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97 of 100 people found the following review helpful
5.0 out of 5 stars Top Screwups is superb!, October 5, 2011
This review is from: Top Screwups Doctors Make and How to Avoid Them (Hardcover)
Conventional wisdom says we mellow as we grow older. The Graedons have not mellowed. They have grown much more skeptical of a medical system that I consider to be an embarrassment from top to bottom.

I've been reading the Graedons' books ever since I graduated from pharmacy school in the mid 1970s. From my perspective, the Graedons started out as strong consumer advocates in the field of prescription and non-prescription drugs. With their first few books, they seemed to be saying that the system was fundamentally sound but that what was needed was informed, intelligent, educated consumers. The Graedons would often compare Drug A vs. Drug B vs. Drug C for any number of medical conditions and then perhaps say "This one may be your best bet."

From my perspective, "Top Screwups Doctors Make and How to Avoid Them" represents the evolution or transformation of the Graedons from strong consumer advocates to genuine full-fledged skeptics. This book is nothing like earlier Peoples Pharmacy books. This is not your father's Oldsmobile. I think it is fair to say that the Graedons are today nowhere near as sanguine about our medical system as they were for so many years.

Some people say that some non-fiction authors keep writing the same book over and over again, only updating the evidence to support their case. In my view, this book represents a major departure from the Graedons' books in the past. I think the Graedons are now in their mid-sixties and I have no idea how many more books they intend to write. This book strikes me as their attempt to finally lay it all on the line.

The Graedons provide lots of questions to ask health professionals and tips to avoid major screwups. Their formula is to warn people of the dangers and then give them something practical they can do to protect themselves. Even though the Graedons discuss a very wide range of screwups throughout our health care system, I feel I am only qualified to comment on those involving pharmacy and pharmacists. So the comments below focus on a very tiny slice of this superb book.

The Graedons accurately point out that the problem of pharmacy mistakes is horrifying and that the public largely has no idea how significant this problem is. A few years back, ABC's 20/20 did a no-holds-barred undercover investigation of pharmacy mistakes. The segment was titled "Pharmacy Errors: Unreported Epidemic?" In my opinion that is an accurate description of the problem except that the question mark should have been replaced with an exclamation point. Search Google for "pharmacy mistakes" if you have any doubt about how serious this problem is.

I quit pharmacy after 25 years because I was fed up with a medical system that I feel is in complete chaos. For a book I'm writing on my disillusionment as a pharmacist, I've been collecting news accounts describing major pharmacy errors. So far I have thirty-four cases in which a pharmacy mistake resulted in a jury award of at least a million dollars and/or resulted in the death of a patient.

Here are the top four awards that I am aware of in pharmacy mistake cases.

1. $31.3 million award in Illinois--Walgreens pharmacist dispensed diabetes drug glipizide instead of gout drug allopurinol, leading to renal failure, stroke, and death

2. $30.6 million award in California--Thrifty-Payless pharmacist dispensed 100 mg of phenobarbital to girl instead of 15 mg prescribed, causing brain damage

3. $25.8 million award in Florida--Walgreens pharmacist dispensed blood thinner warfarin in 10 times the dose prescribed, causing cerebral hemorrhage

4. $21 million award in Illinois--Walgreens pharmacist dispensed adult diabetes drug glipizide to infant girl instead of anti-seizure drug phenobarbital

Several years ago, my own stepfather was given the type-2 diabetes medicine Glucophage at a WalMart pharmacy in Florida, instead of the anti-hypertensive Toprol XL. My stepfather has never had any type of diabetes. Luckily I was visiting my mother and stepfather when my stepfather asked me why the pills in his refill bottle looked different from the Toprol XL he was expecting.

Most people view the pharmacist's job as fairly straightforward, uneventful, and even boring. Doctors write prescriptions and pharmacists fill those prescriptions. What could be simpler? Too often, the reality is quite different. Due to competitive pressures in the marketplace, pharmacy has been transformed into a high-speed, high-stress, high-stakes enterprise in which powerful prescription drugs are just a blur on a hamburger assembly line. The big drugstore chains have embraced the McDonald's fast food model with disastrous consequences.

I quit pharmacy after twenty-five years because I was so fed up with slinging out prescriptions as fast as my hands and feet would allow. I am trying to expose the fact that mistakes are far more common in drugstores than patients and physicians realize. Powerful prescription drugs are dispensed across America in a system that is guaranteed to produce errors. The big chain drugstores don't want you to know that pharmacies are purposely understaffed to increase productivity and profitability.

A huge number of pharmacists are disillusioned with the profession and are not recommending pharmacy as a career for their children. A huge number of pharmacists say that they would never have chosen pharmacy as a career if they had known what conditions are like in what we sarcastically refer to as "McPharmacy." This is a reckless system that treats powerful and potentially deadly prescription drugs as if they were no different from any other consumer product in America. The big drugstore chains run their operations as if pharmacists were dispensing nothing more hazardous than a Big Mac at McDonald's or a Slurpee at 7-Eleven.

