Whither Pharmacy

by Douglas A. Denholm s we in Canada ,i n ,t his year of 1967 celebrate our first centennial as a nation, we look forward to welcoming 'm any thousands of our American neighbors to our country and I hope that many of you will be among them. In less than a decade you will be celebrating your second centennial ,as a nation and so we are just a bit more than half your agebut, as nationhood goes, we are both young. Prior to the Second World War we were among the youngest of nations

A

Presented to the House of Delegates at the annual meeting of the American Pharmaceutical Association in Las Vegas, Nevada, April 10, 1967. o

time of testing ( continued from page

367)

many physicians or pharmacists it takes, in 1967, to render quality health service to 100,000 people. We don't really 'k now whether this ideal number would be higher or lower than it was in 1957 or 1927. The answer has a great deal to do with how those health professionals spend their time and we don't really know very much about tha t, either. About 88 percent of those 118,000 pharmacists were in community pharmacies according to the 1965 survey. How much of their average working day was spent in the practice of their 368

but with the emergence since the war of many new nations we've moved up the ladder. Your country, a child of revolution and mine of evolution, might today pevhaps be termed the teenagers of the world! Well, as one teenager to another-Corne on over to our house this year-we're having a birthday party! The Canadian P.harmaceutical Associationwill be holding its 60th anniversary convention in Toronto, August 13-17, and we are delighted that the AlP hA Board of Trustees la nd the Council of the Federation Internationale Pharmaceutique will be meeting concurrently with us. We certainly hope that members of both groups will remain throughout the

convention, lending it a truly international flavor. I have been virtually instructed to insert at this point a "plug" for Expo '67! This World's Fair, 'commencing on April 28 in Montreal and continuing through October, has all the earmarks of a fair to end all fairs-over 70 nations are participating in one or ,a nother aspect of E~po's theme "Man and His World." In this, our centennial year, I urge you to set your sights for ,M ontreal and Expo '67. A warm welcome will await you. While on the subj ect of visiting between our oountries, I must say how impressed I have always been by the relatively complete freedom with which Amer,i cans and Canadians How

profession-using the skills with which they were endowed in pharmacy sohool, performing the tasks for which they are uniquely wen equipped? How many of t:he tasks they performed could have been done equally well, or nearly so, by persons in whom five years of health professional education had not been invested? What might the professional pharmacists have done with the time thus saved? And what are the implications of the answers to these questions for the educational preparation of pharmacists, for the development of pharmaceuticall assistants? Broadening our field of vision beyond the individual practitioner, we

might ask how might community pharmaceutical services Ibe more efficiently organized to serve the health needs df the community? Should there be, or could there be, a community-wide system whereby each patient's medication record would be tlvailable as it is in a hospitai? Or, widening the focus still further, we see that one of the obstacles blocking access to good health care for many people is not knowing where to start. This is particularly true in a society in which one family in every five changes its place of residence each year. Does the community pharmacist-the most visibly and immediately accessible health professional in

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

back and forth across our long and undefended border to 'a ttend meetings such as A:PhA's annual meeting, to conduct business, to join in ,e ducational conferences and seminars or to just plain visit. This spirit of continental community, which we often tend to take for granted, is something we should cherish and take pride in as a worthy example which we set for many other continents where such intercountry travel is far from free and easy. There are, of course, significant differences between us and we are each, quite properly, proud of our own systems, our own methods, our own .attitudes. The separation of the legislative and executive branches of government, for example, is held forth by Americans as an ideal; in Canada, we integrate the legislative and executive functions and are equally convinced that this is essential to responsible government. The judiciary at the state level in this country is elective; in my country the judiciary is appointed at 'all levels and there is -m uch to be said for-and against-each system. In pharmacy, statutory or licensing bodies in the United States are appointed hy state governments; in Canada the licensing and regulatory function is vested in the pharmacist himself through his professional society or association. One might cite many other differences between us, but of much more significance are the many similarities which mark our endeavors and the problems which face us and our approach to them. I was once told by an American that we were lucky in Canada not to have the kind of jurisdictional rivalry which eX!lsts between state and federal authority in this country. As I told

