Pharmacy has changed a lot in the last 50 years-but a lot of that has been for the good of the profession and the public.
I recently attended my 50th Temple Pharmacy School reunion, causing me to reflect on the changes I have witnessed since I graduated in 1968. As I look back, the profession itself was not one that carried the respect it now does. Pharmacists during this era, almost uniformly, suggested students switch their course of study to medicine.
Immediately following graduation, I purchased a pharmacy in the neighborhood where I grew up. I was not licensed at the time and regulations required an internship following graduation, in addition to the externship mandated during the years in pharmacy school. To comply with the requirements, I hired pharmacists to work for me for six months until I received my license.
During my initial years in pharmacy, independents still dominated the profession-though chains were growing. Fair trade laws had been repealed, allowing the beginning of discounted OTC products. This, of course, made life more challenging to the independent pharmacist who had to compete with the large supermarkets.
My first act as a pharmacy owner was to replace the manual typewriter with an electric one. In my senior year at Temple Pharmacy I selected, as an elective, the initial course in clinical pharmacy. I believe this course had a profound effect on our future practice of the profession-I know it did for me. My second act, therefore, was to purchase a manual profile card system to record each person’s prescriptions allowing me to provide counseling.
Yes, my friends, counseling was not mandated and without computers it was extremely difficult to do and, as a result, rarely done.
To make matters worse, while I was a student, pharmacy regulations prohibited pharmacists from discussing the use and effects of the drugs they were dispensing. We were also prohibited from providing the name of the drug unless the physician indicated his/her permission on the prescription. Fortunately, by the time I graduated, the regulations had changed.
My third act was to change the pricing system. It was quite common to price prescriptions on the “whatever the market would bear.” In essence, the pharmacist would price the prescription differently for each patient depending on what the pharmacist felt was appropriate. Many rounded up to an even number, believing that using odd cents was not professional. Continuing to use my clinical approach to pharmacy, I used cost plus a set professional fee to determine pricing.
During my first year as an owner, I remodeled the store to reflect a more updated, professional approach to pharmacy, in which the pharmacist was more accessible. Prior to remodeling, the pharmacy reflected the traditional pharmacy of the time: constructed in a way as to obstruct the patient’s view of the pharmacist while the pharmacist worked.
Although pharmacy was evolving away from predominantly compounding prescriptions, it was still an integral portion of the practice. Some of the popular drugs at the time included: reserpine, quinidine, and chlorothiazide for heart and blood pressure conditions and tolbutamide, chlorpropamide, and pork insulin for diabetes. Back then, insulins were not prepared using recombinant DNA human preparations. Prior to these new types of insulins, we used insulin 40 Units and 80 Units. There were basically two types, regular which was short acting and NPH which was long-acting. In addition, there were no disposable syringes and needles when I began my career.
Over the next 15 years as pharmacy evolved, the implementation of computers and other technologies grew.
Initially, computer systems were cumbersome-relatively high cost and less forgiving than today’s programs. Drug interactions and warnings were not integrated into systems, so assessments continued to be done manually. Most of us used the Facts and Comparisons manual. For those of us from that era, I am sure you remember the bi-weekly task of replacing and adding pages to maintain an updated reference tool.
In the 1970s, reforms required by the 1962 Kefauver-Harris amendments to the Federal Food Drug and Cosmetic Act mandated that only drugs that demonstrated efficacy were to remain on the market. Implementation of these amendments gradually removed many drugs from the marketplace.
In 1982 we witnessed the Tylenol scare, resulting in the death of seven people. Someone (police are still unsure exactly who) tampered with Tylenol Extra Strength packaging, adding cyanide to the capsules. This ushered in the era of more secure and regulated packaging of OTC medications.
Competition from pharmacy chain stores accelerated more rapidly beginning in the 1970s, causing many independents to close and sell their files to a nearby chain. I added medical equipment and supplies and homecare nursing to my services, which allowed me to continue operations.
As regulations changed and competition from large companies grew, I was forced to close my business after about 25 years. I was totally out of retail pharmacy for about 10 years. During those 10 years, I practiced pharmacy part-time as a consultant to homecare and hospice agencies.
I watched as the professional side of pharmacy grew due to the emphasis by schools on the profession, and the reduction in the number of independents. The six-year PharmD degree became a reality.
Medications that were at the mainstay of pharmacy when I graduated have given way to much more potent, effective, and more selective drugs than those in the past. Monoclonal antibody drugs, kinase enzyme inhibitors, and drugs based on genomics were not only not discussed in school, they weren’t even being researched.
Pharmacy is now rated as one of the most respected profession and, as I reflect on the past 50 years, view the present and look forward to the future of pharmacy, I can only feel pride in the profession to which I have dedicated most of my professional life. Given the opportunity, I will sincerely recommend our noble profession.