history and future of pharmacy

why should we study our history?

“a profession without a history is merely an occupation with pretensions.” - Dr. Gregory Higby

we need to know where we are coming from to know where we are going

what makes pharmacy a profession?

• you can’t just give people drugs just because they asked for them

• pharmacists require specialized education and training

• they follow prescribed moral and professional code of conduct

• committed to continuously develop skills

• member of a professional body

apothecary era (~2600 B.C. - 1700 A.D.)

ancient China (~2000 B.C.)

• prehistoric and ancient western therapeutics

• diagnosed and treated

• utilized plants and natural materials

• apprenticeship-based

  • you study under someone who has been practicing (to learn passed on knowledge)

• educated others on herbs

some herbs they used at the time are: honey, opium, turmeric, sage, mint

apothecary era (~2600 B.C. - 1700 A.D.)

Arabia and Medieval Europe (~700 A.D. - 1300 A.D.)

• private apothecaries emerge by 8th century A.D.

  • people would come in an purchase versus it being out in the open

• standardized instructions for preparing medications appear

  • recipes

• societies separated the arts of apothecaries from physician services

  • formalized by King Frederick II in 1240 A.D.

still at the time passing down knowledge through apprenticeship

in Arabia and Medieval Europe (~700 A.D. - 1300 A.D.), who formalized the separation of arts of apothecaries from physician services?

King Frederick II in 1240 A.D.

• it separated the tasks of diagnosing and treating

in Colonial America (1640)

• few physicians immigrated

• community members filled the gap relying on folklore, herbs, minerals, and even magic

John Winthrop, 1st Governor of Massachusetts Bay Colony, helped people using plant-based remedies

summary of apothecary era (~2600 B.C. - 1700 A.D.)

• healing based on herbs, minerals, and natural remedies

• knowledge passed through apprenticeship or family tradition

• 8th century AD: apothecary shops emerged

• 1240 A.D.: King Frederick II formalized separation of pharmacy from medicine

• 17th Century Colonial America: local plants + Native America remedies (e.g., quinine from cinchona bark)

no standard requirements for education, pharmacopeia, or regulation

The United States Pharmacopeia (1820)

• United States Pharmacopeia convention in1820

• developed list of medicinal drugs with their effects on directs for their use

• designed to bring uniformity, promote safety and quality control

  • wanted to make sure that everyone was getting similar treatments no matter where the patient decided to go get checked at

1820: only physicians at the USP convention; 1840: pharmacists finally included

in 1820, who was at the USP convention?

only physicians

in 1840, who were allowed to the USP convention?

pharmacists and physicians

the first college of Pharmacy was created in 1821. where was it located?

in Philadelphia

Pharmacists of Philadelphia voted in April 1821 to form an associated named the Philadelphia College of Pharmacy. School opened in November 1821

the second college of Pharmacy was created in 1823. where was it located?

in Boston, MA

Massachusetts College of Pharmacy (1823)

founded in 1823 with occasional classes by 14 area pharmacists; first graduation in 1869

• the occasional classes were people coming together to exchange their knowledge

what was the first college to admit black students (1867)?

Howard University College of Pharmacy, DC

• pharmacy program separated from medicine in 1870

  • admitted students of all races and genders

who is considered to be the “mother of pharmacy”?

Elizabeth Gooking Greenleaf (1681-1762)

• born in 1681 in Cambridge, MA

• opened apothecary shop in Boston in 1727

• first female apothecary in 13 colonies

  • first recorded apothecary

• operated with her husband, a physician, for decades

evolution of pharmacy education

what happened in the year 1868?

U of Michigan abandons apprenticeship?

evolution of pharmacy education

what happened in the year 1906?

standardized 4-year BS recommended

evolution of pharmacy education

what happened in the year 1910?

Flexner Report formalized MD training

evolution of pharmacy education

what happened in the year 1922?

era of “count & pour” begins

evolution of pharmacy education

what happened in the year 1932?

nationwide standardized 4-year adopted

evolution of pharmacy education

what happened in the year 1946?

pharmaceutical survey recommends 6-year program

evolution of pharmacy education

what happened in the year 1948?

MA requires a pharmacy degree

evolution of pharmacy education

what happened in the year 1960?

5-year BS program minimum standard

evolution of pharmacy education

what happened in the year 1975?

Mills Report recommends 6-year PharmD

evolution of pharmacy education

what happened in the year 2004?

6-year PharmD implemented nationwide

evolution of pharmacies

what kind of pharmacies were around in 1800s-early 1900s?

independent apothecaries/drugstores

• person starts a pharmacy, trains younger generation (their kids/relatives) and then the cycle keeps going

evolution of pharmacies

what kind of pharmacies were around in mid-1900s?

chain pharmacies grow

• inc in consumer demand

• health insurance

evolution of pharmacies

what kind of pharmacies were around in 1960s-2000s?

growth of insurance and mail order

evolution of pharmacies

what kind of pharmacies were around in 2010s?

speciality pharmacies enter

evolution of pharmacies

what kind of pharmacies were around in 2020s?

telemedicine & digital pharmacies era

• amazon pharmacies and having people mail their prescriptions rather than going to pick it up in person

evolution of pharmacy practice

Mills Report, 1975 → recommended a 6-year PharmD

Pharmaceutical Care → first emerged in 1970s, widely adopted in 1990s

OBRA 1990; Drug Utilization Review (DUR), Patient Counseling, Maintaining Records 2000s. Patient Centered Medical Home concept expands to include pharmacists.

what was the “count & pour” era?

pharmacists were taking the prescription and counting it out and then handing it to the patient

factors driving growth of clinical pharmacy

• decline of pharmacology in medical schools

• growth of physiology and therapeutics education in pharmacy schools

• development of Pharmacists’ Patient Care Process vision

1962: drug info center at U of Kentucky

1966: pharmacists rounding with medical teams at UCSF

• pharmacist is there when physicians and the rest of the medical teams are engaging with the patient (provides a more wholistic experience for patients)

evolution of the pharmacist role

• diagnostician, preparer of medication and spiritual healer →

• preparer of medication →

• drug development (still do this) →

• dispenser of medication (still do this) →

• evaluator of how drugs work (still do this) →

• patient educator (still do this)