him, we not only have such disputes between provincial and federal authority but perhaps even more so, as exemplified by ,t he title chosen by the fifth writer of a book about elephants -the .first, a Russian, entitled his book The Daily Work Load of the Elephant; the ,g'econd, a ,F renchman, The Love Life of the Elephant; the third, an Englishman, Hunting the Elephant in India; the fourth, an American, The Elephant-the Biggest Animal in the World; and the fifth, the Canadian, The Elephant- a Provincial or Federal Responsibility? Certainly, in the practice of pharmacy, our problems are more similar than different. Our approaches to them 'm ay vary but, to a great extent, in degree only. The present battle you are entered upon respecting the intrusion in the practice of our profession by members of another-the medical profession-has its counter-

part in Canada. We are following with great interest, and ,cheering from our northern Isideline, the progress of the ,H art IBill in your Congress. I would be remiss if I did not tell you how impressed we were by the submis-sion made by Dr. Apple on behalf of APhA to the Senate subcommittee studying that bill. In the field of health insurance we are probably involved 'a t a more advanced stage than you are, simply because our country has already traveled much farther along the road of providing tax-supported social measures than yours. Canada lies somewhere between the free-wheeling hyperfree enterprise philosophy of the United States and the father-image socialist philosophy of the United Kingdom. I suggest there lis much to your future advantage to be learned from a perusal of our suhmis-sions to the Oana-

any neighborhood-have a special role to play in he~ping people 'gain initial linkage with the health care system? You know your specific problems better than I do. The questions that I have asked may be the wrong questions. Certainrry there are many others. The important point is that in this time of testing for all the health professions, each profession should search its own soul. One generalization applies equally to all the hearl th disciplines-if we are to pass the test that our time and our SOciety have set before us, a great many walls will have to come tumbling down. Some of these wans separate one profession or subprdfession

from others whose duties are inseparalb'ly interrelated. Isolated professionalism is a luxury we cannot afford. Instead of wasting our energies in defending obsol~te barriers, we need to devote our efforts to finding better ways of interlocking skills, of working productively together. Other walls separate town and gown, institutional and non-institutional care, public and private health enterprise. These may have been useful once-though I doubt it. They are anachronisms today. Instead of waHs we need bridges, based on mutual con1fidence and dedicated to service. Finally, we need to' break down 'the

waH that separates the provider from the consumer of health services. As health professionals we need to recognize that health does not belong to us. It belongs to all the people. In our planning and in our actions, we need not only the support and understanding but the fun participation of all elements of the community. Once they ,really get the idea that health is for peoprre, they may make it hot for us but 'they win help us get the big job done. This is indeed a time of testing. It is also a time of oppoctunity unlimited. I hope you share with me a sense of excitement in a career dedicated to health at this time and place. •

President of the Canadian Pharmaceutical Association, Douglas A. Denholm, has been active for many years in association work. A native of Comox, British Columbia, Denholm served in the Canadian Army and upon his discharge in 1945 began his apprenticeship in pharmacy. Upon graduation from the University of British Columbia in 1951, he was a practicing pharmacist and was on the faculty of pharmacy at his alma mater. Denholm is presently the appointed registrar for the British Columbia Pharmaceutical Association and is also councilor of CPhA. Among the positions he has held are the presidency and vice presidency of BCPhA, director of the Canadian Foundation for the Advancement of Pharmacy and vice president of the Pharmacy Examining Board of Canada. He is a member of the Royal Society of Health and the health committee of the Vancouver Board of Trade.

( continued on page 370)

Vol. NS7, No.7, July 1967

369

As the president of the Canadian Pharmaceutical Association Douglas A. Denholm (at the rostrum) addressed the House of Delegates in ~as Vegas, ~e haC! as atte~­ tive listeners (left to right) Chairman Charles A. Schreiber, Executive Dlfector William S. Apple and Vice Chairman W. Byron Rumford.

