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The changing role of pharmacists in society

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By Tom Stafford, Staff Writer Updated 1:03 AM Monday, September 13, 2010

SPRINGFIELD — By the time William Whitacre founded his Springfield pharmacy in 1910, it happened less frequently.

But in a nod to the old days of so-called heroic medicine, he kept on hand and likely made for human consumption compounds including oil of hemlock and mercury bichloride, the latter of which could cause patients’ teeth and hair to fall out while providing no real medical benefit.

The pharmacy of Whitacre’s day included several chemicals that could be used as flame retardants and more than a few that standard pharmacy references of the day labeled as poisonous.

Those shared shelf space with some compounds containing sobering amounts of alcohol and other “medicines” whose purposes were to clean out the digestive tract at a variety of speeds, some of them alarming.

“Outside of opium which was good for pain, and quinine, which was specific for malaria, you really didn’t have any drugs that had a pharmacological action,” Robert A. Buerki, Ph.D., said in his home just south of Greenon High School.

In his 46th year at the Ohio State University, Buerki, 70, teaches the history of pharmacy and professional ethics to students at the university’s College of Pharmacy. For those susceptible to nostalgia, the man with two degrees in pharmacy, one in education and a master’s in history from Wright State University is a strong antidote.

Four humors

Although chemistry, organic chemistry, physics, astronomy and other fields were making great strides during the 19th century, “medicine as a science was pretty much back where we were in the dark ages,” Buerki said.

In a tradition that had its roots in Rome, the goal of medical treatment was to restore balance to the body’s four so-called humors: blood, black bile, yellow bile and phlegm.

The practice of bleeding patients, for instance, was to reduce the amount of blood in the system and thus restore the supposed balance.

The approach was to restore the balance aggressively.

“They would give very strong laxatives or emetics, and the idea was to really get in there and fight that disease,” Buerki said.

That approach “calmed down” somewhat as the 19th century went on, giving way to homeopathy.

Conceived in Germany, “It was the idea that like cures like,” Buerki said.

So, if a person had a fever, the approach would be to prescribe something that would also give a fever, using “just enough of the drug to excite the vital force,” Buerki said. “It was essentially leaving the cure to nature.”

Purity laws

A second reaction to heroic medicine’s use of strong chemicals was a back-to-nature or botanical movement.

“Many of the drugs they used were powerful as well,” Buerki explained, but being plant-based, proponents of the movement viewed them as more healthful.

Throughout this period, a pharmacist’s job was to combine basic ingredients into the compound a doctor ordered. In a time before drug manufacturing, they made prescriptions one by one.

It was their interest in doing so that in the 1850s led pharmacists to organize.

The problem they faced was the same one extra-legal drug dealers would have in years to come: adulterated product shipped in from overseas.

If the plant or root arrived in its natural form, pharmacists could identify it.

“If it was all ground up,” Buerki said, “you didn’t know what was in it.”

To combat the problem, local pharmacy associations formed the American Pharmaceutical Association in 1852 to lobby for changes to ensure the purity of the products they used.

A new era

Once organized, American Pharmaceutical Association got involved in other matters, principally the education and certification of professional pharmacists.

But Buerki said that it wasn’t until the appearance of sulfa drugs in the 1930s — “I guess you could call them the first antibiotics” — that the era of chemotherapy arrived and the pharmacist of today emerged.

Although most often spoken of today in terms of cancer drugs, chemotherapy more broadly means using a specific drug that’s effective in treating a specific disease.

Sulfa drugs were followed by penicillin and other antibiotics, along with insulin, vitamins and other drugs. Because these were “not the kinds of things pharmacists could make themselves,” Buerki said — and because compounding drugs with their mortars and pestles was the job pharmacists traditionally had done — pharmacists roles changed.

The constant

One thing didn’t change.

However pharmacy has been practiced in the United States, Buerki explained, the professional pharmacist has “had to subsidize his professional functions with the selling of other things.”

In Europe, the pharmacist’s function was separated from the institution we know as the drug store, Buerki said. But the United States followed the British tradition, something Buerki said led pharmacists to put up greater resistance to government regulation of drugs and, in general, “hampered the development of the professional pharmacist.”

Soda fountains and the sales of products have little to do with pharmacists’ professional function. But with a willingness to do “anything to keep that door open” and essentially subsidize the professional work, Buerki said, pharmacists made those products part of their businesses.

That’s been true since the mom-and-pop pharmacies operated like neighborhood groceries, then went through the era in which larger drugstores mirrored supermarkets.

Buerki predicts the revolution in pharmaceuticals that came with the beginning of sulfa and is continuing in our era may change the business model for pharmacists in the foreseeable future.

As for heroic medicine?

He assures us that the pharmaceutical use of the sort of chemicals William Whitacre kept on hand will remain safely, or perhaps unsafely, in the past.

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