The Role of the Pharmacist in Healthcare Lincoln School of Pharmacy Pharmacy Law & Ethics The Role of the Pharmacist in Healthcare

Good Apothecaries! ...fie, fie, fie! pah, pah! Give me an ounce of civet, good apothecary, to sweeten my imagination: there’s money for thee. William Shakespeare King Lear Act IV. Scene VI.

The Healing Professions In early modern Europe many practitioners of medicine were not formally trained Much of medical practice was carried out by village healers and family members But as the economic structure of the continent developed professional activities began to be structured into corporations Medicine was no different to other ‘business’

The Requirements of Licence Between 1500 & 1700 all those providing medical care for profit needed to be licensed The physicians (doctors) formed guilds just as other trades and professions The early pharmacists (apothecaries) also had trade guilds Theses guilds were designed to monopolize the trade as much as ensure quality in practice

Licensed Practitioners By 1500 in Europe three kinds of medical practitioner were licensed Physicians (Doctors GP’s) Barber-Surgeons Apothecaries (Pharmacists)

Apothecaries Apothecaries had formed a licensed corporation or college by 1487 The professions were distinct in how they carried on their trade The Physicians were concerned with the inner workings of the body And they had a supervisory role over the other practitioners

Physicians Treated infections, inflammation, fevers and diseases. They also supervised the surgical and medicinal treatments of the patient by the other medics

Barber-Surgeons Treated wounds, set bones, carried out surgery and cauterization, administered bloodletting along with other services like cutting hair and shaving Supervised by the soon to become all powerful physician

Apothecaries Were the custodians of recipes for medicinal potions and authorities on the pharmacological properties of herbs Again under the supervision of the physicians Occasionally intense rivalry was seen between the guilds largely because they competed for the same patients The echos of this very old rivalry are still with us today

Apothecaries Apothecaries were the manufacturers and vendors of medicines from ancient times They were trained by apprenticeship and were required to be literate in order to read the physicians prescription As early as the 16th century they had the trappings of a learned society or profession

Apothecaries & Doctors The relationship between doctors and pharmacists has often been competitive Even involving strong rivalry Pharmacists were seen by the physicians as interlopers and a competitive threat Medical licensing excluded all but members of medical corporations (The Royal Colleges)

The Rose Case 1704 Only licentiates or members of the Royal College of Physicians could practice ‘physic’ in London (Licensed by the Bishop) In 1704 London Apothecary William Rose challenged this monopoly in a case before the House of Lords And won the right to practice physic without the College’s Licence

The Rose Case 1704 The case was really a battle between the Royal College and The Society of Apothecaries A ‘test case’ as we would today call it The Royal College fought from the position that it was ‘dangerous’ to allow ‘empirics’ of all kinds to practice medicine Medicine was a calling or an professional art while ‘empirics’ were tradesmen

The Rose Case 1704 The Society of Apothecaries argued that they were the doctors of the poor The late 17th century had seen the urban population rise by significantly higher numbers than the population as a whole The towns and cities had insufficient doctors The towns and cities had many poor people Public interest served by allowing apothecaries to practice medicine

The Rose Case 1704 Many believed that the monopoly of the medical profession was an affront to the Englishman’s right to pursue any career he chose The British establishment distrusted corporate monopolies and refused to grant any more medical corporations charters

The Legacy of The Rose Case The battle between the physicians and the pharmacists led to the involvement of law in medical practice It had taken a law suit to determine who could practice in which way And from that point the law took control of the qualification and role of the practitioner

The Changing Role of the Pharmacist The modern pharmacist is part of the treatment team By far the most common medical intervention today is the pharmaceutical intervention Pharmaceutical science is hugely complex and even today very much of how drugs ‘work’ is not fully understood Clearly a need for highly developed expertise

Changes to Practice Changes in pharmacy practice have been evolutionary rather than revolutionary Pharmaceutical knowledge has taken centuries to accumulate From the potions and nostrums of the middle ages and earlier To the complex molecules of modern drugs

Changes to Practice As pharmacy developed from a trade to a science the relationship between the physician and the apothecary changed Modern pharmacists are closely involved in patient care from the development of new drugs, through to finding new uses for old drugs and in applying their skills in designing patient treatment plans

Evolving the Law As pharmacy practice evolved the law governing it had to evolve too… Evolving Pharmacy Jurisprudence: Changing the Law for a Changing Profession Walker & Hoag (1996) 44 Drake Law Review N°. 34

Evolving Pharmacy Jurisprudence “From a professional practice model that focused almost exclusively on fast and accurate dispensing of prescription medications, we can now observe practitioners involved in planning specific drug therapy for individual patients and in sharing the professional responsibility for drug therapy outcomes”

Modern Regulators The profession moved inexorably from one governed by trade guilds and apprentice masters To one governed by Judges, legislators and regulators Pharmacy professional standards are now governed by the law

The Law Comes to Pharmacy Regulation of Henry VIII The first Medical Act Required that all who practiced medicine in London were examined and licensed by the Bishop of London or Dean of St Paul’s Effectively restricting medical practice to physicians

Primacy of the Physicians Throughout the first half of the 16th century physicians maintained the monopoly on patient care (College of Physicians founded in 1518) The Medical Act of 1543 granted rights to apothecaries to administer medications without licence Society of Apothecaries founded in 1617

The Effect of the Law The Medical Act 1543 gave apothecaries rights to treat patients directly Many took this lucrative opportunity and left the confines of the apothecary shop The shops became the responsibility of their apprentices or to ‘druggists’ These individuals needed highly developed skills in materia medica

Apothecaries & Chemists The introduction of the law into medicine resulted in a splitting of the professional duties The apothecaries more and more became involved in patient treatment And the Druggists became more technically skilled in chemistry and the manufacture of the medications

Apothecaries Act 1815 The Apothecaries Act granted rights to the chemists and druggists The Act involved apothecaries in medical education to control standards Leaving the sale and dispensing of medications to the chemists and druggists The Act precipitated a new division in the professions

Manufactures and dispensers of medicines The Evolution of the Pharmacist Apothecaries Manufactures and dispensers of medicines Manufactures and dispensers of medicines Treating patients Medical Education Chemists and Druggists take over preparing and dispensing medicines Manufacturers Dispensing Chemists The Modern Pharmaceutical Industry The Invention and Development of Drugs

The Evolution of Pharmacy As pharmacy developed along professional lines it instigated new innovations The formation of drug companies resulted in new discoveries and inventions Synthetic dye manufacturers evolved into drug companies in Europe Hoechst and Bayer

The Status of the Druggist The skills of the dispensing chemist and druggist were recognised to be of a high level requiring professional examination and licensing in their own right A professional body equal to that of the apothecaries, physicians and surgeons was needed Status and privilege needs protecting

The Pharmaceutical Society In 1841 a resolution was passed bringing into being the Pharmaceutical Society The Pharmaceutical Society adopted laws and a constitution in June 1841 Regulations were instituted establishing examinations and requirements for admission as a pharmacist In 1843 the Society received its royal charter

The Pharmacy Act 1852 The Pharmaceutical Society were instrumental in the formation of the Pharmacy Act 1852 The Act brought the bye-laws and regulations of the Society into the law of the land Establishing regulations for licensing and regulating dispensing chemists across Britain Pharmacy was now incorporated into national law