The Pharmaceutical Journal
Vol 269 No 7206 p58
13 July 2002

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The profession of pharmacy leaves science behind at its peril

By A. T. Florence

It is rather sad and possibly illuminating that in all the discussions about the future of the Royal Pharmaceutical Society and the future of the Council and its make-up and responsibilities, little has been said about the role of academic pharmacists, especially those with expertise in the sciences that underpin our profession. Academics can yield a tremendous influence for good, enthusing and educating future generations of the profession. One of the Society's roles is to promote pharmaceutical education. Up until now it has attempted to do so without the influence of academics at the centre of things, although it draws on the experience of some academics on its Education Committee. Until recently all important decisions made by that committee had to be ratified by the Council. But it was sadder to read (PJ, 22 June, p885) Peter Curphey's reported words (albeit in relation to the training of pharmacy support staff), and no doubt deep-seated feelings, that pharmacy "might be regarded in the future as part of the health family and not as some weird science profession that worked in laboratories" — a beautiful turn of phrase or mind. Now we know. So much for the pharmacists who work in laboratories in hospitals or industry, producing products for patients to take and for Mr Curphey to dispense. And forget those pharmacists doing research in laboratories to gain their masters degrees and doctorates to furnish the intellectual elite of the profession and even, perhaps, one or two future academics. So much for the unified profession.

An anti-academic tinge

There has been an anti-academic tinge to some of the discussions in the corridors of Lambeth, echoing the problem Cyril Maplethorpe had in the 1960s in persuading the Council that pharmacy should be an all degree profession. I was told once by a past-president, that education was far too important to be left in the hands of the likes of me. My response at the time, which increasingly becomes prescient, was that the profession was perhaps too important to be left in the hands of the Council. The drive for the four-year degree was led by academics, myself being one, and not with wholehearted support from every Council member.

With Council members who have such a disdain for, or probably ignorance of, science is it any wonder that the profession is constantly being overlooked when matters requiring real expertise are needed. With such lack of understanding we should not be surprised if there has not been at Council level a debate about the need for, impact of and consequences of the setting up of new schools of pharmacy? Has the Higher Education Funding Council for England been engaged about the wisdom of investing in new schools or in our existing network of 16 schools, or both?

In the avowal of its non-partisan nature, to many of us it seems that the Council's bias is towards community pharmacy, and hence cannot represent us. So far community pharmacy has not been the hotbed of new ideas, new developments or, because of its structure, innovative leadership. Although the Society by and large tolerates us, others welcome us. Academics serve the community through being part of the Committee on Safety of Medicines, the committees of Cancer Research UK and the Medical Research Council, the Medicines Commission, and the British Pharmacopoeia Commission. But on our Council? No. Yes, we do not get elected, but the Council has also found in the past no need to change the way it is elected and constructed.

The presence of some academic authority is essential if the Council is to have any credible role in the future of the educational provision for pharmacy. Although some would not like lay representation to be in the majority on the new Council, the Council inflicts, effectively, lay members on the regulation of schools of pharmacy in pursuing its statutory role. This is certain to change, but it would be better if the Council not only exercised what it is eternally good at, policing, but was involved in more informed educational drive and experiment, a source of ideas and support. Its community bias has, I suspect, led to it when it thinks of education to be over-enamoured with pharmacy practice as an academic discipline.

Over the years we have heard much of the need for more pharmacy practice in our schools. Students often believe that pharmacy practice is a subject with a life of its own. The real preparation for practice is the application of science to practice. This gives meaning to practice and prepares us all for the future. But we are growing a professional breed of academic pharmacy practitioners whose science has been left further and further behind. Clinical pharmacy was and is different, because it was rooted in clinical pharmacology, but many new practice colleagues are of a new breed, and their PhD students and successors will be even more remote from the science base. Good, some might say, Mr Curphey no doubt among them, we need graduates more in touch with reality and less with esoteric facts. Today's reality will impact on our graduates soon enough. Tomorrow's science will also. We may be found wanting.

The problem is that we might be so re-engineering our graduates that they will be merely organisers, professional auditors and empathisers, the science left behind at the blunt end of the wedge scheme of pharmacy education, where the first and second year science falls away to a pinhead in the final year to allow, no doubt, "skills for health" to flourish. Perhaps we in the schools of pharmacy are our own worst enemies, but these trends have been encouraged and promoted by the Society.

Bereft of science

The pages of The Pharmaceutical Journal are practically bereft of science. So to the casual reader it appears that we practise without science. This reinforces the views of the neophyte pharmacist that science is for passing examinations not enhancing patient care; in other words, some weird activity only for laboratories and certainly not dispensaries. The letters pages erupt with discussions on homoeopathy: the espousers of the craft castigate those who attempt a scientific, rational critique of what homoeopathy really is. Pharmacy persists because of fear of offending, and does not educate the public whose understanding of homoeopathy is far from secure. We scorn grocers and newsagents who sell medicines, but do not bring our superior knowledge to bear on the aromatherapies and other dubious remedies that we sell. The Council supports PhDs in ethics, yet cannot see the most obvious problem with pharmacy in the high street: in attempting to sell nearly everything that can find an excuse for being in a pharmacy and some things that cannot, we lose our moral authority and thus cannot criticise garages and grocers for selling medicines that could be argued should be exclusive to ourselves. I trust that it has an intelligent way of espousing the prescribing and dispensing of medicines by the profession in the context of its views on dispensing doctors. An interesting future awaits.

Beware Council members dictating our future. Without the weird science we have none. Nurses will take over all our roles if we have nothing distinctive to offer. We can have no monopoly of generic skills whether they be communication skills or the philosophy of ethics; perhaps only we can look at the structure of a statin and say not only which one is hydrophobic or hydrophilic and hence likely to be the safer, but also to know why. But perhaps that is not a "skill for health" for those who cannot tell why. I believe that weird scientists need their say otherwise we will all end up holding hands around the bedside and there will be no one in our laboratories to provide the essentials — the new medicines, the new knowledge.