For the Public, for the Profession

state of pharmacy • • •

for the public, for the ·profession fter ten years of being intimately involved in the affairs of our AsSOCIATION, I should have known that when I took office a year ago I could expect to have the most exciting year of my professional life. I recently told our 'associates in industry at their annual meeting that the presidency of the AMERICAN PHARMACEUTICAL ASSOCIATION is anything but an honorary position. It is the opportunity of a lifetime for a pharmacist to champion his profession with all the resources of his national professional society at his disposal. Notwithstanding all of the problems of American pharmacy, I can assure you that we have made progress this past year, that we have advanced pharmacy the profession, that we have improved the public image of pharmacists and that we have experienced considerable self-improvement. We have every right to be proud of ourselves just as we have a continuing responsibility never to be satisfied with ourselves. We can and we will do better-for the public, for the profession and for ourselves. In inter professional affairs, it has been my privilege to speak for and about pharmacy at meetings with medical practitioners, dental practitioners, practitioners of veterinary medicine and the nursing profession. Everywhere I was received graciously and with the accord given a professional colleague. The profession of pharmacy, through the efforts of her dedicated

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practitioners, continues to gain in stature and importance in the eyes of our prescribing . and patient-care associates. Our health associates and their societies are recognizing our new professional determination, our increased · effort to be in the mainstream of professional health care today. The encouraging fact is that as these other health professions see us improving and advancing ourselves, the more they will support and assist us. Within the profession itself, these past months have seen me carrying the message of APHA from coast to coast and border to border. Wonderful were the many kindnesses, the many, many times the hand of fellowship was extended to me by pharmacists. No inconvenience, no sacrifice, seemed too great to those pharmacists who met me at airports at four in the morning or who had worked to bring a group together to visit with me at 11 that night. The list of such instances would be too long to recite so allow me to thank you now . You were all wonderful hosts. I will call upon my year's experiences to report to you on the state of pharmacy. We pharmacists are, first of all, citizens of the greatest country in the world. Like all citizens we are feeling · the social tensions of this particular moment in our history, we are experiencing the same economic uncertainty of our neighbors and we are-even with our education and experience -apprehensive about the proliferation Vol. NS6, No.6, June 1966

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of scientific and technical devices for good and evil. Like our neighbors, we are disquieted by a shooting war overseas that eludes solution. As health professionals, we pharmacists are wondering about medicare, its implementation and its probable expansion. We are concerned with the economics of pharmaceutical service, with professional fees, with dual pricing practices, with generic-only directives and with discount and mail order drug programs. Pharmacists are concerned with complaints from their patients about drug prices, about proprietaries and o-t-c's that are introduced through the pharmacy but then mass merchandised through the supermarkets, about being excluded from VA hometown programs, abou t the increase in the number of pharmacy holdups and narcotic thefts, about being accused of profiteering by ambitious politicians who make headlines with sweeping charges about drug costs. Pharmacists tell me they are tired of defending manufacturers, disgusted with organized medicine's refusal to act decisively on physicianownership and physician-dispensing and weary of pharmacy's being overlooked or ignored when it comes to planning and carrying out governmental health programs. These are some of the things that pharmacists are thinking about. These are some of the things that are bothering them. The AMERICAN PHARMACEUTICAL ASSOCIATION, as an association of like-minded professionals, reflects the thinking and the needs of its members. Additionally, it assumes the responsibility of national leadership for those members when work must be done. APHA is working on the needs of pharmacists in the area of medicare. It is working on the economics of supplying pharmaceutical service. It is working on the problems and obstacles that detract from the professional and social stature of pharmacists. When medicare became a legislative reality last year, APHA and its affiliated associations fought for the freedom of choice principle--for the public and the pharmacist. Through the efforts of the Delaware Pharmaceutical Society, we secured a freedom-of-choice provision in the U.S. Senate bill. It was lost in the give and take of the Senate-House compromise bill that resulted in medicare, but we did cause Congress to consider the freedom-of-choice principle. I daresay that if it had been the national professional society and her 50 affiliated states working together on it a t that time that we would have been completely successful. APHA, being in Washington, is naturally in daily contact with medicare officials. Our executive director, William S. Apple, is, as you know, an 290

