The Pharmaceutical Journal Vol 264 No 7095 p692
May 6, 2000 Letters

Pharmaceutical care

An attack on critical thinking

From Professor N. Barber, MRPharmS

SIR,-I was disappointed to find myself sniped at from your recent editorial (PJ, April 22, 609). Your implication seemed to be that by discussing the philosophy of pharmaceutical care I was missing the point that pharmacists need to be getting out there and doing it. This is wrong on two counts: first, pharmaceutical care is a philosophy of care, so should be the subject of debate; second, we are teaching and doing it in plenty.
It seems ironic that I should be lampooned for "philosophical musings", when pharmaceutical care is the result of the "philosophical musings" of Hepler and Strand. However, pharmaceutical care, as originally defined by Hepler and Strand,¹ and as adapted by Cipolle, Strand and Morley² is, in my view, flawed.³ While I agree with everything it is trying to do, it is not sufficient to deal with the real world many practitioners find themselves in. Put simply, it does not help practitioners when they come to rationing decisions - the issues that sometimes lead to the conclusion that it is right for someone to receive treatment that is good, but not the best possible. The fact that most research has taken place in community pharmacy in the United States means that this issue has been unlikely to feature much, but it has long been an issue for hospital and health authority pharmacists in the United Kingdom, and will become so for those advising primary care groups. If pharmaceutical care is to be a unifying philosophy of care for all pharmacists then it must be useful in all settings.
My second point is that you imply that I am fiddling while Rome burns. Nothing could be further from the truth. At the Centre for Practice and Policy most of our research is in the area of medicines management/pharmaceutical care - identifying medication related problems in patient care and developing new services to help solve them. We have an international reputation for this work. We also teach it extensively. Our undergraduates are in no doubt that their role is helping patients with their medicines - they meet patients within the first few weeks of their first year and regularly throughout their undergraduate course. We have also been providing postgraduate qualifications in this area for 20 years and are one of the largest providers of these courses in Europe.
What worries me is that this attack on me is also an attack on critical thinking. Surely our professional journal should be encouraging people to think critically about issues in pharmacy. The fact that the PJ publishes an editorial that criticises me for doing so reflects far worse on the PJ than it does on me.

Nick Barber
Professor of the Practice of Pharmacy, School of Pharmacy, University of London

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