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Address of the President of the American Pharmaceutical Association
ADDRESS OF THE PRESIDENT OF THe
AMERICAN PHARMACEUTICAL ASSOCIATION ROY BIRD COOK PRESENTED AT THE 91ST ANNUAL MEETING COLUMBUS, OHIO, SEPTEMBER 9, 1943
M
any years ago it was set down by a man learned in the la w that men will always consider the problem of men if the solution is good for society as a whole. Public Health, including the basic sciences of medicine and pharmacy, through all the ages has occupied a prominent place along the corridors of time. It touches all men and the preparation of "an ointment compound after the art of the Apothecary" was known long before the writing of the Book of Exodus. A glance backward shows clearly
ROY BIRD COOK
that Brunfels had the same thing in mind when in 1536 he wrote, "in my shop of drugs are stored many things of sweet accord." The same was true when Francis Gilead, apothecary with Cartier, set foot on American soil as the first of our profession in our land. The belief was carried into the opening days of our American Revolution, when Washington set out with a little army, a handful of drugs and medical supplies aud with primitive scales on which justice and medicine alike were measured out. Indeed, at that time, in all the Colonies not over five hundred men had even the most meager of training, in any branch of medicine. By 1778 a little Pharmacopceia appeared, and by 1800 a century of progress opened up in which mountains were surmounted and the influence of pharmacy spread beyond the great valley of the Mississippi. The interdependence of pharmacy and medicine still held sway and the tendency toward specialization became more and more pronounced. But the days of "sweet accord" of 1536 were quietly slipping into the pages of his· tory and new problems were arising on every hand. Some great leader has suggested that a "reformation in Pharmacy is needed today. II On an October day in 1852, a group of splendid "Apothecaries" met in Philadelphia and organized the AMERICAN PHARMACEUTICAL ASSOCIATION. A new source of hope came to this growing field of hu· man endeavor. The establishment of the U. S. P. in 1820 and of five colleges of pharmacy between that year and 1850 had brought pharmacists together. The organization of our ASSOCIATION, the experiences of the American Civil War, the opening of additional schools and the advance of leadership by the 1900's brought pharmacists to a point where it was time to stop and take an inventory. A militant press aided and abetted. The pharmacist set about looking into education and regulation as a means of protecting the public health as well as lift· ing the profession Into its proper place in society. A combination of education and legal requirements opened a new road strewn with perplexing problems. The passing of intervening years has not lessened the work in any direction. Questions arising out of
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PRACTICAL PHARMACY EDITION
the general field of public health and medicine continue to grow.
And so it is with considerable pride in the past and confidence in the present that this great organization assembles here in the city of Columbus, in its ninetyfirst annual meeting . With the smoke from Pearl Harbor still smarting in our faces we stop to take stock of yesterday, inventory today and look into tomorrow. It may be 'a "War Conference," or a "Streamlined Convention" perhaps, but nonetheless devoted to practical evaluations of how we stand.
POSTW AR PROBLEMS At this time we hear on every hand of postwar problems in the field of medicine. We read in the press reams of words on postwar planning. It is hardly possible from this point of vantage to make any predictions but it does seem inevitable that public health will become a governmental function more than ever. There may be some approach to socialization of medicine. Without attempting to predict, or suggest, in which direction the future lies it can be affirmed that the future of pharmacy i~ deeply involved regardless of the direction in which medicine may advance. At the Denver meeting, the Committee on Long Range Program of Policy was instructed to inaugurate an integrated program in the matter of war and postwar problems, and the Committee will submit a report at the first meeting of the House of Delegates, which report with its recommendations, will be one of the important contributions at this meeting.
WHERE ARE WE GOING? This is a very commonplace question in any field of human endeavor, but it is particularly pertinent at the present time in the field of pharmacy. It will be even more true with all the perplexing problems that will grow out of postwar conditions. This question rests on the minds of our profession from the rock-ribbed shores of New England to the sunny sands of southern California; and from the gleaming retorts of great manufacturing houses to the shining prescription case of a modern pharmacy with its underworked equipment. And, no satisfactory answer appears. One of our great national leaders of long ago observed that it would not be answered until "pharmacy had a common objective," but that answer is not sufficient because pharmacy is so dependent upon other fields. And who would formulate a program leading to that common objective? Certainly as yet, no such power has been entrusted to us. None within the sound of my voice is unaware of the marvelous advances made in the science of medicine and pharmacy. Yet, the same listeners know full well that some way must be brought about to utilize the same powers if we want pharmacy to maintain the lofty standards it now enjoys. Some.
