This drug age; 5; The Pharmacist

Why. When it comes to a more enlightened approach to the practice of Pharmacy what contribution is right. This drug a talk about drugs. What they are and how they affect modern man produce for radio by the American University broadcast center in collaboration with the National Institute of General Medical Sciences Unit of the National Institutes of Health. In our discussions with authorities on drugs and their use We'll explore where drugs come from how they are

discovered the natural substances provided by nature and products invented by man. We'll examine why people take drugs of all kinds and the effect of drugs on 20th century society. We'll investigate the latest developments in pharmacological research. Ways in which the federal government is concerned with drugs and drug use. Drug laws why we have them and whether they are beneficial. These and other questions facing us all in this drug age. On today's program the changing role of the pharmacist between the companies who make the drugs and the users the patients who purchase them. There is a complex distribution network included in it by the independent pharmacists the large chain drug stores prescription pharmacies mail order pharmacies and hospital

pharmacies. Joining Patricia Wakeling for a discussion of how this machinery operates and how it is changing are Frank Albright a community pharmacist and drug store owner in Virginia. Milton Scarlet a hospital pharmacist and former president of the American Society of hospital pharmacists now chief of the pharmacy department of the clinical center of the National Institutes of Health in Bethesda Maryland. And Edward Feldman who directs the scientific division of the American Pharmaceutical Association and who is chairman of the National Formulary board and editor of The Journal of pharmaceutical sciences. These three pharmacists will talk about ways the role of the pharmacist has changed in the past 20 years. One way is in the dispensing of drugs. It used to be the pharmacist who received drugs in bulk and himself made up the capsules. Now more

than 90 percent of the drugs he dispenses are supplied by the manufacturer in the final dosage form. Does a pharmacist today need the same sort of professional training he required 20 years ago merely to read a doctor's writing and pull a bottle from the shelf. The time seems not so far off in fact when the human pharmacist like so many other institutions will be replaced by the cold efficiency of the computer. How do our three pharmacists view the changes in their field. Dr. Feldman there actually is a veritable revolution taking place in the practice of pharmacy. Today it is becoming less and less a matter of what the pharmacist does and more and more what he knows. And I think this is a very important distinction. I think that this is part of the reason that automation is becoming more of a tool for the pharmacist it's going to become of increasing importance to him in

order that he can apply his knowledge to the practice of pharmacy. The very training of the pharmacist has changed considerably in the last few years. Before graduation he is learning more and more about the pharmacology of drugs in addition to their chemistry. He is studying things such as bio pharmaceutics which provide him with information on how drugs are absorbed other distribution in the body fluids how they're metabolized how they're excluded. He's also studying things such as human relationships how to handle deal with people. This is more than just the scientific studies that pharmacy had been provided for providing for students in the schools. Just a few years ago we also find that in many schools he now is being taught what is referred to as clinical pharmacy. And this is taking the pharmacists

into the actual setting where the drugs are being administered to patients such as in or in hospitals and providing him with a first hand opportunity to see how drugs are being utilized their effects on the patient and so forth. Following graduation we find that pharmacists are. Finding out more and more important to attend professional meetings to participate in continuing education seminars meetings and things of that nature in this general area. The associations are becoming more and more important because they are providing a floorman opportunity for the continuing education of pharmacists and many pharmacists and many of these areas. What it comes down to is that there is a more enlightened approach to the practice of pharmacy and more total contribution on the pharmacists part. The pharmacist you think becomes a drug information specialist.

