The pharmacists' quintessential art


Compounding is still the quintessential art of a pharmacist.

A patient recently complained to a pharmacist in California about the price of a compounded prescription. He bellyached that the doctor had said it should only cost $20.

Our good friend looked the patient in the eye and said, "Have your doctor make it, then."

1954 is not that far back in my rear-view mirror. That was when the Durham-Humphrey Amendment caused the differentiation between legend drugs (Now called Rx Only) and over-the-counter medicines. Hubert Humphrey was a pharmacist from Minnesota and his new law gave birth to Pharma. It took a few decades to really gain speed, but all of a sudden in 1954 a new game was created. One-strength-fits-all products. The claim that they were not safe for self-use and they were deemed to be legend drugs.

Chortle, chortle, chortle. Pop the corks. Light up the big cigars. Stuff the money into the bag and run to the bank. Everybody loved the idea of the standardized, shiny-red, sugar-coated tablets. The football-shaped ones came in more than one color and we bought them by the ten thousands. It was pretty slick to be able to fill a prescription just by counting out some tablets. Compounding took time. In 2009, you'd better bill at least $3 a minute to compound. That's your time, overhead, and a fair profit for your skill. Cost of ingredients does not count.

Nothing in this column, by the way, is meant to denigrate the marvelous education that new pharmacists bring to the profession. They are clinically adept and more ready than ever to be partners in the mission of providing superior healthcare to patients in need. Do they come out adept at compounding?

An Internet blogger whose handle is PharmacySlave reported that a professor showed the class a torsion balance and claimed, "You can forget this. No one uses these anymore." That is irresponsible. The profession is called Pharmacy.

I love the impressive laboratories and compounding pharmacists. Some doctors have chosen to turn their backs on the strictures of the shiny red tablet and prescribe transdermal products in strengths that are customized for the patient. You and I see nothing wrong with that, but some people do.

Holy Moly, Captain Marvel! We need only one strength, not 100 different strengths. The control we could lose! There is whining going on, but the moaning is at the right place, the FDA. Our friend in California said it is like AIG complaining about your Mom's Social Security.

That control-freak organization, the AMA, can't admit that the medical pyramid is flattening. It has had derisive things to say about compounded prescriptions. The good news is that the AMA is toothless. It was unable to deliver even one vote to either side in the recent healthcare proceedings. Most young doctors want to make a living. They are not interested in shining their light into every single corner of medical care.

We must encourage compounding. We must not hide our light under the prescription-mill basket. We are obliged to protect our classical skills. Compounding belongs to us.

JIM PLAGAKIS is a community pharmacist in Galveston, Texas. You can e-mail him at
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