285
one has even suggested that the Boards of Pharmacy are check ~alves on our profession, but may I ask you what IS to become of our profession unless the medical profession and allied groups utilize to a greater extent that product known as a pharmacist? The most needed objective as I see it is to bring about some plan that will change some aspects of the teaching of medicine and bring about a sound u.nderstanding that pharmacy and medicine have a mutual field. I am not alone in this view. The annual report of the Rockefeller Foundation in no uncertain terms decries the lack of teaching of such subjects in medical colleges and comments that something must be done on the applied side of teaching-the administration of drugs-tlwhich is notably weak in most American medical schools." Observers in many fields are noting this sitftation. It is this lack of training that makes the bush physician fall an easy prey to the soft talk of some promotion agent who by the printed and spoken word, can prove tnat one brand of bicarbonate of soda, made in certain rays of enlightenment is superior to others made elsewhere under a setting sun. We cause our young men to walk down the aisles of ethics in the face of startling statistics which show that from 1913 to 1938 the use of U . S. P. and N . F . prodllcts has dropped from 54% to 22%, and in the meantime, this same study shows that the cost of a prescirption has risen 50%. A learned man of the old south, recently pointed out that medicine is in a changing world and that numerous signs point to a "new orientation of the medical profession in the United States." I might add that this sounds like the word of a Prophet, and how true it will be in postwar medicine when the many changes growing out of this war come to pass. Those who would look to see how a physician views the situation, may turn the pages of a most interesting book titled "Doctor, Here's Your Hat." The volume is replete with humor and much common sense. The author affirms that the graduates of the present-day medicine courses "are in sore need. of assistance" largely due to "inadequate training in prescription writing." So the answer to "Where are we going?" still is hidden away in the midst of the future, but the certain fact that emerges out of it all is that the practice of pharmacy will always be circumscribed to a large degree by the demands made upon it by the other public health professions. The needs of society, as I see it, are best served when society has the right!: 0 use to the fullest extent the combined powers of all these groups. The bCit, at most, is none too good for the sick. Indeed, if the whole public health program is to advance properly, we must have more practical cooperation among the professions most interested. The practice of medicine would gain in all directiolits
286
JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION
were physicians to use to a larger degree the training and ability .of the professional pharmacist. We know, and they should know, that the pharmacist is the only one in the public health field with the proper training to handle the preparation and distribution of drugs. Just what pharmacy faces in the postwar years we cannot set down here. We have helped to give America the finest system of medical care. Are we now to lose it because of a lack of initiative on our part, or are we to share that loss with other groups? Who shall carry the responsibility? As I see it, all groups are to act jointly and forget any selfish ends or the challenge now made by war and changing conditions will not be met.
Dr. L. Pierce Anthony, editor of the Journal of lhe American Dental Association, observes . "the only thing we dentists can do as I see it is to devise a plan of procedure fitted to the new order." James A. Hamilton, president of the American Hospital Association, writes that private hospitals must adapt themselves to modern needs or face replacement by hospitals, staffed and conducted by the government. The West Virginia Medical Journal, August 1943, editorially, under the caption of "Let's direct the changes," takes stock of this challenge. "The profession by and large is ready to meet the issue," it is affirmed and then continues: "One of the most intelligent comments along this line that we have heard comes from one of our members now in the armed forces and is contained in a letter of comment upon Dr. R. J. Wilkinson's presidential address before the recent meeting of the State Association. It is so sensible and so apropos that we 'quote three paragraphs: 'It has been my observation that som~ of those most vociferous in their protests against "socialized medicine" have been the very ones guilty of the practices that have been bringing the issue to a focus. Moreover, it would appear that· their understanding of the fundamentals behind the whole trend is quite superficial. They have lost sight of the fact that change is one of the fundamental laws of the universe. Instead of trying to direct that change into the right and most desirable channels, they have been blindly and dogmatically bucking the whole issue. Change there should be, and I'm not so certain that much of it may not be salutary. The point paramount is to direct that change intelligently, patiently and yet positively to the end that the medical profession may not descend to a mediocre level and the service rendered the people is not likewise of an inferior quality. No scheme can be ideal for any group; it must or should be a balance that promises the greatest value for the greatest number. Why do we resist change rather than try to direct it as nearly aright as is humanly possible'?"
As a matter of fact. the whole field on all sides is faced with the threat of having the public health instrumentalities regimented and controlled by the state. It is our duty to do our part, and the duty of the whole field of medicine to support any sound move to protect the public. The public~ on the other hand, is bound to be attracted by any scheme or plan that carries some promise, no matter how visionary, of some social betterment. And indeed the social planners have not been idle at all. Senate Bill No. 1161, the so-called Wagner-Murray Bill. now before the Senate C()mmittee on Finance, is an example of what may follow. This Bill, carried along on the wings of a disguised social security need, would at once set up an annual payroll tax of approximately twelve billion dollars, half payable by employee and half by employer, which, of course, would influence in some way the financial structure of some 82,000 pharmacists in one direction or another. It provides, in general. that every individual insured would receive general medical care. The physicians would be brought under the direction first and it needs no crystal gazer to point out that pharmacists would follow. We also view with interest the rise of great hospital and medical centers and the consequent effect on the ·distribution of drugs. Changes may come and certainly will in the retail distribution. Plans must be laid to preserve pharmacy under any system that may come into existence. I do not mean to imply that I am a pessimist as to the future of pharmacy, for I am an optimist in that direction, and no matter how dim the outlook it must be recalled that drugs and medicines are essential to the needs of man. By the same token, the pharmacist is indispensable to the physician. Why these movements? One thing as I see it the public is not educated with regard to the achievements of medical and pharmaceutical research. Retail pharmacy is condemned for the commercialization that exists because the basic reasons therefore are not understood. The public is not told that due to the advance in medicine, there is now a lower incidence of disease in the United States than in any other country in the world. The public never hears of the fact that oar death rate has dropped to the lowest in history, or that the life span has been lengthened many years. To illustrate, one hears but little of those contagious diseases which were the scources in years gone by. And now that these problems confront us, we must not forsake what experience has taught us to be sound. It is our duty to protect the public as well as to protect .our own profession at the same time. One great public health administrator once wrote and wisely so that "there can be no practice of medicine without the aid of pharmacy, and there can be no practice of pharmacy without the aid of medi-
PRACTICAL PHARMACY EDITION
cine." To those aRsembled here, I can only say that this is a self-evident truth long held in respect by me. Common sense demands that some plan be de· vised to use the full ability of both. Some phases have been exploited to a sHght degree by a meeting of representatives of the AMERICAN PHARMACEUTICAL ASSOCIATION and the American Medical Association. but the rising clouds of uncertainty n"ow demand more than mere consultation.
287
We cannot but wonder, however,. if the advance gained after years of toil will escape greater State direction or Governmental control in the postwar period. In all events, we must hold the position gained in the educational and legal fields and not let any external force, now in the making, affect the lowering of standards for which we have worked so many years. These unusual times will no doubt lead to further efforts of this kind. However, it is encouraging to note that none was successful in the state legislatures that have met during the year. EDUCATION AND REGULATION Robert Cloth~er, in the Educational Record (July, It may be pointed out here that there has been more progress in the field of pharmaceutical educa- 1943) commenting on a broader concept of education tion and regulation in the last quarter of a century in the postwar readjustment remarks. "This shatthan any other branch\of pharmacy. Indeed, one of tering war, so destructive to all human and physical our chief concerns in the postwar period will be the values has at last given us the opportunity for self rehabilitation of professional education, be it in" appraisal. If we have the wisdom we are supposed to pharmacy, medicine or dentistry. We must expect have, we will seize it eagerly. examine our methods that education in our field will emerge from the war and our purposes ruthlessly and with perfect candor in a far different situation. We must assure our- formulate new purposes. In doing so we shall see education in its essential relationship to the new selves of no permanent damage. world which will follow the war. There wilJ be no On every hand it is claimed already that the room in our educational architecture for ivory streamlined and accelerated courses could be and towers and traditional shibboleths. The ultimate should be continued. It is argued that if a satisfac- destiny of America in this brave world may be now in tory job can be done in much less than four years in the hands of America's educators." time of war, it can be done in time of peace. One noted student of this field writes that "there are some who feel that if the entire four-year curriculum PROGRESS DURING 1942-1943 can be condensed within 24 calendar months during As Theodore Roosevelt years ago pointed out. the war, without impairment of educational standards, then there seems little justification for return- "aggressive fighting for the right is the noblest sport ing to the procedure under which this same training the world affords," so American pharmacy must is spread over four calendar years." Others argue keep up aggressive work in our field and always in for a compromise of three years, but if after the war the interest of the public. As I pointed out in Denall standard college courses revert to the usual four- ver last year, at that time the two great objectives year course, then we cannot afford in the meantime were (1) prosecute with all the vigor at our comto lose the standing for pharmacy which it took so mand any responsibility placed upon the field of long to attain. It is avowed by some that men and pharmacy in helping win the war, and (2) to use women should not be barred by certain requirements all the power in our command to secure public fer entrance to the profession when many of them recognition of pharmacy. Through the efforts of the Committee on War Accould do the work well if given a chance. There is also the question of whether the graduates under the tivities and the cooperation of. those standing and accelerated course are eligible under the existing special committees of the ASSOCIATION which had a provisions of the state laws to registration byexam- direct relation to the war effort. it is correct to state ination and by reciprocity. Medicine and dentistry that our responsibility in helping win the war has are deeply involved in the same problems. At the been discharged reasonably satisfactorily and to the present time, all medical schools are accepting stu· greatest extent possible. The report of this Comdents who have had sixty hours of premedical work. mittee which will follow this address is another imThe students are to be graduated in two and two- portant contribution to this War Conference. thirds years which means a reduction from eight In connection with the work of this Committee. years in Class A Schools down to about four and two- we are again indebted to the A. A. C. P., to the N. A. thirds years. In dealing with these procedures and B. P. and, more recently, the N. A. R. D. This questions. the ASSOCIATION has had and can look Committee has carried an unusually heavy responsiforward to the active cooperation of the A. A. C. P. bility and, as will be pointed out in its report, our and the N. A. B. P. which associations have a pri- profession has made its contributions to the war mary interest in pharmaceutical education and regu- effort without impairment to its civilian service to lation and which are giving these matters fu.rther an extent and in a manner which should be a matter of pride to every' pharmacist in the country. consideration and action at this meeting.
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JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION
Turning now to the second objective, the recognition of pharmacy, the passage of the Pharmacy Corps Bill stands in no uncertain position as an answer. It is not the outgrowth of a new movement, and the passage cannot be set up as the result of any individual's effort. It is the result of the age-old application of the principle of proving to be a governing body the justice of a cause and the need therefor. To us it is the fruition of years of effort on the part of our people to have in the army the same medical service as they were able to procure for themselves in civilian life. This recognition of pharmacy on the part of the most representative legislative body in our country cannot but lead to a greater recognition of the profession on the part of the American people. The legislation will also serve as an incentive toward similar legislation affecting other branches of the armed forces as well as in other divisions of the Federal Government. Another very important development in this connection was the adoption by 20 of the states of our Union of resolutions in favor of the Pharmacy Corps Bill and by resolutions and messages addressed to Congress by other organizations, notably the American Legion, and by prominent officials and citizens of the country. The Committee which had the Pharmacy Corps Bill in charge and the Committee on the Status of Pharmacists in the Government Service have not only brought this important effort to a successful conclusion, but have also contributed to an extent which it is difficult to appraise to the public recognition of pharmacy. This Committee will report other developments in connection with the status of pharmacists in the Government services which also will bring about publk recognition. The question of the deferment of pharmacists and students of pharmacy has received much attention. Encouraging advances have been made in that direction hot only that public health may be main· tained at home but also making it possible for students to complete necessary courses of training. The provisions for the deferment of pharmacists, teachers of pharmacy and pharmacy students involve the recognition of pharmacy as a public health profession and as an activity necessary to the prosecution of the war effort. It seems then that the professional status of pharmacy is no longer a matter of question and that it now remains to make better known the scope and character of its public health service to the American people. The National Quinine Pool is another activity of the ASSOCIATION which has brought the profession and the pharmacists of the country to the favorable notice of the people. The wholehearted response to the appeal for this critical drug and the fact that such a large quantity of it was donated to the use of the men and women in our armed forces and. above all. tbe fine spirit of patriotism in whicb tbese~coD-
tributions were made by pharmacists has and will be an important factor in developing a more favor. able public relation. The services of the Committee on Pharmacy Week should also be referred to in this connection and the developments referred to above should stimUlate this Committee to greater efforts in the future.
