Evolution Of Pharmacy Ancient to Modern Times Angela Singh, PharmD Assistant Professor of Pharmacy Practice Florida A&M University College of Pharmacy & Pharmaceutical Sciences

Prehistoric Pharmacy Shanidar (30,000 BC) Supports the theory that prehistoric people gathered plants for medicinal purposes. Knowledge was widespread enough to prevent the need for a special class of drug gatherers and keepers.

Prehistoric Pharmacy cont. Illness was explained in supernatural terms. Disasters Spirits Treatments would follow suit with beneficial medicines working through supernatural means. This pattern continued for nearly all of the span of human existence.

Role of the Shaman Responsible for the compounding of magical potions of cure In charge of all things supernatural within the tribe Diagnosed and treated most serious or chronic illnesses.

Prehistoric Pharmacy cont. Although primitive this period of time brought forth an important concept… Bodily functions could be influenced by an outside force. In order for this concept to flourish the necessary tools such as writing, and a system of exchange and weights would have to be developed.

Civilization is Born Organized settlements arose along the river valleys of the Nile, Tigris, Euphrates, Yellow, Indus and Yangste rivers. The powers of the Gods in day to day life declined A separation between empirical healing and spiritual healing began.

Medicine in Ancient Babylonia

Empirical versus Spiritual: Babylonian Medicine Asu (empirical healer) Used a large collection of drugs Manipulated them into several dosage forms such as suppositories, pills, washes, enemas and ointments. Asipu (magical healer) Relied heavily on spells Used magical stones more than plant materials The two were not in direct competition and would work together on difficult cases. Often times the ill would seek out both looking for a cure

Egyptian Medicine

Egyptian Medicine Papyrus Ebers" (1500 B.C.), a collection of 800 prescriptions, mentioning 700 drugs Demonstrated greater pharmaceutical sophistication with many dosage forms compounded Close connection between supernatural and empirical healing. Plant drugs were the main vehicle of healing power especially enemas and laxatives.

Pharmacy in Greece Most medicines were prepared from plants. Physicians took care of the pharmaceutical part of treatment and they were responsible for the drug being prepared properly and for the administration of the drug. Were groups of drug preparers and sellers which some physicians used.

Religion and Pharmacy: Greece Asklepios Powerful spirit and was a divine ideal for physicians Hygeia Daughter of Asklepios who aided him Carried a bowl and sacred serpent which is internationally recognized as the symbol of pharmacy

Pharmacy in Greece: Hippocrates Father of Medicine Developed the concept of the “ four humors”. Blood, phlegm, yellow bile and black bile. Believed that illness was a result of an imbalance of the humors.

Pharmacy in Greece: Galen Attempted to balance the humors of an ill patient with a drug of supposedly contrary nature. Developed a system of classifying drugs based on their counteractive effects. Simples: One quality Composites: More than one quality Entities: Drugs with specific effects that did not fit the other categories.

Pharmacy in Greece: Dioscorides Traveled with Roman soldiers and recorded his observations. Developed the first encyclopedia of drugs, Materia Medica A systematic way of describing the drugs, their effects and how they should be stored.

Pharmacy in the Middle Ages: The West Crumbling civil authority and the church assumed control Rational drug use declined with the church’s teaching that sin and disease were related. Monasteries became centers for both physical and spiritual healing. Monks wrote short medical texts and grew medicinal herbs in their gardens. Often healing was ascribed to God and not to the medical resources.

Monastic Pharmacy                                                                         

Islam and Pharmacy: Middle Ages Large areas were conquered by the Nation of Islam including… The Middle East, Africa, Spain, Sicily and Eastern Europe. Respected the written word and those who taught it. Many of the Greek writings, including medical, were translated to Arabic. Adopted the teachings of Galen and eventually added to the writings.

Islam and Pharmacy cont. Expansion of trading outposts brought new drugs and spices to the center of learning. Arab physicians began to develop palatable dosage forms. These medications required more elaborate preparation and therefore the work was taken over by specialists, the occupational ancestors of today’s pharmacists.

