Vance Crowe Podcast 009: Kelly Erdos, Clinical pharmacist discusses prescription medicine

About this episode

Kelly Erdos, a clinical ambulatory-care pharmacist and old friend of Vance's, joins him to demystify what pharmacists actually do beyond "counting pills." They open on the length and difficulty of pharmacy school (six to ten years including residency), the gap between retail pharmacists (understaffed, high-volume, limited clinical authority) and ambulatory-care pharmacists like Kelly (who run collaborative-practice agreements with physicians and can independently adjust medications like insulin and warfarin dosing). Kelly explains "the Swiss cheese effect" behind medication errors using a real case of a patient nearly dying from a dosing mix-up, and the concept of "perfect world versus real world" medicine — prescribing what a patient will actually take rather than the theoretical ideal. A long middle stretch covers essential oils and CBD, where Kelly argues they can have real psychosomatic benefit but become dangerous when used in place of antibiotics or vaccines for children, and that "natural" is being wrongly equated with "safe." They close on the opioid epidemic and drug-company price collusion (the EpiPen price-gouging example), and Kelly's advice for how listeners should vet their own pharmacist. Label note carries forward: due to a speaker-tag bleed in the source transcript, several long answers are misattributed to "Vance Crowe" in the raw text; content has been cross-checked against context (Kelly speaks as the clinical pharmacist throughout the middle and back half) for this summary and the sections below.

Key moments

• Cold open — pharmacists working 12-hour shifts without a lunch break, limited to two bathroom breaks per shift.
• Pharmacy school runs six to ten years including a required or optional specialized residency.
• Retail pharmacists have no authority to change a prescription without a physician touchpoint; ambulatory-care pharmacists like Kelly can adjust insulin and warfarin dosing directly under a collaborative-practice agreement.
• "Perfect world versus real world" — the right theoretical dose is worthless if the patient won't take it; better a lower, sustainable dose than an ideal one that gets skipped.
• The "Swiss cheese effect" story — a patient nearly dies from a warfarin dosing mix-up when a new prescription's mislabeled/different-looking pills sailed through multiple safety checks.
• Essential oils get "a little bit more in the middle" verdict — real psychosomatic value, dangerous when substituted for antibiotics or vaccines in children.
• CBD and marijuana — genuine medical utility (rare pediatric seizure disorder, appetite stimulation, anxiety) but not a cure-all, and still carries drug-interaction risk.
• The Swiss-cheese story returns for handwriting/prescribing errors — Latin shorthand and illegible handwriting still causing real mistakes despite electronic prescribing.
• Opioid-epidemic collusion — drug companies in the 1990s telling doctors patients "aren't gonna get addicted," and separate price-fixing collusion between manufacturers.

Notable quotes

“So he takes that for two or three weeks and he ends up with a massive blood clot because he's on half the dose of what he should be. So that's all those little holes lining up.”

“In the nineties these drug companies said your patients aren't gonna get addicted. You can use them safely and come off at any point... that's why there are people going to jail at this point now for driving that, because that drove sales.”

“Just because it's natural doesn't mean it's safe... if you're rubbing it on your child thinking that it's gonna cure them of everything, I think that's a naive perspective.”

“The EpiPen is a good example... they gouge the price of that so much. I mean that is a lifesaving medication that is not something to mess around with. So you can have another cruise on your yacht.”