MEMBERSHIP It should be emphasized on every possible occa·
sion that the State Pharmaceutical Associations are affiliated with the A. PH. A., that these Associations name a majority of the delegates to the House of Delegates of the ASSOCIATION, and that the State Association members are affiliated members of the A. PH. A. Through this affiliation we have the opportunity of developing a very representative and strong national professional association. It is estimated that the members of the State Associations who are in good standing, total from 82,000 to 40,000 out of the 82,000 pharmacists who we!"e in active practice in 1940. If this estimate is reasonably correct, the affiliation between the A. PH. A. and the State Associations represent'S from 42% to 50% of the active pharmacists of the country, as compared to about 75% representation in the field of medicine. The A. PH. A. is supplying the Practical Pharmacy Edition of the JOURNAL to dues-paid members of the State Associations as a means of strengthening this affiliation and with the hope that the publica· tion will contribute to an increase in the membership of east State Association. As is well known, the A. PH. A. also has honorary, active and associate members. The active members pay dues and are eligible to serve as officers and on committees and to vote in the election of the officers of the ASSOCIATION. The question of active membership is of great importance because only through an increase in the number of active members can other activities be promptly and properly established. And the active members, where were they to come from? The backbone of the profession, the practitioner. In 1941 President Evans remarked that "the most im· portant branch of pharmacy, which is responsible for 80% of its membership has been ne· glected most." Quite true no doubt and deserving of credit because the statement came from a leading practitioner. It was refreshing then to turn to a statement by President Christensen, in 1942, that Hit must be recognized that the backbone of pharmacy is the practitioner. The profession of pharmacy is made up of the practicing pharmacist." So you have the viewpoint of a practitioner and an understanding educator. Evans further noted that "there has been a feeling on the part of some of our pharmaceutical educators that retail pharmacy was
PRACTICAL PHARMACY EDITION
289
mentioned among other prominent scientific, professional and educational institutions very properly ceutical education was keeping up with the practice relieves the ASSOCIATION of a heavy burden. In addition, this legislation is a further recognition on the of pharmacy? But be that as it may. the question part of Congress of pharmacy as a profession and of of membership has received a great deal of attention inthe last year. No matter what we do. if we are to the ASSOCIATION. go forward and render the service we owe to our The Laboratory and the Reference Library in people it must be done through that field. And it our building as well as the offices of the ASSOCIATION is with no small degree of pride that we report an have had to carry an increased load during this year, increase of almost 1200 active members. most of and under trying conditions. At the same time, the whom are practicing pharmacists. and of almost 800 value of the Referenc~ Library and of the Laboratory associate members. all of whom are students of and of the various offices of the ASSOCIATION has pharmacy. It is my most sincere hope that this ef- not been impaired and the added activities which fort will he continued. Our great organization will be reported by others have added to the presshould have not less than 80% of all pharmacists as tige of the ASSOCIATION as well as of pharmacy as a active members. whole. The increase in the active and associate memberUnder the conditions, the number of visitors to ship is due in large part to the splendid work of the our building has been decreased and the Museum Committee on Membership and the Committee on has not attracted its customary attention. Under Local and Student Branches. these circumstances, it was thought advisable to permit part of the space heretofore allotted to the Museum to be temporarily occupied by a division of the REGULAR ASSOCIATION ACTIVITIES National Research Council. This arrangement, Reference has already been made to the special together with many services that have been rendered during the year, has strenghtened our rela,.. activities which the war effort has made necessary, which in most instances are an extension of the usual tions with that important group. activities carried on by various divisions of the AssoAnother organization, the American Society of CIATION including its Standing and Special CommitHospital Pharmacists, has been established during tees. It is impossible in an address of this length to the year. and we congratulate those who have refer to each of these divisions and committees. but brought this effort to a successful conclusion, at the it is an obligation as well as a pleasure to acknowl- same time offering our best wishes for the future sucedge the faithfulness and effectiveness with which cess of the Society. The Society is taking its place. their duties have been carried out during this trying and properly so. among the several organizations period. However. certain of the regular activities affiliated with the AMERICAN PHARMACEUTICAL of the ASSOCIATION are of such character and im- ASSOCIATION which meet at the same time and place portance that they should be referred to briefly. with it, and which are cooperating effectively by The Council has had an unusually busy year and taking over and extending activities formerly carits activities will be reviewed in the annual report to ried on by the ASSOCIATION, This is an age of spethe House of Delegates. In addition to the business cialization and the AMERICAN PHARMACEUTICAL transacted by mail, the Council has found it necessary ASSOCIATION is finding it necessary, as well as adto hold two meetings. since the Denver meeting, in visable, to assist each group of pharmacists to work order to give proper attention to the many important out a professional organization suitable to its special problems which were referred to it at Denver or have needs; it only asks that each of these organizations maintain an affiliation with the AMERICAN PHARMAdeveloped since that time. The publications of the ASSOCIATION have now CEUTICAL ASSOCIATION in order that the profession become an increasingly important feature in the be not too greatly divided in dealing with the broad ASSOCIATION'S program, and while it is difficult to and fundamental problems of pharmacy. meet the views of all pharmacists in these publications, it is true that the pUblications are being more favorably received from year to year and are an important contribution to the progress of pharmacy CONCLUSION in this country. In closing I want to express my deep appreciation The financial position of the ASSOCIATION, together with its resources, have been materially of the honor that has been conferred upon me by strengthened during the last year as will be indicated this organization. Circumstances over which none in the report of the Treasurer. The exemption of of us had any control almost overnight changed the the real property of the ASSOCU.TION from taxation operation of all organizations and not the least of by an act of Congress in which our ASSOCIATION is these was ours. oot keeping pace with pharmaceutical education."