Journal of the

official consultant to the Welfare Administration on Title XIX. The Academy of General Practice of Pharmacy has scheduled several programs and discussions specifically to acquaint you with medicare, its regulations and its opportunities. APHA continues to help pharmacists make the transition from markup to professional fee. Equally important, APHA is advising and helping state governments arrive at just and reasonable professional fees for your professional services when you take part in state welfare programs. Opposition by the pharmaceutical industry and others to the professional fee may delay its acceptance, but it will not prevent it from eventual, universal use by pharmacists. Pharmacists who utilize the professional fee report overwhelming patient and prescriber acceptance. Third party payees recognize its validity and appreciate its simplicity and administrative economy. We are all encouraged, I know, by the increasing acceptance and success of the APHA Pharmaceutical Center. I consider it to be one of the biggest breakthroughs to have taken place in the community practice of pharmacy in the past 60 years. Since I became your president, two more wholesale firms have joined in the program and are offering a number of approved Center designs for pharmacists. At this meeting we have on display for you a new Center with several innovations, including modifications to help you serve nursing homes. While we have made progress in many areas with our prescribing associates, such is not the case in the matter of physician-ownership and physician-dispensing. We have met formally and informally with the American Medical Association and frankly we find little hope of interprofessional success. Certainly no better example of APHA's leadership of the profession and service to its members exists than in the work done by APHA on the Drug Abuse Control Amendments. We literally worked on and with the bill right from Congressional consideration to the White House signing and on to implementation. A brochure that went through many reprintings was prepared and in the mails the day after I witnessed the signing of the bill into law at the White House. I am very proud to have a pen President Johnson gave me after signing the law. The APHA brochure explained the law's provisions and requirements to pharmacists, as did a special tape recording prepared by our legal division for use at state and local meetings, not to mention the direct telephone question-and-answer hook-ups that were arranged between APHA and state and local meetings. A 12-page inventory form listing the

AMERICAN PHARMACEUTICAL ASSOCIATION

more than 300 stimulant and depressant drugs which had to be inventoried on February 1 was provided to pharmacists by APHA. APHA itself distributed more than 62,000 copies of the form and several state associations, state boards, wholesalers, National Association of Chain Drug Stores, American Hospital Association and others were given permission to reprint the copyrighted forms. Every APHA member in community and hospital practice also received an APHA Record Book of Stimulant and Depressant Drug Transactions. We continue to advise the Food and Drug Administration on the views of the profession as it further implements the drug abuse law and we continue to try to help practitioners fulfill the requirements of the law. The drug abuse symbol that FDA requires was originally recommended by APHA and rubber stamps bearing the identifying symbol are available from APHA for use in your practice. As pharmacists we are especially familiar with the influence research has had in the developmen t of the pharmaceutical industry. Research can have a similar effect in helping the profession find solutions to problems, discover new opportunities and improve present practices. In the past the profession has invested only a pittance in research and study for its self-improvement. APHA is trying to change this. APHA and its specialty affiliate, ASHP, have just completed a year-long study of pharmaceutical services to ambulant patients by hospitals and related facilities. The report has been received and approved by the APHA Council and the complete report will be available in book form. Glenn Sonnedecker recently completed an exploratory paper for a possible national study of pharmacy as a professionalized occupation. Your APHA Council reviewed the Sonnedecker report before coming here and voted to seek funds to implement the study. It will cost an estimated $500,000. Is the profession prepared to make this investment? The nurses recently did; other professions do it periodically. If the pharmacists of this country assume their membership responsibilities, the profession would not have to look beyond its own ranks to invest in developing its future. You will recall that it was APHA in 1960 that initiated a research and study program on prepaid pharmaceutical services. The formal study was begun in May 1961 by Joseph McEvilla. During the past year, a number of prepaid plans have been submitted to APHA for endorsement or direct sponsorship. We have not endorsed any. Many pharmacists have urged APHA to operate its own prepayment plan. \Vhether this is wise, necessary, practi-

on the presidential trail President Grover C. Bowles accepts the key to the city of Dallas from Mayor Protem R. B. Carpenter, Jr. (below) at the APhA opening session. On the lighter side (left), he laughs his way out of his own hanging by the Cow Town Posse at the barbecue.

The final touch, the pinning on of a boutonniere by Mrs. George Griffen hagen (right) preceded President Bowles' appearance at the annual banquet where the lady in his life, Mrs. Bowles, accepted a bouquet of roses (far right) from House of Delegates chairman, William R. Whitten, for her untiring devotion during the president's year in office.

cal, or even possible, must be carefully thought out. Our decision must be based on all the information we can possibly secure. APHA did not give up studying prepayment during the past five years just because there was little interest in it throughout the profession and APHA is not going to act hastily now just because prepaid prescriptions have become a popular idea. Just a few weeks ago the school of pharmacy at the University of Mississippi sponsored an outstanding conference on this subject. We need more such critical discussions and fewer sales pitches. I can assure you that APHA will continue to work on this project. We believe a prepayment program good for the public will also be good for the profession and we will be a party to nothing less. In services to members, APHA continues to expand. A film strip and , tape recording explaining pharmaceutical services in nursing homes will be premiered here at our meeting and will

be available afterward for your meetings at home. The APHA Health Education Cen ter Service is providing more and more pharmacists with health information material for their patients and the service itself was highly praised to millions of newspaper readers by Margaret Dana in her syndicated column. The committee on disaster and national security has published an Orientation Manual on Disaster Preparedness for Pharmacists clearly outlining the pharmacist's responsibilities in a disaster. A new income replacement insurance program has been approved which is an addition to our professional liability insurance program, our hospital money plan, our retirement investment program and, of course, our APHA life insurance plans. These plans have all been carefully studied and have been added to help pharmacists meet not only their personal needs but the needs of the pharmacists who are employed by them. Other plans will be

added as the needs occur and as qualified programs are proposed. In Washington, the second session of the 89th Congress is being viewed as a consolidating and appraising period in contrast to the first session which brought forth more major health legislation than ever before enacted. Bills of great interest to the profession continue to be introduced. I refer to the proposals for mortgage insurance for group practices of medicine and dentistry, for study of U.S. adoption of the metric system, physician-ownership, prescription-legend drugs for noninstitutionalized patients under medicare, of the mailing of drug samples and of President Johnson'S broad proposals for improved facilities and consumer protection. APHA receives daily reports on the progress of these and other measures of interest to you and APHA speaks for the profession on them when advisable. The realities of life in Washingtonand in state capitals across the country Vol. NS6, No.6, June 1966