The First Apothecary Shops in Baghdad

Expansion of Pharmacy In areas where Arabic culture interacted with the West the idea of separation of pharmacy and medicine was passed on.

The Birth of European Professional Pharmacy Frederick II: German Emperor Issued an edict which codified the separate practice of pharmacy for the 1st time in Europe. The edict contained three regulations that created pharmacy as an independent branch of government healthcare. Separation of the pharmaceutical profession from the medical. Official supervision of pharmaceutical practice Obligation by oath to prepare drugs reliably according to skilled art & in a uniform suitable manner.

Information Revolution Printing had a profound effect on the study of plants. Plants could now be illustrated and reproduced in mass quantity. Allowed for field work to be conducted. Allowed practitioners to locate medicinal plants for use in their practice. Valerius Cordus ( 1515-1544) Responsible for writing the first pharmacopeia, Dispensatorium.

The Emergence of Chemistry Paracelsus Advocated the preparation of chemically prepared drugs from crude plants and mineral substances. Sparked the growth of the modern pharmaceutical sciences. Chemical processes allowed for the isolation of the healing properties of the drug. Chemistry emerged as an essential tool in the development of drugs

The Profession is Further Established. During this period pharmacy established legal and scientific foundations. Pharmacy practitioners aligned themselves with similar groups or guilds. Established training requirements, examinations and restrictions on the number and location of shops. Conflicts between groups led to government intervention and the creation of laws which further defined pharmacy.

The Development of Pharmacopeia Physicians were concerned by Greater pharmaceutical sophistication The growth of literature like herbal and distillation books Availability of new drugs Wanted assurance that prescriptions were prepared in a uniform manner. Cooperation between pharmacy and physician guilds led to the development of pharmacopeia.

Practice of Pharmacy: Britain While in Europe the profession of pharmacy had become established the same was not true for Britain Original class of pharmacy practitioners evolved into a second group of medical practitioners. Saw people who could not afford the physicians. As the apothecaries became more like general practitioners of medicine, the chemists and druggists rose up to take over the open pharmaceutical niche. Boundaries between the different professions shifted according to conflicts and court cases. The pharmaceutical profession did not become established until the mid 1800s.

Pharmacy In America

Typical Pharmacy 1850’s Composed of….. Front end work area Emporium Miniature factory to prepare the many preparations and ingredients for medication.

The Pharmacist 1850’s Known as the apothecary Primary duty was compounding Supervised a staff of clerks and apprentices whose duties included… Waiting on customers Sorting, grinding, sifting and filtering the crude drugs. Through their work they learned the science and art of pharmacy

A Profession Facing Challenges In 1852 many problems threatened the development of the profession. Quack Remedies Made false claims of cure Endangered the public health Poisons were being sold No laws effectively governed the medical or pharmaceutical profession. The apprenticeship system was breaking down.

American Pharmaceutical Association ( APhA) In 1852 APhA was founded. Many members felt that the primary duty of the apothecaries was compounding. Battled against the buying of “ ready made” pharmaceuticals.

New Laws Establish Boundaries In response to public and professional concerns new laws regulating pharmacy were passed. Quality of practice began to improve Boundaries were drawn between the medical and pharmacy profession. Previously doctors practiced compounding and apothecaries practiced diagnosing.

The Late 1800’s Large scale manufacturers produced almost all ingredients and were moving toward producing end dosage forms, such as the compressed tablet. Pharmacies began to carry high markup goods and placing soda fountains within the stores.

The Great Transformation 1902-1952

The Practitioners Practice moved from apprenticeship training to requirement of a 2-year course in pharmacy. Period of tremendous growth 1900 = 57,000 pharmacists 1948 = 90,000 pharmacists. At least half of all pharmacists were owners or managers. Served as proprietor, professional pharmacist and general salesman.