This might be amplified by some to :ask if pharma-
AMERICAN PHARMACEUTICAL ASSOCIATION ROY BIRD COOK PRESENTED AT THE 91ST ANNUAL MEETING COLUMBUS, OHIO, SEPTEMBER 9, 1943
M
any years ago it was set down by a man learned in the la w that men will always consider the problem of men if the solution is good for society as a whole. Public Health, including the basic sciences of medicine and pharmacy, through all the ages has occupied a prominent place along the corridors of time. It touches all men and the preparation of "an ointment compound after the art of the Apothecary" was known long before the writing of the Book of Exodus. A glance backward shows clearly
ROY BIRD COOK
that Brunfels had the same thing in mind when in 1536 he wrote, "in my shop of drugs are stored many things of sweet accord." The same was true when Francis Gilead, apothecary with Cartier, set foot on American soil as the first of our profession in our land. The belief was carried into the opening days of our American Revolution, when Washington set out with a little army, a handful of drugs and medical supplies aud with primitive scales on which justice and medicine alike were measured out. Indeed, at that time, in all the Colonies not over five hundred men had even the most meager of training, in any branch of medicine. By 1778 a little Pharmacopceia appeared, and by 1800 a century of progress opened up in which mountains were surmounted and the influence of pharmacy spread beyond the great valley of the Mississippi. The interdependence of pharmacy and medicine still held sway and the tendency toward specialization became more and more pronounced. But the days of "sweet accord" of 1536 were quietly slipping into the pages of his· tory and new problems were arising on every hand. Some great leader has suggested that a "reformation in Pharmacy is needed today. II On an October day in 1852, a group of splendid "Apothecaries" met in Philadelphia and organized the AMERICAN PHARMACEUTICAL ASSOCIATION. A new source of hope came to this growing field of hu· man endeavor. The establishment of the U. S. P. in 1820 and of five colleges of pharmacy between that year and 1850 had brought pharmacists together. The organization of our ASSOCIATION, the experiences of the American Civil War, the opening of additional schools and the advance of leadership by the 1900's brought pharmacists to a point where it was time to stop and take an inventory. A militant press aided and abetted. The pharmacist set about looking into education and regulation as a means of protecting the public health as well as lift· ing the profession Into its proper place in society. A combination of education and legal requirements opened a new road strewn with perplexing problems. The passing of intervening years has not lessened the work in any direction. Questions arising out of
284
PRACTICAL PHARMACY EDITION
the general field of public health and medicine continue to grow.
And so it is with considerable pride in the past and confidence in the present that this great organization assembles here in the city of Columbus, in its ninetyfirst annual meeting . With the smoke from Pearl Harbor still smarting in our faces we stop to take stock of yesterday, inventory today and look into tomorrow. It may be 'a "War Conference," or a "Streamlined Convention" perhaps, but nonetheless devoted to practical evaluations of how we stand.
POSTW AR PROBLEMS At this time we hear on every hand of postwar problems in the field of medicine. We read in the press reams of words on postwar planning. It is hardly possible from this point of vantage to make any predictions but it does seem inevitable that public health will become a governmental function more than ever. There may be some approach to socialization of medicine. Without attempting to predict, or suggest, in which direction the future lies it can be affirmed that the future of pharmacy i~ deeply involved regardless of the direction in which medicine may advance. At the Denver meeting, the Committee on Long Range Program of Policy was instructed to inaugurate an integrated program in the matter of war and postwar problems, and the Committee will submit a report at the first meeting of the House of Delegates, which report with its recommendations, will be one of the important contributions at this meeting.
WHERE ARE WE GOING? This is a very commonplace question in any field of human endeavor, but it is particularly pertinent at the present time in the field of pharmacy. It will be even more true with all the perplexing problems that will grow out of postwar conditions. This question rests on the minds of our profession from the rock-ribbed shores of New England to the sunny sands of southern California; and from the gleaming retorts of great manufacturing houses to the shining prescription case of a modern pharmacy with its underworked equipment. And, no satisfactory answer appears. One of our great national leaders of long ago observed that it would not be answered until "pharmacy had a common objective," but that answer is not sufficient because pharmacy is so dependent upon other fields. And who would formulate a program leading to that common objective? Certainly as yet, no such power has been entrusted to us. None within the sound of my voice is unaware of the marvelous advances made in the science of medicine and pharmacy. Yet, the same listeners know full well that some way must be brought about to utilize the same powers if we want pharmacy to maintain the lofty standards it now enjoys. Some.