Many pharmacists feel that the chains have made the cold calculation that it is more profitable to sling out prescriptions at lighting speed and pay customers harmed by mistakes than it is to provide adequate staffing so that mistakes are a rarity rather than a predictable occurrence. Understaffing sometimes forces pharmacists to take educated guesses rather than call doctors to clarify illegible prescriptions. Understaffing sometimes causes pharmacists to override potentially significant drug interactions rather than phone the doctor who prescribed the drugs.

The chain drugstores' obsession with speed increases the occurrence of pharmacy mistakes. Pharmacists are under tremendous pressure to fill prescriptions at unsafe speeds. Drive-thru windows increase mistakes by creating the expectation among customers that prescriptions should be filled as quickly as McDonald's fills burger orders. It is a fact that the speed with which pharmacists fill prescriptions is one of the primary criteria used by chain management in determining whether pharmacists are doing a satisfactory job.

Pharmacists go home at night crossing their fingers and wondering whether all the prescriptions they filled (and supervised techs in filling) that day were filled properly. They say to themselves something like, "Mrs. Jones was in today but I don't even remember checking her prescriptions."

Pharmacists will be grateful to the Graedons for discussing the tremendous problem of understaffing as an important cause pharmacy mistakes. Pharmacists desperately hope that the public will become so enraged as to demand that the chains provide adequate staffing for the safe filling of prescriptions. Understaffing increases pharmacy profitability but it also increases the frequency of serious pharmacy mistakes. Don't allow yourself to become a pharmacy statistic. Read "Top Screwups" and let chain management know that the current system is entirely unacceptable. I can state with certainty that the public has no idea how common pharmacy mistakes are today.
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Tracked by 3 customers

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Showing 1-7 of 7 posts in this discussion
Initial post: Oct 7, 2011 5:42:07 AM PDT
Thank you for your review. I plan to give this book as Christmas present to all my family.

In reply to an earlier post on Oct 10, 2011 12:25:26 PM PDT
Thank you for taking the time to write your comments. They were very insightful. I think I'm going to get this book....

Posted on Oct 16, 2011 8:19:02 PM PDT
Lincoln Weed says:
Thanks to the "former chain pharmacist" for an unusually informative and provocative review. One of its virtues is that the review recognizes a systemic failure beyond the the control of pharmacists: understaffing by pharmacy chains and the resulting "pressure to fill prescriptions at unsafe speeds."

It is important to recognize that an analogous problem exists when doctors decide the prescriptions that pharmacists fill. Indeed, not just prescription decisions but all medical decisions are crippled by one basic systemic failure - misguided reliance on the personal capacities of individual doctors. Just as pharmacists are expected to do their jobs at a speed that no one can safely handle, so doctors are expected to perform feats of information retrieval and processing that the human mind cannot handle. This failing, its consequences, and solutions for it, are the subject of a new book, entitled Medicine in Denial. See

The book's lead author is my father, Dr. Lawrence L. Weed (LLW), whose work the Graedons reference at several points. For some background, see a December 2005 article in The Economist at This article describes LLW as one of the pioneers of using computers in medicine, but his work goes far beyond that. He has reconceived the practice of medicine as a scientific discipline, in contrast to the ad hoc, out-of-control practices that doctors routinely engage in. This reconception has led LLW to design a blueprint for rebuilding the health care system from its foundations, as described by Medicine in Denial.

Posted on Oct 16, 2011 8:34:46 PM PDT
[Deleted by Amazon on Oct 18, 2011 7:26:18 PM PDT]

Posted on Dec 6, 2011 7:23:18 AM PST
M. barnes says:
lts give a little credit to the hard working,intelligent pharmacist who checks interactions,consults with patients(when the need arises) and performs a million and one duties connected with accurate filling and dispensing of prescriptions.the statistics of getting inaccurate prescriptions are very slim(as compared to hospital errors made by doctors and nurses)I dispensed rx for almost 40 yrs and have a stellar record.

Posted on Dec 25, 2011 9:02:03 PM PST
Thank you for taking the time to post this review and virtually a free lance article. The most helpful part to me was the clear appreciation that this was not a simple recycling of older material.

Posted on Apr 27, 2015 7:22:30 PM PDT
Last edited by the author on Apr 27, 2015 7:23:25 PM PDT
Mark says:
I'm glad you went into so much detail, thank you. Several of the other reviews were so sloppy and indistinct, substituting vague sweeping dismissals without enough actual content to convince a third grader, much less adults, I'd given up obtaining an intelligent appraisal with which to arrive at a realistic idea about the book. Thanks very much!
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