The Drugstore Birth of chain pharmacies Charles R. Walgreen acquired 116 drugstores between 1901 and 1927. Independent pharmacies were vulnerable to the efficiencies and practices of the chain operation.

The Medications Dispensed Near disappearance of compounding. 1920’s = 80% compounding 1951 = 10% compounding Increase in the number of prescriptions dispensed.

The Environment Soda Fountain Social center especially after the prohibition act. 60% of pharmacies had soda fountains Also offered food services Began to disappear after World War II largely due to lack of personnel and decrease in profit.

The Hospital Pharmacy Hospital pharmacists were largely unappreciated and under compensated. American Society of Hospital Pharmacists was founded in 1942. Organized local groups Set standards for hospital internships Graduate instruction was fostered. Hospital formularies emerged Pharmacists were seen as drug therapy consultants Hospital pharmacists began to use their knowledge to the extent not feasible for the average community pharmacist.

The Continuing Evolution 1952-2002

Emerging Trends New drugs and new dosage forms lead physicians away from prescribing complex mixtures toward prescribing ready made medications. The Food, Drug and Cosmetic Act categorized drugs as either legend or over-the-counter medications. Removed the discretionary power that the pharmacist had over the sale of drugs.

The Era of Count and Pour Restrictive nature due to the APhA Code of Ethics of 1952 led to the era of count and pour. “ The pharmacists does not discuss the therapeutic effects or composition of a prescription with a patient. When such questions are asked he suggests that the qualified practitioner ( physician or dentist) is the proper person with whom such matters should be discussed.”

Clinical Pharmacy Emerges In 1960 Eugene V. White remodeled his drugstore into an office-style practice and started using patient profile cards. In 1965 APhA promoted the Pharmaceutical Center based on White’s idea. This design influenced consultation areas throughout American pharmacies.

Clinical Pharmacy Emerges Donald Brodie Argued that “the ultimate goal of the services of pharmacy must be safe use of drugs by the public” Ninth Floor Project at University of California Used technicians, unit dose, patient drug profiles, and drug information center. Led to the expansion of pharmacy departments across America. APhA Code of Ethics 1969 “ A pharmacist should…render to each patient the full measure of his ability as an essential health practitioner.”

Clinical Pharmacy Emerges Pharmacists gradually adopted the role of drug advisor Began to see customers as patients Began to check for compliance and interactions

Computerization Computers were expensive during the 1970’s, however by the 1980’s they became affordable and were commonplace in pharmacies Brought a higher degree of accuracy to the payment system. Allowed pharmacists to check for drug interactions and track profiles to improve patient care.

Pharmacy in the 1980’s Growth of Chain Pharmacies Growth of Mail Order Pharmacies Decline in independent pharmacies Adoption of managed care by both private companies and governmental agencies. New pharmacy industry was born Pharmacy Benefits Manager

Birth of Pharmaceutical Care Pharmacy in the 21st Century Conference in 1989 Douglas Hepler and Linda Strand proposed a new practice paradigm. Pharmaceutical care Called for the pharmacist to take responsibility for drug use control “ leading to specific therapeutic outcomes”

Omnibus Budget Reconciliation Act of 1990 ( OBRA ‘’90) Included aspects of pharmaceutical care “ recognized pharmacists as professionals whose expertise can be effectively utilized to … promote rational outcomes from drug therapy.” Required Drug Utilization Reviews (DURs) on all Medicaid patients and also required that patient counseling be offered to these patients.

Pharmacy in the 1990’s Widespread closure of independent pharmacies Mergers in manufacturing and chain sectors. New drugs led to skyrocketing prescription volumes. Pharmacists were generally too busy to devote much time to pharmaceutical care. Very few programs that allowed for reimbursement of pharmaceutical care services.

The Future Innovations such as automation should facilitate the expansion of pharmacists’ professional role.

Questions angela.singh@famu.edu Office #345 New Pharmacy Building 599-3369