285
one has even suggested that the Boards of Pharmacy are check ~alves on our profession, but may I ask you what IS to become of our profession unless the medical profession and allied groups utilize to a greater extent that product known as a pharmacist? The most needed objective as I see it is to bring about some plan that will change some aspects of the teaching of medicine and bring about a sound u.nderstanding that pharmacy and medicine have a mutual field. I am not alone in this view. The annual report of the Rockefeller Foundation in no uncertain terms decries the lack of teaching of such subjects in medical colleges and comments that something must be done on the applied side of teaching-the administration of drugs-tlwhich is notably weak in most American medical schools." Observers in many fields are noting this sitftation. It is this lack of training that makes the bush physician fall an easy prey to the soft talk of some promotion agent who by the printed and spoken word, can prove tnat one brand of bicarbonate of soda, made in certain rays of enlightenment is superior to others made elsewhere under a setting sun. We cause our young men to walk down the aisles of ethics in the face of startling statistics which show that from 1913 to 1938 the use of U . S. P. and N . F . prodllcts has dropped from 54% to 22%, and in the meantime, this same study shows that the cost of a prescirption has risen 50%. A learned man of the old south, recently pointed out that medicine is in a changing world and that numerous signs point to a "new orientation of the medical profession in the United States." I might add that this sounds like the word of a Prophet, and how true it will be in postwar medicine when the many changes growing out of this war come to pass. Those who would look to see how a physician views the situation, may turn the pages of a most interesting book titled "Doctor, Here's Your Hat." The volume is replete with humor and much common sense. The author affirms that the graduates of the present-day medicine courses "are in sore need. of assistance" largely due to "inadequate training in prescription writing." So the answer to "Where are we going?" still is hidden away in the midst of the future, but the certain fact that emerges out of it all is that the practice of pharmacy will always be circumscribed to a large degree by the demands made upon it by the other public health professions. The needs of society, as I see it, are best served when society has the right!: 0 use to the fullest extent the combined powers of all these groups. The bCit, at most, is none too good for the sick. Indeed, if the whole public health program is to advance properly, we must have more practical cooperation among the professions most interested. The practice of medicine would gain in all directiolits
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were physicians to use to a larger degree the training and ability .of the professional pharmacist. We know, and they should know, that the pharmacist is the only one in the public health field with the proper training to handle the preparation and distribution of drugs. Just what pharmacy faces in the postwar years we cannot set down here. We have helped to give America the finest system of medical care. Are we now to lose it because of a lack of initiative on our part, or are we to share that loss with other groups? Who shall carry the responsibility? As I see it, all groups are to act jointly and forget any selfish ends or the challenge now made by war and changing conditions will not be met.
Dr. L. Pierce Anthony, editor of the Journal of lhe American Dental Association, observes . "the only thing we dentists can do as I see it is to devise a plan of procedure fitted to the new order." James A. Hamilton, president of the American Hospital Association, writes that private hospitals must adapt themselves to modern needs or face replacement by hospitals, staffed and conducted by the government. The West Virginia Medical Journal, August 1943, editorially, under the caption of "Let's direct the changes," takes stock of this challenge. "The profession by and large is ready to meet the issue," it is affirmed and then continues: "One of the most intelligent comments along this line that we have heard comes from one of our members now in the armed forces and is contained in a letter of comment upon Dr. R. J. Wilkinson's presidential address before the recent meeting of the State Association. It is so sensible and so apropos that we 'quote three paragraphs: 'It has been my observation that som~ of those most vociferous in their protests against "socialized medicine" have been the very ones guilty of the practices that have been bringing the issue to a focus. Moreover, it would appear that· their understanding of the fundamentals behind the whole trend is quite superficial. They have lost sight of the fact that change is one of the fundamental laws of the universe. Instead of trying to direct that change into the right and most desirable channels, they have been blindly and dogmatically bucking the whole issue. Change there should be, and I'm not so certain that much of it may not be salutary. The point paramount is to direct that change intelligently, patiently and yet positively to the end that the medical profession may not descend to a mediocre level and the service rendered the people is not likewise of an inferior quality. No scheme can be ideal for any group; it must or should be a balance that promises the greatest value for the greatest number. Why do we resist change rather than try to direct it as nearly aright as is humanly possible'?"
As a matter of fact. the whole field on all sides is faced with the threat of having the public health instrumentalities regimented and controlled by the state. It is our duty to do our part, and the duty of the whole field of medicine to support any sound move to protect the public. The public~ on the other hand, is bound to be attracted by any scheme or plan that carries some promise, no matter how visionary, of some social betterment. And indeed the social planners have not been idle at all. Senate Bill No. 1161, the so-called Wagner-Murray Bill. now before the Senate C()mmittee on Finance, is an example of what may follow. This Bill, carried along on the wings of a disguised social security need, would at once set up an annual payroll tax of approximately twelve billion dollars, half payable by employee and half by employer, which, of course, would influence in some way the financial structure of some 82,000 pharmacists in one direction or another. It provides, in general. that every individual insured would receive general medical care. The physicians would be brought under the direction first and it needs no crystal gazer to point out that pharmacists would follow. We also view with interest the rise of great hospital and medical centers and the consequent effect on the ·distribution of drugs. Changes may come and certainly will in the retail distribution. Plans must be laid to preserve pharmacy under any system that may come into existence. I do not mean to imply that I am a pessimist as to the future of pharmacy, for I am an optimist in that direction, and no matter how dim the outlook it must be recalled that drugs and medicines are essential to the needs of man. By the same token, the pharmacist is indispensable to the physician. Why these movements? One thing as I see it the public is not educated with regard to the achievements of medical and pharmaceutical research. Retail pharmacy is condemned for the commercialization that exists because the basic reasons therefore are not understood. The public is not told that due to the advance in medicine, there is now a lower incidence of disease in the United States than in any other country in the world. The public never hears of the fact that oar death rate has dropped to the lowest in history, or that the life span has been lengthened many years. To illustrate, one hears but little of those contagious diseases which were the scources in years gone by. And now that these problems confront us, we must not forsake what experience has taught us to be sound. It is our duty to protect the public as well as to protect .our own profession at the same time. One great public health administrator once wrote and wisely so that "there can be no practice of medicine without the aid of pharmacy, and there can be no practice of pharmacy without the aid of medi-
PRACTICAL PHARMACY EDITION
cine." To those aRsembled here, I can only say that this is a self-evident truth long held in respect by me. Common sense demands that some plan be de· vised to use the full ability of both. Some phases have been exploited to a sHght degree by a meeting of representatives of the AMERICAN PHARMACEUTICAL ASSOCIATION and the American Medical Association. but the rising clouds of uncertainty n"ow demand more than mere consultation.
