Pharmacy Perspectives - Winter 2012 - 9

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telephone him at two o’clock in the morning, describe their symptoms, and ask if they should call an ambulance for the two-hour trip to the nearest hospital. Occasionally, they show up at his house. A few years ago, a Mexican immigrant family had an eight-ear-old son who was sick; twice they visited a clinic in another community, where they were told that the boy was dehydrated. But the child didn’t improve, and finally all eight family members showed up one evening in Don’s driveway. He did a quick evaluation – the boy’s belly was distended and felt hot to the touch. He told the parents to take him to the emergency room. They went to the nearest hospital, in Montrose, where the staff diagnosed severe brucellosis and immediately evacuated the boy on a plane to Denver. He spent two weeks in the I.C.U. before making a complete recovery. One of the Denver doctors told Don that the boy would have died if they had waited any longer to get him to a hospital. At the Apothecary Shoppe, Don never wears a white coat. He takes people’s blood pressure, and he often gives injections; if it has to be done in the backside, he escorts the customer into the bathroom for privacy. Elderly folks refer to him as “Dr. Don,” although he has no medical degree and discourages people from using the title. He doesn’t wear a nametag. “I wear old Levi’s,” he says.

“People want to talk to somebody who looks like them, talks like them, is part of the community. I know a lot of pharmacists wear a white coat because it makes you look more professional. But it’s different here.” He would rather be known as a druggist. “A druggist is the guy who repairs your watch and glasses,” he explains. “A pharmacist is the guy who works at Walmart.”

drug coverage for the elderly and disabled, insuring that millions of people get their medication. But it’s also had the unintended effect of driving rural pharmacists out of business. Instead of establishing a national formulary with standard drug prices, the way many countries do, the U.S. government allows private insurance plans to negotiate with drug providers. Big chains and mail-order pharmacies receive much better rates than independent stores, because of volume. Within the first two years of the program, more than five hundred rural pharmacies went out of business. Don gives the example of a local customer who needs Humira for rheumatoid arthritis. The insurance company reimburses $1,721.83 for a month’s supply, but Don pays $1,765.23 for the drug. “I lose $43.40 every time I fill it, once a month,” he says. Don’s customer doesn’t like using mail-order pharmacies; he worries about missing a delivery, and he wants to be able to ask a pharmacist questions face to face. “I like the guy,” Don says. “So I keep doing it.” Don’s margins have grown so small that on three occasions he has had to put his savings into the Apothecary Shoppe in order to keep the doors open. He is, by the strictest definition, a bad businessman. If a customer can’t pay, Don often rings up the order anyway and tapes the receipt to the inside wall above his counter. “This one said he was covered by insur-

ance, but it wasn’t,” he explains, pointing at a slip of paper on a wall full of them. “This one said he’ll be in on Tuesday. This one is a patient who is going on an extended vacation.” Most of his customers simply don’t have the money. Each year, Don writes off between ten and twenty thousand dollars, and he estimates that he is owed around three hundred thousand dollars in total. His annual salary is sixty-five thousand dollars. Over the course of many days the Apothecary Shoppe, I never saw a customer walk in whom Don doesn’t know by name. “It’s just a cost of doing business in a small town,” he says. “I don’t know how you can look your neighbor in the eye and say, ‘I know you’re having a tough time, but I can’t help you and your kid can’t get well.’” Settlers originally came to this remote place because they desired an alternative to capitalism. During the eighteen-nineties, a group called the Colorado Co-operative Colony hoped to build a utopian community in the region. Its Declaration of Principles explained that market-oriented competition makes it “almost impossible for an honest man or woman to make a comfortable living, and that a co-operative system, if properly carried out, will give the best opportunity to develop all that is good and noble in humanity.” (The history of the colony and its values is described in a 2001 dissertation by Pamela J.

Clark at the University of Wyoming.) At the end of the nineteenth century, socialist communities weren’t uncommon in the West. The arid landscape required extensive irrigation systems, and principles of shared labor made sense to people who were inspired by the theories of Karl Marx and Robert Owen. Anaheim, California, was settled through a coöperative water venture, as was nearby Riverside. Others failed but left idealistic names on the map: Equality, Freeland, Altruria. The Colorado Co-operative Colony published a newspaper called the Altrurian, which tracked the progress of the colony’s founding project, an eighteen-mile irrigation ditch that was intended to carry water from the San Miguel River. Settlers also planned to do away with debt, interest, and rent. The Altrurian dreamed of a glorious future: “If a small colony of outlaws and refugees could build Rome and maintain the state for twelve hundred years, who could guess what a well organized colony of intelligent Americans may accomplish.” Within a year, they held their first purge. Ten members were expelled for being too communistic, and after that the newspaper often published aphorisms that clarified theories. (“Communism may be co-operation, but co-operation is not necessarily communism.”) By the winter of 1898, settlers were running out of food. (“Competition is a product of Hell; Co-operation will make a paradise of earth.”) In 1901, a member of the board revealed that the colony was bankrupt. A former president committed suicide. (“So long as you think of yourself alone, you cannot be a good cooperator.”) Eventually, the settlers abandoned the principle of shared labor and

He keeps watch-repair tools behind the counter, and he uses them almost as frequently as he complains about Walmart, insurance companies, and Medicare Part D. Since 2006, the program has provided prescription-

“It’s just a cost of doing business in a small town,” he says. “I don’t know how you can look your neighbor in the eye and say, ‘I know you’re having a tough time, but I can’t help you and your kid can’t get well.’”
Winter 2012

Pharmacy Perspectives - Winter 2012

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