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-include questions on the number of voters our organizations represent, on the unified strength pharmacy has. The linking of arms with us by the pharmacists of Texas and South Carolina has brought to 11 the number of states that have voted to affiliate with APHA. Others continue to study this critically essential step and in some states the question of affiliation is now being decided. Less than three years ago, many Texas pharmacy leaders were against affiliation but in a democracy nothing is final. New leadership brought new attitudes and the courage to let the members decide. I regret that I cannot be very optimistic about the outcome of several pending affiliation votes. The leaders in these states are unequivocably opposed to affiliation. This is their privilege; yet these same leaders advocate and pursue affiliation of local associations within their states, using the very same reasons APHA has offered from the start in advocating state-national affiliation. To the state leaders who oppose affiliation, I would ask one questionIs not what you advocate for your states worth advocating for the profession nationally? One such state last year adopted a house of delegates system, a mail ballot and a unified dues structure for all pharmacists- all principles advocated and utilized by APHA for years. As long as organized pharmacy remains anemic in number of members and divided instead of united in a localstate-national structure, we will be

played off against each other. The principle of affiliation- that is that pharmacy will be stronger when all pharmacists are members of their local, state and national associations- cannot be denied by even affiliation's most selfseeking opponent. Noone has ever said the affiliation mechanism is perfect; we have only said that it is the one best method we have at hand to give pharmacy back to pharmacists. Furthermore, we all realize that we will never get 100 percent membership by pharmacists in their local, state and national associations. Some pharmacists are not now deserving of having their names on the rolls of professional societies. Only if they are willing to change their ways will they be welcome in our national professional society. I have been most encouraged during my travels by the deep conviction of pharmacists that ultimate success in community pharmacy lies in increased professionalism. Pharmacist members have given us hundreds of suggestions for saving the independent practice of pharmacy. While economic proposals are many, the suggestions concerning education and increased professionalism in practice far outnumber them. Obviously, community practitioners, while dissatisfied with pharmaceutical education in some respects, see education as a major method not only of saving pharmacy but of advancing it. I would urge educators to give heed to the practitioners' suggestions for increased professionalism and to consider the consequences when they fail to motivate our young pharmacists toward careers as

Preluncheon comment from Thomas B. Curtis, Congressman from Missouri, draws chuckles from fellow Missourians and APhA staff members attending a luncheon in his honor. Pictured are (left to right) Ken G. Mehrle, president-elect of the Missouri Pharmaceutical Association; Gerald C. Henny, grand secretary of Kappa Psi Fraternity; Robert Steeves, APhA legal division director; Cora D. Cox, executive secretary of the Missouri Pharmaceutical Association; Congressman Curtis; J.W. Lansdowne, past APhA president, and William S. Apple, APhA executive director.

practicing health professionals. While our young pharmacists are the best scientific and technical graduates our profession has ever produced, our colleges are still failing to instill in our young people the image of the community pharmacist as a health professional and not just a Main Street merchant with five and six years of college education. Our colleges must help the profession bring its practices of pharmacy up to the same high level of professionalism as the science of pharmacy. It has become obvious to me that the missing link in pharmacy education, and even frequently in pharmaceutical practice, is personal contact by the practitioner with the patient. Our students must be exposed to institutionalized patients and must have a firsthand opportunity to observe how drugs function. Our community practitioners cannot be content to let patients be anonymous to them, but known to a clerk who receives the pre- ' scription-order and hands back the dispensed prescription. APHA is urging the American public to select a personal pharmacist with the same care it would select a personal physician. Is your practice helping to implement this policy? In conclusion, I want to thank you again for allowing me to serve as your president and for giving me the most exciting and satisfying year of my professional life. I am proud that I may have had a small part in helping the AMERICAN PHARMACEUTICAL ASSOCIATION move forward and gain recognition as a vital, essential force in American society. I hope that you will give my successor the same unstinting cooperation and support you have given me. I would urge that in the years ahead~

pharmacists practice continued introspection to guard against that uneasiness in the public mind that could produce additional, restrictive legislation concerning us ~ pharmacists resist the temptation to seek competitive relief through self-interest legislation ~ pharmacists continue to make the health needs of the public their true objective so that they can instinctively and aggressively respond to the expanding needs of the American public ~ pharmacists provide the financial assistance the profession requires to undertake research on the practice of pharmacy. The harvest of this investment will certainly benefit them and the people they serve.

The AMERICAN PHARMACEUTICAL ASSOCIATION believes that professional growth can be achieved by helping individual pharmacists improve themselves and their capacities to contribute to our national health . • Z9Z

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION