Pharmacy in the Digital Age

In 1979, I was a pharmacy intern. I was given a task every intern was “blessed” with: doing the monthly updates for Facts and Comparisons. This amazing reference came in a 6-in-thick binder that would be opened, have old sheets removed, and new sheets inserted. Every intern would moan when that big envelope arrived in the mail. It was the best reference of its time.

Peter A. Kreckel, RPh

Back in 1984, I looked high and low in pharmacy journals for any information on veterinary products. I reached out to one of the journals and asked them to publish a continuing education article on veterinary medications. They said they did not have anyone with any expertise but that I was free to write a continuing education (CE) article on the topic. I remember buying a book, similar to the old Physician’s Desk Reference (PDR), that contained some information about medications that veterinarians used. But it was not nearly enough information to create a CE article, so I busied myself with creating and helping raise our 3 children instead.

Fast-forward to 2005: I landed a job teaching pharmacology at St Francis University in their prestigious physician assistant program. The department chair provided me with a weekly list of learning objectives, and I spent hours in our basement creating lectures. Although the internet was available, there were very few references online; Ask Jeeves was as close to Google as we had, and digital research using our dial-up internet would have tied up the phone lines for hours on end. Instead, I would use my own vertical file that had magazine articles in manila folders arranged by topic, and—of course—the trusted Facts and Comparisons. Even with my wife, Denise, helping me scour print references for information, it took me 6 hours to create a 1-hour lecture.

In 2010, after conducting live, online presentations for PharmCon, I proposed doing a veterinary medicine lecture. The owner gave me the go-ahead and I started my internet research. I found a few veterinary references online that were helpful, and I bought a copy of Plumb’s Veterinary Drug Handbook. I covered medications for horses and cows as well as dogs and cats. I submitted the program and it went live; the views were through the roof! No one had seen a CE program in the world of pharmacy that focused on veterinary medications before. It was through this program that most pharmacists learned for the first time that a single dose of acetaminophen could kill a cat.

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The following year, I reworked the program, this time featuring only dogs and cats and using only medications that were available in the drugstore. I bought a copy of Blackwell’s Five-Minute Consult: Canine and Feline. Of course, I found out about this reference on the internet. There were more and more veterinary references available, and this program too had impressive viewership. Today, pharmacy students can complete a residency focusing on veterinary medications; at the start of my career, there was no mention of veterinary medications in the pharmacy world.

Information is at our fingertips, and we seasoned pharmacists use the internet as a tool to supplement and extend our knowledge. But this wealth of information still requires a working knowledge of pharmacology to know what to ask. So many of my students, both pharmacy and physician assistant alike, have been frustrated with pharmacology and would ask, “Why do I have to know that when I can look it up?” I tell them that a physician never asks you a question that you can answer on your phone; they have a phone too—and probably a better one than yours! I tell them that if they look up Premarin (conjugated estrogens), they will learn that is approved for prevention of bone loss. But they must dig further to learn that we never use Premarin for osteoporosis prevention, based on the HERS trial. We must know the drugs, and we must know what questions to ask so we can really care for our patients.

Of all the things I write about with regard to the changes of the profession in the past 45 years, one of the benefits I have seen is the wealth of information now at our fingertips. But pharmacists should never forget that it takes 4 years of intense study to know what to ask, how to interpret the data, and, most of all, whether those data come from a reliable source.

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