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We cannot but wonder, however,. if the advance gained after years of toil will escape greater State direction or Governmental control in the postwar period. In all events, we must hold the position gained in the educational and legal fields and not let any external force, now in the making, affect the lowering of standards for which we have worked so many years. These unusual times will no doubt lead to further efforts of this kind. However, it is encouraging to note that none was successful in the state legislatures that have met during the year. EDUCATION AND REGULATION Robert Cloth~er, in the Educational Record (July, It may be pointed out here that there has been more progress in the field of pharmaceutical educa- 1943) commenting on a broader concept of education tion and regulation in the last quarter of a century in the postwar readjustment remarks. "This shatthan any other branch\of pharmacy. Indeed, one of tering war, so destructive to all human and physical our chief concerns in the postwar period will be the values has at last given us the opportunity for self rehabilitation of professional education, be it in" appraisal. If we have the wisdom we are supposed to pharmacy, medicine or dentistry. We must expect have, we will seize it eagerly. examine our methods that education in our field will emerge from the war and our purposes ruthlessly and with perfect candor in a far different situation. We must assure our- formulate new purposes. In doing so we shall see education in its essential relationship to the new selves of no permanent damage. world which will follow the war. There wilJ be no On every hand it is claimed already that the room in our educational architecture for ivory streamlined and accelerated courses could be and towers and traditional shibboleths. The ultimate should be continued. It is argued that if a satisfac- destiny of America in this brave world may be now in tory job can be done in much less than four years in the hands of America's educators." time of war, it can be done in time of peace. One noted student of this field writes that "there are some who feel that if the entire four-year curriculum PROGRESS DURING 1942-1943 can be condensed within 24 calendar months during As Theodore Roosevelt years ago pointed out. the war, without impairment of educational standards, then there seems little justification for return- "aggressive fighting for the right is the noblest sport ing to the procedure under which this same training the world affords," so American pharmacy must is spread over four calendar years." Others argue keep up aggressive work in our field and always in for a compromise of three years, but if after the war the interest of the public. As I pointed out in Denall standard college courses revert to the usual four- ver last year, at that time the two great objectives year course, then we cannot afford in the meantime were (1) prosecute with all the vigor at our comto lose the standing for pharmacy which it took so mand any responsibility placed upon the field of long to attain. It is avowed by some that men and pharmacy in helping win the war, and (2) to use women should not be barred by certain requirements all the power in our command to secure public fer entrance to the profession when many of them recognition of pharmacy. Through the efforts of the Committee on War Accould do the work well if given a chance. There is also the question of whether the graduates under the tivities and the cooperation of. those standing and accelerated course are eligible under the existing special committees of the ASSOCIATION which had a provisions of the state laws to registration byexam- direct relation to the war effort. it is correct to state ination and by reciprocity. Medicine and dentistry that our responsibility in helping win the war has are deeply involved in the same problems. At the been discharged reasonably satisfactorily and to the present time, all medical schools are accepting stu· greatest extent possible. The report of this Comdents who have had sixty hours of premedical work. mittee which will follow this address is another imThe students are to be graduated in two and two- portant contribution to this War Conference. thirds years which means a reduction from eight In connection with the work of this Committee. years in Class A Schools down to about four and two- we are again indebted to the A. A. C. P., to the N. A. thirds years. In dealing with these procedures and B. P. and, more recently, the N. A. R. D. This questions. the ASSOCIATION has had and can look Committee has carried an unusually heavy responsiforward to the active cooperation of the A. A. C. P. bility and, as will be pointed out in its report, our and the N. A. B. P. which associations have a pri- profession has made its contributions to the war mary interest in pharmaceutical education and regu- effort without impairment to its civilian service to lation and which are giving these matters fu.rther an extent and in a manner which should be a matter of pride to every' pharmacist in the country. consideration and action at this meeting.
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Turning now to the second objective, the recognition of pharmacy, the passage of the Pharmacy Corps Bill stands in no uncertain position as an answer. It is not the outgrowth of a new movement, and the passage cannot be set up as the result of any individual's effort. It is the result of the age-old application of the principle of proving to be a governing body the justice of a cause and the need therefor. To us it is the fruition of years of effort on the part of our people to have in the army the same medical service as they were able to procure for themselves in civilian life. This recognition of pharmacy on the part of the most representative legislative body in our country cannot but lead to a greater recognition of the profession on the part of the American people. The legislation will also serve as an incentive toward similar legislation affecting other branches of the armed forces as well as in other divisions of the Federal Government. Another very important development in this connection was the adoption by 20 of the states of our Union of resolutions in favor of the Pharmacy Corps Bill and by resolutions and messages addressed to Congress by other organizations, notably the American Legion, and by prominent officials and citizens of the country. The Committee which had the Pharmacy Corps Bill in charge and the Committee on the Status of Pharmacists in the Government Service have not only brought this important effort to a successful conclusion, but have also contributed to an extent which it is difficult to appraise to the public recognition of pharmacy. This Committee will report other developments in connection with the status of pharmacists in the Government services which also will bring about publk recognition. The question of the deferment of pharmacists and students of pharmacy has received much attention. Encouraging advances have been made in that direction hot only that public health may be main· tained at home but also making it possible for students to complete necessary courses of training. The provisions for the deferment of pharmacists, teachers of pharmacy and pharmacy students involve the recognition of pharmacy as a public health profession and as an activity necessary to the prosecution of the war effort. It seems then that the professional status of pharmacy is no longer a matter of question and that it now remains to make better known the scope and character of its public health service to the American people. The National Quinine Pool is another activity of the ASSOCIATION which has brought the profession and the pharmacists of the country to the favorable notice of the people. The wholehearted response to the appeal for this critical drug and the fact that such a large quantity of it was donated to the use of the men and women in our armed forces and. above all. tbe fine spirit of patriotism in whicb tbese~coD-
tributions were made by pharmacists has and will be an important factor in developing a more favor. able public relation. The services of the Committee on Pharmacy Week should also be referred to in this connection and the developments referred to above should stimUlate this Committee to greater efforts in the future.
