The words in the title will be familiar to those of us who are, or have been, the parent of a teenager. They were written, however, not in the past few months or years, but 5,000 years ago, on a clay tablet by an exasperated Sumerian father in Mesopotamia - now part of Iraq. Present-day parents will empathise with this sentiment. I gleaned this gem of information from a fascinating book,1 a Christmas gift from my own son, which tells the story of the "number" zero.
In Europe, we count by 10s, our mathematics being to the base 10. I recall being taught at school that this was because we have 10 fingers and that mathematics started with people counting on their fingers. According to Kaplan, the Sumerians counted by a number of different bases, including 1, 10 and 60. Our use of 60 minutes to the hour, and 360 degrees in a circle, may have originated with the Sumerians. We know so much about Sumerian mathematics (and much else about their lives) because they left a vast amount of written information, in the form of thousands of clay tablets covered with their cuneiform writing. The tablets recorded details of financial transactions, family history and even the little exchange recorded in the title to this article. Kaplan goes on to describe other historical peoples' experiments with mathematics, down the ages, culminating in such greats as Isaac Newton and Albert Einstein.
How do we know so much about people of the sometimes distant past and their thinking? It is only because they have left behind them records, in the form of clay tablets, carved stelae, vellum or paper. I have, in my own collection, a number of books from the early Victorian age, and one or two from the 18th century. All are perfectly legible, even if the language seems a little quaint. Great libraries possess books from much earlier ages (university libraries often have remarkable collections, as does the British Library). Go to Lincoln cathedral and you can see a copy of the Magna Carta, the great charter signed by King John in the 13th century. It is still clear and legible (if you can read medieval Latin).
Our age is often referred to as the information age. No peoples in the past have ever had access to as much information as we have. With a link to the internet, for instance, almost all the knowledge of the world is at one's fingertips, just a few key strokes away. I can roam the entire catalogue of Cambridge university library from where I am sitting at this moment. I have referred in a previous article (PJ, February 12, p255) to our ability to search the world's medical literature through the website Pub Med and, indeed, started what I hoped would become a regular "website of the week" spot in The Pharmaceutical Journal (whatever happened to that idea?). However, in our marvelling at the wonders of technology in general and the internet in particular, we should remember that much of the information available through, say, the net, is of the most volatile kind. Switch off the computer and it is gone. This is potentially very worrying. A website located today will most likely have changed by next month, perhaps by next week. It can disappear or be altered in a matter of hours. Although the continuous updating of information has its uses (it is never out of date), it has its disadvantages. One of these is that history effectively ends, if the only information is that which has just been put on the website, and we have no idea about what people were thinking, even in the very recent past. Someone (I forget who) once wrote: "History repeats itself. It has to, because nobody listens the first time." This will be even more true if we have no historical records, only that which has just been written. Another disadvantage, which is an off-shoot of the lack of history, is this: for how long will a particular piece of information still be available online? How ironic, then, that Kaplan's little book, which sings the praises of ancient records and which uses them so effectively in the hunt for the "history" of zero, has its bibliography and notes to the text on the web.
Our profession seems to be having its first brushes with the new technology and, as is usual for pharmacy, it is taking fright. Witness the recent alarums and excursions over the first internet pharmacies, which seem to some of our colleagues to herald the death of traditional community pharmacy. Dire predictions of the effect of the net on the profession have, as is customary, been made, such predictions being of course very negative. When I first qualified, in the 1960s, headlines in The Journal in those days seemed always to be on the lines of "Whither pharmacy?" or "Wither pharmacy?". This theme was repeated only a few weeks ago (PJ, April 22, p618). However, more than 35 years after I qualified, the profession seems to be moving forward at an unprecedented pace. We have seen the rise of the primary care pharmacist to supplement the now ubiquitous prescribing and pharmaceutical advisers. The move from primary care groups to primary care trusts over the next year or so will bring about profound changes. This will, for instance, give unrivalled opportunities to integrate some aspects of hospital pharmacy, at one time seen as the Cinderella branch of the profession, into the new primary care structure. The various roles of the community pharmacist will be extended, in support of the Prime Minister's challenge to modernise the National Health Service - that is if we have the courage as a profession to embrace the necessary changes.
The need for high quality pharmaceutical services has never been greater, and if pharmacists do not provide these services then others will do so. To those of our colleagues who fear that "internet pharmacy" will put them out of business, I would say, see the internet as a challenge and a tool, but not a threat. Also, look at the shambles on the stock exchange from the collapse of share prices in the so-called high technology stocks. The first high-profile internet retailer to go out of business has recently done so and it will almost certainly not be the last.
A recent report stated that three to five per cent of the population would regularly be shopping on the net by 2005. However, this also implies that 95 to 97 per cent of the population will still be shopping in the traditional way by 2005. Let us, as a profession, keep things in proportion and not go overboard either in totally embracing technology to the exclusion of everything else, or in taking a latter-day Luddite approach. Both attitudes are wrong. Technology has its place, and we should exploit it to the full, but in support of our traditional role of personal service to patients, not in place of it. Indeed, we have not yet even begun to scratch the surface of the potential benefits of new technologies, both to our profession and to the patients we serve.
| 1. Kaplan R. The nothing that is. A natural history of zero. London: Allen Lane The Penguin Press, 1999. |