That's correct. I think that that's the direction that we're heading on this just go on the Earlier I mentioned just in passing clinical pharmacy and I I think you're an excellent position to elaborate a little further on this I think that it's a real novel A new development that deserves some additional elaboration. What clinical pharmacy is of course can be described in many fashion so I won't really try to describe what we mean by it but rather comment on some of the results that I see from educating our new graduates in the area of clinical pharmacy. I look upon these senior students probably in a school the pharmacy being placed on nursing units in under proper supervision. Actually confronting patients patients diagnoses discuss this with a physician be able to have an

understanding of the clinical laboratory results X-ray findings and so forth to be able to assist the physician in the proper selection of the drug. And I actually get so much actual patient contact. Now this is important to me to teach students. Contact patience because it will help them in their hospital practice it will also be very helpful to them in their community practice. They can deal with individuals and we hope to do is to really make true drug information experts who can really be helpful to the physician in discussing diagnoses and proper drug selection. Observing the adverse results as well as beneficial results and really truly understand diagnoses and be able to discuss these with a physician rather than merely read drug information

to the physician from this out of a reference book which of course a lot of people could do. The end result will be that we will have a pharmacist who will then be patient oriented. In all aspects of practice whether it be in a hospital community or in some governmental agency rather than a pharmacist who may be only product oriented. I think the patient will benefit also so will the medical care team. Mr. Bryant how does a person these days if he wants to become a pharmacist and own his own store set about going into business. Well there are number of things to consider in doing this. First of all you know and most important as he has to have some managerial training. That's the first thing I would advise someone who want to own their own business to sake get a position someplace where you can learn to make decisions. And the second thing then that you need that MOST IMPORTANT IS a proper location.

If you have those two points covered then it doesn't become too great a problem to get the financial backing necessary to get your own business. Any number of ways can be sought out to handle this problem. But how does a small man compete. By which I mean adequately serve the customer in the change. Well. It depends on how you define the word compete. First of all if the small man specializes in prescriptions and health supplies sickroom supplies competition is no longer a problem. You will become the expert in the man who devotes a lot of his time to other facets of his business will not be up to years of your standard of knowledge. You know when it comes to pricing if you are in the proper location where your volume is up. If you're a good businessman then the you can also overcome this obstacle and be a big factor I believe the small man has in his

favor is in the area of service to the people and with whom he deals. If you give the service a 24 hour answering service for instance to cover emergencies if you deliver to the shot in to the invalid to the emergency patient if you keep family records systems which we do in my pharmacy which the chains do not do. If you stay on top of the information field and become the first person the physician seeks when he wants information he's going to remember this and your patrons will remember this who he referred to the family medical records. This is a very important contribution which pharmacy is just within the last few years providing to the general public and it's one that as a result is little known outside of pharmaceutical circles. What this does is that a

practitioner such as Mr Albright record for the individuals within a given family that patronize her. Pharmacy the various drugs that the individual has been taking that have been prescribed for him by various different medical practitioners. So that right in one single place the pharmacist has a detailed record of all the Medicaid patients that you Jon Jones are receiving and that he then has an excellent means of establishing whether or not this individual perhaps is receiving or has a drug prescribed for him which would be not in the best interest of the patient because of other aspects of his medical history. In other words a therapeutic in

compatability where perhaps drug B is contra indicated when that patient is already receiving Drogheda. And this can readily happen in today's specialized medical situation where individuals will go to an ophthalmologist for an eye condition and that they perhaps receive treatment from some other medical specialist in another entirely different area. How does the pharmacist know which drugs new drugs to buy hid. Do the drug manufacturers send out detail man to the stores do your shops and how do you buy drugs on sale retail. Well let me first answer this statement by saying that I've. I've had I happen to belong to the American College of Apothecaries and one requirement in order to stay a member of this organization is to keep a new drug section. Therefore we allow the manufacturers to ship us and a national

supply of all new drugs which we date upon receipt. And if they aren't used in a certain period of time we send those back. You don't have to pay for them. Oh yes. Used or not. Well they usually give you some kind of dating say maybe 90 days in which to pay for them and if if their representative is doing his job we'll sell some of them within 90 days and if not that's a good item to return. So we don't have any problem on stocking which new drugs we should. The problem is. More of an inventory control. Now how is a small store going to afford the instrumentation the automated equipment. I believe this problem will be solved for us by the wholesale druggist these gentlemen in order to stay in business as they have practiced in the past need us. And currently they're working on a plan through the telephone companies to install some means of communicating from our pharmacy

