [00:20:55] I’ll let the new graduate talk about where pharmacy is going! I’m excited with new pharmacists like her coming on board, it’s looking real good.

Swathi [00:21:06] I would say that the way that I see it is that there will be a lot of overlapping; when it comes to integrative health, for example, looking into a lot of different modalities that involves a lot of inter-professionalism, so I think there’ll be a lot more team based approach to help the patient. I think using a wide variety of resources and media will become very much like a mainstay of education. Those are my initial thoughts.

Pam [00:21:38] Yeah I think that in my view, my world view of pharmacy, integrative strategies, supporting immune systems, helping the way that the body naturally responds to challenges, that’s becoming more and more important. Especially with the role of inflammatory diseases. So I believe that pharmacists are going to get more involved in how to support the body before it needs pharmaceuticals. And that patients want one place where they can go, where they can talk about a lot of things and find a knowledgeable, caring health care practitioner. The other area that I see pharmacy going into, because we’re the ones that should, is having to do with cannabis based medicines. So that patients also could get the medicinal use of cannabinoids, is about the most exciting thing that I’ve come across in the last five years!

Lynn [00:22:47] Yeah. That’s a whole section of pharmacy in itself from from my understanding. I think that cannabis based medicine is going to become huge in the next upcoming years.

Pam [00:23:03] Yes and geography would have to do with that as it varies state to state. But it’s not just that cannabis based medicine is the way to go versus not doing anything else. Diet, exercise, meditation, possible dietary supplements, medication when needed, to integrate all of that into a fairly cohesive or at least a patient centered shared decision making plan. That’s how I would like to see pharmacists.

Lynn [00:23:31] Absolutely. You got to combine all the factors, definitely.

Pam [00:23:35] That’s the integrative part of it!

Lynn [00:23:41] Well, thank you guys both so much for sharing your experience! I know a lot of people listening to this will definitely benefit from your insight and can look look to you as leaders, and can hopefully connect with you on LinkedIn if they’re interested. And I will definitely be sure to add the links that you guys send underneath this post so you can get more information.

[00:24:01] Thank you for all the nontraditional things you do, we really enjoy your podcast. Thanks for inviting us!

Resources:
To stay up-to-date and learn more about natural medicines, some recommended resources include Natural Medicines: Interaction Checker, NIH Office of Dietary Supplements, Linus Pauling Institute, Dr. Jeffrey Bland’s website and PharmSupplement, as well as the Consumer Lab and American Botanical Council free email newsletters. We would love to connect with you on LinkedIn and continue the conversation!