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

2. 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.

3. 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’

4. 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

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

6. 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

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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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”

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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