MEMBERSHIP It should be emphasized on every possible occa·
sion that the State Pharmaceutical Associations are affiliated with the A. PH. A., that these Associations name a majority of the delegates to the House of Delegates of the ASSOCIATION, and that the State Association members are affiliated members of the A. PH. A. Through this affiliation we have the opportunity of developing a very representative and strong national professional association. It is estimated that the members of the State Associations who are in good standing, total from 82,000 to 40,000 out of the 82,000 pharmacists who we!"e in active practice in 1940. If this estimate is reasonably correct, the affiliation between the A. PH. A. and the State Associations represent'S from 42% to 50% of the active pharmacists of the country, as compared to about 75% representation in the field of medicine. The A. PH. A. is supplying the Practical Pharmacy Edition of the JOURNAL to dues-paid members of the State Associations as a means of strengthening this affiliation and with the hope that the publica· tion will contribute to an increase in the membership of east State Association. As is well known, the A. PH. A. also has honorary, active and associate members. The active members pay dues and are eligible to serve as officers and on committees and to vote in the election of the officers of the ASSOCIATION. The question of active membership is of great importance because only through an increase in the number of active members can other activities be promptly and properly established. And the active members, where were they to come from? The backbone of the profession, the practitioner. In 1941 President Evans remarked that "the most im· portant branch of pharmacy, which is responsible for 80% of its membership has been ne· glected most." Quite true no doubt and deserving of credit because the statement came from a leading practitioner. It was refreshing then to turn to a statement by President Christensen, in 1942, that Hit must be recognized that the backbone of pharmacy is the practitioner. The profession of pharmacy is made up of the practicing pharmacist." So you have the viewpoint of a practitioner and an understanding educator. Evans further noted that "there has been a feeling on the part of some of our pharmaceutical educators that retail pharmacy was
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mentioned among other prominent scientific, professional and educational institutions very properly ceutical education was keeping up with the practice relieves the ASSOCIATION of a heavy burden. In addition, this legislation is a further recognition on the of pharmacy? But be that as it may. the question part of Congress of pharmacy as a profession and of of membership has received a great deal of attention inthe last year. No matter what we do. if we are to the ASSOCIATION. go forward and render the service we owe to our The Laboratory and the Reference Library in people it must be done through that field. And it our building as well as the offices of the ASSOCIATION is with no small degree of pride that we report an have had to carry an increased load during this year, increase of almost 1200 active members. most of and under trying conditions. At the same time, the whom are practicing pharmacists. and of almost 800 value of the Referenc~ Library and of the Laboratory associate members. all of whom are students of and of the various offices of the ASSOCIATION has pharmacy. It is my most sincere hope that this ef- not been impaired and the added activities which fort will he continued. Our great organization will be reported by others have added to the presshould have not less than 80% of all pharmacists as tige of the ASSOCIATION as well as of pharmacy as a active members. whole. The increase in the active and associate memberUnder the conditions, the number of visitors to ship is due in large part to the splendid work of the our building has been decreased and the Museum Committee on Membership and the Committee on has not attracted its customary attention. Under Local and Student Branches. these circumstances, it was thought advisable to permit part of the space heretofore allotted to the Museum to be temporarily occupied by a division of the REGULAR ASSOCIATION ACTIVITIES National Research Council. This arrangement, Reference has already been made to the special together with many services that have been rendered during the year, has strenghtened our rela,.. activities which the war effort has made necessary, which in most instances are an extension of the usual tions with that important group. activities carried on by various divisions of the AssoAnother organization, the American Society of CIATION including its Standing and Special CommitHospital Pharmacists, has been established during tees. It is impossible in an address of this length to the year. and we congratulate those who have refer to each of these divisions and committees. but brought this effort to a successful conclusion, at the it is an obligation as well as a pleasure to acknowl- same time offering our best wishes for the future sucedge the faithfulness and effectiveness with which cess of the Society. The Society is taking its place. their duties have been carried out during this trying and properly so. among the several organizations period. However. certain of the regular activities affiliated with the AMERICAN PHARMACEUTICAL of the ASSOCIATION are of such character and im- ASSOCIATION which meet at the same time and place portance that they should be referred to briefly. with it, and which are cooperating effectively by The Council has had an unusually busy year and taking over and extending activities formerly carits activities will be reviewed in the annual report to ried on by the ASSOCIATION, This is an age of spethe House of Delegates. In addition to the business cialization and the AMERICAN PHARMACEUTICAL transacted by mail, the Council has found it necessary ASSOCIATION is finding it necessary, as well as adto hold two meetings. since the Denver meeting, in visable, to assist each group of pharmacists to work order to give proper attention to the many important out a professional organization suitable to its special problems which were referred to it at Denver or have needs; it only asks that each of these organizations maintain an affiliation with the AMERICAN PHARMAdeveloped since that time. The publications of the ASSOCIATION have now CEUTICAL ASSOCIATION in order that the profession become an increasingly important feature in the be not too greatly divided in dealing with the broad ASSOCIATION'S program, and while it is difficult to and fundamental problems of pharmacy. meet the views of all pharmacists in these publications, it is true that the pUblications are being more favorably received from year to year and are an important contribution to the progress of pharmacy CONCLUSION in this country. In closing I want to express my deep appreciation The financial position of the ASSOCIATION, together with its resources, have been materially of the honor that has been conferred upon me by strengthened during the last year as will be indicated this organization. Circumstances over which none in the report of the Treasurer. The exemption of of us had any control almost overnight changed the the real property of the ASSOCU.TION from taxation operation of all organizations and not the least of by an act of Congress in which our ASSOCIATION is these was ours. oot keeping pace with pharmaceutical education."
This might be amplified by some to :ask if pharma-