dian Royal Commission .on Health Services and the two-volume report .of that commission. IB ut these and other activities in which we are engaged .on both sides of the bovder are but symptDmatic treatments of the ailing body of pharmacy. The mainstream of our profession-community pharmacy--in North America seems dedicated to self-destruction. We soothe ourselves into complacent somnolence by pointing to increasing prosperity in our commercial undertakings, meanwhile blithely ignoring the storm signals posted on all sides by such thought leaders, in this country, as 'Brodie in his Challenge to Pharmacy . . . , Sonnedecker in his proposal for a national study and, in my country, IBaxter in his report on future planning, to name but a few. We cry that our public image is deteriorating, we lament the failure of many of our courts to recognize us -as professionals and we curse our legislators for not protecting us. Where does the fault lie? With the public? With the courts? With our legislators? Not by a damn sight! It lies with us, with .our failure to recognize the utter incongruity of professional aspiration in an increasingly commercial milieu. As the professional-commercial balance of our dichotomous profession moves more and 'm ore towards a commercially oriented imbalance, we are faced with an increasing lack of sympathy in .our professional endeavors from the public, from the courts and from legislators. There have been some notable exceptions, of course, such as the recent judgment of the Supreme Court of New Jersey in the matter .of professiDnal advertising, but 370

let's not fDol ourselves that such instances are 'a nything more than exceptions to what j,s rapidly becDming the rule-a public conviction, based on what they see of us at the community level, that pharmacy is just anDther business not a profession at all. I can hear the screams of protest from the mainstream already-"But it's traditional"-"It's free enterprise" -"It's the great NDrth American way." I can only ask, are you prepared to be a traditional, free enterprise North American businessman selling balloons and silk stockings while drugs are dispensed by others, perhaps in the near future exclusively by others; by government dispensaries, by hospitals, by physicians? Well, not me, not me! In my country, and I know in yours, the question is being askedCan society continue to expend vast sums to educate a group of people who, upon graduation, utilize that education to such a small degree to society's benefit?

Ominously, the RDyal Commission on Health Services in Canada, commenting on the alleged (by pharmacy) shortage of pharmacists, statedManpower requirements ... must be based on the efficient utilization of personnel. That is, the retail pharmacist should be engaged as far as possible exclusively in performing tasks.

Let's face it, our legislatDrs and SDciety are IDoking fDr la better educational investment than we are presently offering. We were perhaps slow in achieving a measure of educational excellence in pharmacy compared to .other majDr health professions but we've caught up

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

now. Undoubtedly the greatest strides in the advancement of our profession in North America in the past 20 years have been in the field of education. Our colleges today provide a caliber of pharmaceutical education second to none. It is hard to visualize, and becoming impossible for society to accept (in terms of tax dollars), such an expensive educational system for people content during their productive lives to do little more than pay lip service to their learning. Are you, the leaders .of pharmacy in America, prepared to write off the fantastic strides which pharmacy educators have made in this country? Well, not me, not me! How can we bring about a reversal in this pell-mell road we are traveling to professional suicide? Ideally, by persuasion-but we've tried that and our time is frighteningly short. The alternative is regulation-regulation, self-imposed, and designed to limit, if not le nd, the bifurcat,ion of pharmacy; to establish the professional function and the provision of pharmaceutical service to the public as .our principal concern rather than the residual activity it is becoming today. I am ,realistic enough to realize that such regulatDry controls would be unpalatable but how much more so if initiated from without the prDfession and along their guidelines rather than .ours? I know too that such a suggestion is foreign to the principles of free enterprise but I submit to you that for too long altogether we have allowed our slavish devotion to free enterprise to be used as a license fDr the prostitution .of .our profession. Make no 'm istake, opposition to such efforts from within the profession will be mDnumental. NDtwithstanding, I suggest to you that this is the path that you must set yourselves upon, without reference to such .opposition and in the face of colossal ignorance .of, and indifference to, your motives. That is the price 'Of leadership. The alternative is to allow the world to pass pharmacy by, to ,ignore the sociological, political and economic forces of 20th century NDrth America, to rest content with .our minds firmly imbedded in the professional dDgmas of the 19th century-with the 21st just around the corner. If this is our position, then let us prepare ourselves for the Tole of a mere button on the computer of medical care, rather than the vibrant and integral part of health care which all .our training, all our histDry, all our ideals 'a nd aspirations fit us for. Are you prepared to stand silently by and allDw this to happen? Well, not me, not me! •