through the telephone system to a computer at the wholesaler. Therefore I don't think the expense will be prohibitive to the independent pharmacy practitioner. There are tremendous number of drugs on the market both prescription legend drugs and over-the-counter drugs and this problem is further compound by the fact that. There are many new drugs constantly appearing so that in order to make it possible to go to the automation that you've been discussing here it's necessary to arrive at a more scientific technical way of a done to find drugs and as a result we have seen in the last year a great strides being made toward the development of a national drug code system and directories which will enable us to utilize such coding mechanisms and this will go a long ways towards making

feasible automation and data processing equipment. This will be in addition to what it compliment. National Film day the pharmacopeia very definitely these compendia the national formulary and the US P. are books of standards for the drugs they use provide various types of chemical physical standards whereby the drug quality purity potency and identity can be established and both as to the methods of testing drugs for these characteristics as well as specifications as to defining whether or not the drugs actually do in fact meet these standards. No drug information in the hospital is one of our. Most useful services that we can provide. And being in a concentrated location or it's a pharmacy and having all the physicians around our job actually is

easier at the moment in that we can either send a copy of the information to the physician or having contact the pharmacy but when the day of computers comes into the hospital to really be useful it will be awful helpful to us also if the physician has a direct tie in with the information because the easier and the quicker that he can get it the more available he will. We can make it to him and he will also avail insult of it resulting in better patient care. We are in the second interim report of the AGW Tosk force on prescription drugs amassed a drug list was compiled of the 409 most frequently prescribe drugs dispensed to the elderly and perhaps I should point out for listeners that although the elderly represent a little less than 10 percent of the total populace there conference some 23 percent of the drug expenditures. So if these 409 drugs 300 and were dispensed under their brand names

at an average cost of $4 an 11 cents per description and 30 under their genetic names for two dollars and two cents at description. How does a pharmacist make a larger profit on brand name drugs than on genetic compounds Dr. Feldman. That really depends upon his method of pricing the American from a sort of close association has generally advocated that pharmacists consider the adoption of a professional fee system rather than one which would be based upon a percentage markup or some other system of that nature under a professional fee system. The pharmacist adds to the cost of the ingredients a certain fixed amount which covers his overhead and he has a professional fee his profit if you will and that the amount that he adds is. The same regardless

of the price cost to him of the ingredients and our way of thinking this makes a good deal of sense because the services that he's providing to the patient need case are the same. The checking that he's doing a patient record keep enough of the delivery services. The knowledge which he's bringing to bear on whether the dosage is correct whether the conditions for which the drug being dispensed are correct. All of these things are the same regardless of the cost of the ingredients involved. So when you really analyze it a professional fee makes a good deal of sense. Now under the system as I say there would not be any difference in the amount of profit or whatever we choose to call it regardless of the cost of the ingredients or whether those ingredients are made available under there.

Generic Gore nonproprietary name or their brand or trademark name. There have been many reports over the years on the relative costs of medical services in one of the most hotly debated points has been and is whether the cost of drugs has gone up or decreased over the years. Mr. SCOTT Well the cost of drugs I dont really think has increased that much as we have newer and more specific drugs reaching the market these replacement drugs so-called replacing older drugs usually always come on the market at a higher cost than the one that they replaced. But the intention is here that if it is a good product that it will shorten the days of illness and also lessen the days off from work that a patient must take frequently can be treated without even leaving work or losing a day's work.

