The profession of pharmacy was founded in the art and science of compounding medications. The beginning of compounding dates back to medieval times with priests, monks, and medicine men. Specialization first occurred in the early 9th century in the civilized world around Baghdad. Over time it gradually spread to Europe as alchemy evolved into chemistry as doctors began to abandon beliefs that were not demonstrable in the physical world. During this time, doctors began prescribing medications to patients.
Pharmacists then began compounding these prescriptions and producing them in mass uantities for general sale. It was not until the 19th century that there was a distinct difference between the pharmacist as a compounder of medications and the physician as the therapist. In the 1930s and 1940s, approximately 60 percent of all medications dispensed were compounded. Then in the 1950s and 1960s, with the creation of commercial drug manufacturers, compounding declined. It was during this time that a pharmacist, known as a compounder or apothecary, became known as a dispenser of manufactured drugs.
In the 1980s and now in the 1990s, patients and doctors are realizing the need for specific oses and customized medications. Today, almost 43,000 compounded dosage forms are dispensed each day. In the 1990s, even with the popularity of compounding growing again only a few pharmacists can be known as a compounder or apothecary, because this technique was forgotten by most. The Evolution of the Word “Pharmacy” It is from this evolution of a pharmacist being the maker and compounder of medications that the word pharmacy is defined.
The word pharmacy is defined as “the art of preparing and dispensing drugs or a place where drugs are sold; a drugstore. ” The word harmacy originates from the Greek word pharmakon or remedy. There has been some arguments that the word pharmacy came from the Egyptian term ph-ar-maki or the bestower of security, which the god Thoth, patron of physicians, conferred as approbation on a ferryman who had managed a safe crossing. However, the word pharmacy and its many cognates derived, like many of the other scientific terms, most likely originates from the Greeks.
It is impossible to put a exact date when the word pharmacy originated since people were practicing medicine before the word even existed. Priests and Doctors in the medieval times were combining different ingredients or compounding, but was it called compounding, we are not sure. The Artisans of Mesopotamia, Egypt, and China were the first known people to actually carry out chemical processes. Most of these people worked in the temples and palaces, making luxury goods for priests and nobles. Priests also speculated on all the changes that were going on in the world about them.
Their theories often involved magic. However, some of these theories are now considered chemical. Greeks Think Scientifically The Greeks were the first culture to think scientifically and not just rely on myths to explain occurrences. This began during the time of Thales about 600 B. C. Thales believed that all matter was derived from water, which could evaporate into the air or dissolve into the earth. His successors expanded on this theory and came up with the idea of the four elements that composed the earth: earth, water, air, and fire.
With this scientific break through, others like Democritus thought these elements were composed of atoms with minute particles moving in a vacuum. Aristotle believed that the elements formed a ontinuum of mass and therefore a vacuum could not exist. Slowly, the atomic idea was lost by the Greeks, but it was revived in the Renaissance once again. Today, the modern pharmacist deals with more complex pharmaceutical remedies than the elixirs, spirits, and powders described in the Pharmacopoeia of London (1618) and the Pharmacopoeia of Paris (1639).
Today, all major medicines which are considered having the greatest therapeutic value have to be passed by the Pharmacopoeia of the United States. The Pharmacopoeia of the United States was first published in 1820 by a Committee on Revision. This Committee was represented by all colleges of medicine, all colleges of pharmacy, all state medical associations, all state pharmaceutical associations and the surgeon general. After the drugs are chosen, the standards for quality and potency are formulated by the pharmacists and pharmaceutical chemists.
Other drugs that are considered to have less therapeutic value are analyzed by the National Formulary. These less therapeutic value drugs are then published by the American pharmaceutical Association which was founded in 1852. They have been published since 1888. If their is ny significant variation from the pharmacopoeia and formulary standards, the violator may be prosecuted by the Food and Drug Administration under the Pure Food, Drug and Cosmetic Acts.
The word “Pharmacy” began to develop as a profession separate from medicine in the early 18th century. In 1821, the first U. S. chool of pharmacy was established in Philadelphia. Since then, the community pharmacist, or druggist, is increasingly called upon to give advice in matters of health and hygiene. The advise they are now called on to give to their patients and doctors are drug action, the use of drugs in treating certain iseases and drug-induced side effects. Neighborhood Compounding Pharmacy The Industrial Revolution had a major effect on how the art of Pharmacy was practiced. The making of medications by hand almost became extinct when scientific developments through the use of machines developed.
