The evolution of the R.Ph.: No longer 'seen but not heard'

Those roles tend to fall into one of five categories: access, accuracy, efficiency, safety, or quality. That's how David Brushwood, professor of pharmacy and healthcare administration at the University of Florida, Gainesville, describes pharmacy. "As we move into new areas, we can put just about anything pharmacists do-from compounding to risk management to robotic design to drug utilization review-into one of those categories," he said. "Pharmacists who are prospering and happy are those who are flexible and can see themselves doing things differently as needs change."

The first known American pharmacist was a 17th century apothecary who opened for business when New York was still known as Niew Amsterdam, said Michael R. Harris, M.S., R.Ph., former associate curator of pharmacy and public health for the Smithsonian Institution. The earliest surviving pharmacy inventory order was a mix of patent medicines, charcoal, pots, and pans imported from Europe.

Expect change

Pharmacy changed as America changed, Harris continued. By the time of the American Revolution, pharmacists had become smugglers and counterfeiters. Trade sanctions had cut off supplies of vital medications such as quinine and opium. Only R.Ph.s knew where the raw materials came from or how to turn dusty bark and dried poppy juice into useful formulations.

After the Revolution, pharmacists became skilled chemists. European suppliers reserved special stock for what most of the world saw as a poverty-stricken backwater: GEFA, good enough for America. Americans got the leftovers that suppliers couldn't dump anywhere else.

One result of supply problems was the creation of the U.S. Pharmacopeia in 1820. USP was an attempt by physicians and pharmacists to create quality standards and standard formulas for medicines.

More than 300 pharmacy cookbooks were published in the United States during the 19th century, Harris noted. One of the most active publishers was the American Pharmaceutical Association, founded in 1852.

When the Civil War broke out, pharmacists on both sides were scaling up familiar compounding techniques into vast factories that churned out such vital medicinals as whiskey and morphine.

During Prohibition, many pharmacists turned to distillation to meet continuing demands for potable alcohol. During the Great Depression, demand shifted to cold cream and other cosmetics that pharmacists had the skill to create.

When a 1950 survey found that only 26% of all Rxs were compounded, pharmacists began looking at ways to move out of the shrinking world of compounding and into the new universe of direct patient care.

In 1955, the University of California, San Francisco, created the first six-year Pharm.D. program. Ten years later, UCSF had pharmacists in the wards and round-the-clock pharmacy services based on unit-dose distribution, consultative services, and a drug information center.

Enter the future