Now if this does this cost or if it does in fact what its supposed to do then the cost of drugs really hasn't risen as much as people would assume because you have reduced other costs of medical care. This whole matter of drug prices sort of reminds one of the old saying of How to Lie with Statistics. One of the. Things that often times the site is consumer price index. Unfortunately the Consumer Price Index is largely based upon certain set drugs. Now as time goes on things such as the looks are a few Novara battell have dropped in price or they remain the same. But this in a sense is not reflective of the true situation because it doesn't take into account those new drugs. And yet on the other hand

which ones do you substitute if you are going to update it and how do you maintain a degree of continuity without introducing other variables so it's very difficult to really say that drug prices are going up down and if so how much. We have very specific drugs these days that will actually keep patients alive. Take for instance treatment leukemia. A few years ago a child directed leukemia was almost certain death. Now our treatment may cost as much as a hundred dollars a day but they couldn't reach remissions for 12 20 months now without the disease reoccurring and for many years these individuals can lead a useful life with some medical care in between. But really how do you calculate just simply the

cost of drugs as having gone up without adding to it or the benefits that the patient derives even by living to a ripe old age. Am I correct Mr. Albright in thinking that laws in certain states prohibit a pharmacy from advertising. There are laws. They vary from state to state that which affect advertising. Most of these though are tied in with the advertising of prescriptions and the wording of such advertising in the state of Virginia where I practice pharmacy you cannot advertise the word price and prescription in the same ad. And then in addition you have the matter of ethics is not considered very ethical to advertise that I fill prescriptions cheaper than the drug store down the street or I fill mine more carefully. This is also frowned upon them because this infers that someone else fills them less carefully and this is not ethical but

I would say that certain stores could advertise a service as a renter rather than the prescription products or services that they can render to the family and to the community. The thing that specifically is prohibited is that a pharmacist cannot advertise a certain prescription drug by name and its a price for it. You have to read bear in mind that prescription drugs are potentially. Dangerous articles that have to be handled with care and under the proper supervision and conditions of use. This is the reason why they are restricted to dispensing only on a duly authorized practitioners written prescription. One of the wisest statements a man has ever made is a little learning is a dangerous thing. An example of this is relevant to our present discussion is self doctoring and over the come to

drugs now. Thought 21000 or 75000 depending on how you count them over drugs I the numbers pretty large and in nine cases out of 10. So if ascribing is potentially and sometimes actually dangerous in the same way and for the same reason namely lack of ability to diagnose correctly your friendly neighborhood pharmacist isn't qualified to describe for you either. But he does. And we've also had him we've all asked him to be helpful to be kind. But he has been doing wrong. Now how are the pharmaceutical associations dealing with that problem. Well I think that the situation isn't Wheatley as you suggested as there are at least I would hope it is and it is true that the average individual has a greater degree of contact with a family pharmacist than he has with physicians. You have to

make an appointment or perhaps wait several weeks if there's an emergency matter or an appointment with. Physician especially if he is a specialist whereas you find yourself frequently in the pharmacy for one reason or another and it's very natural to ask the pharmacist about this lump on my hand or this dark spot that's showing up rather suddenly on my forehead or whatever the situation is. We encourage a pharmacist to and by and large they do this to refer such individuals to a specialist to a physician to suggest that they have the matter looked into by a competent. Medical authority. The thing that I want to particularly stress here is that it isn't the over the counter

drugs that are dangerous but rather the condition which the individual may attempt to self diagnose which can be potentially hazardous. And it's in this area that the pharmacist can provide a very useful service in other words he can differentiate between something that the individual should seek expert medical advice on and something which is a minor matter that can be adequately taken care of by some proprietary or over-the-counter medication. Today Patricia Wakely talked with three pharmacists about the changing role of their profession in list drug A which. The pharmacist was Frank I prythee nothing scalloped and Edward Feldman. On the next and last program in this series. The head of the and I JMS pharmacology Toxicology Program. Byron Clarke

discusses how the principles that underlie him directly and I JMS program have affected both the theory and the practice of pharmacology as we know it today. Joining Dr. Clark and Patricia Wakeling I John J Burns of Hoffman La Roche incorporated and Leon Goldberg professor of pharmacology and medicine at Tufts University. This drug they just produced for radio in collaboration with the National Institute of general medical sciences a unit of the National Institutes of Health. This is the national educational radio network.