Phytochemistry and synthetic chemistry created new derivatives of old drugs and new chemical entities of medicinal value that strained the capacity of the individual pharmacy. The result of the Industrial revolution was Pharmaceutical Companies. These companies were founded to manufacture drugs in mass quantities. Pharmacies then worked with companies such as G. D. Searle, which by the late 1880s listed 400 fluid extracts, 150 elixirs, 100 syrups, 75 powdered extracts and 25 tinctures and other drug forms.
With the increase number of pharmaceutical companies being formed patents were created during the industrial revolution. The industrialization of the medical industry had an impact in every aspect in the medical community. First, it led to the creation of new drugs. These new drugs could not be created by pharmacists because they did not have the resources to create them. Second, rugs that could be made by the local pharmacist could be made in a more economical manner by the larger companies in a purer form.
Third, pharmaceutical companies assumed responsibility for the quality of the medication they were producing. Finally, it opened the market to more competition from merchants and grocers that pharmacies had not occurred before. During the Industrial Revolution and the nineteenth century, the art of compounding was not dead, although the number of pharmacists practicing it declined. It has been estimated that eighty percent of the prescriptions dispensed in the 1920s required a broad nowledge of compounding.
During this time, however, pharmacists increasingly relied on the purchase of chemicals from manufacturers in order to fill these prescriptions. Pharmacists still spread their own plasters, prepared pills, powders, and made up medicated waters. They also frequently combined a single dosage from several medicines that today would be written and dispensed as separate prescriptions. During this time period, pharmacists were also called upon to provide first aid and medications for common ailments such as burns, frostbite, flesh wounds, poisoning constipation, and diarrhea.
Therefore, they still maintained a prescription laboratory, but also carried the pharmaceutical companies medications as well. Twentieth Century Pharmacist The virtual disappearance of the preparation and compounding medicines is the most notable change in pharmacy in modern times. In the 1920s, over 80 percent of the prescriptions filled in American Pharmacies required a knowledge of compounding. However, in the 1970s only one percent or less combined two or more active ingredients. Another change that has occurred is what the pharmacist now actually knows.
Most pharmacists now only know the facts such as the shelf life of the medication, the effect on the drug when exposed to light, and the reliability and reputations of the manufacturer. When in the past, all pharmacists were committed to maintaining the quality of drugs dispensed. All of these changes meant that the pharmacists education and activities had to undergo changes as well. The scientific education of the pharmacist increased and therefore more demanding. Also, their role in the provision of health care was becoming more and more circumscribed.
Moreover, they were increasingly subject to government and institutional requirements that diminished the importance of the patient-pharmacist relationships. Also, they were under heavy competition from chain and department stores which demeaned both the role and the dignity of the pharmacist as a health-care professional. The reaction to these changes was the increasing number of students that changed from community pharmacy to other areas of pharmacy. In 1947, about 90 percent of graduates planned to go into some aspect of community pharmacy; in 1973 only 76. 6 percent and in 1988 only 57. 1 percent.
Today, custom compounding pharmacies are on the rise. Medical institutions, doctors, and veterinarians realize more than ever the importance of tailoring an individuals medications to meet their unique needs. This has allowed many pharmacists to once again look out for the well being of the patient and go back to the roots of practicing pharmacy. Finally, it has also allowed the pharmacist to enter the search for new drugs and innovations that have been rapidly attaching themselves to the medical industry. Philosophy Traditionally, the pharmacist’s role has been that of a dispenser of medications.
However, this traditional method of practice is no longer adequate to ensure safety and effectiveness in the use of medications and health devices. The focus of practice must change from one of product distribution to a more expansive duty; assuming the responsibility for our patients’ outcomes from the medications we dispense. Health care reform has put an emphasis on primary health care. This emphasis coupled with a lack of access, increasingly rising costs, and a concern for quality is placing the pharmacist in an important role as a member of the primary health care delivery team.
Pharmacies are located in most rural communities and throughout inner cities and urban sprawl across the country. This physical placement of the pharmacist, who is trained in delivering comprehensive care to the public, allows access to primary health care where it is critically lacking. The role of the pharmacist as a member of the primary health care team does not replace the physician, physician assistant or nurse practitioner, but enhances their effectiveness.
The pharmaceutical services provided in this changing arena will include participating in the drug therapy decision process through recommending herapeutic objectives, selecting the most appropriate drug product to achieve the desired therapeutic outcomes given the patient’s unique characteristics, determining dose and dosage schedule, selecting the drug product source of supply and drug preparation, and monitoring the patient’s response to the therapy so that the patient receives the optimal benefits with minimal adverse drug effects.
