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Pennant Roberts is a pharmacist from Altrincham,
Cheshire
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It used to be that NHS prescriptions had a tick-box inscribed with the
letters NP. These letters, standing for nomen proprium, the Latin for “proper
name”, allowed doctors to keep aspects of their prescribing practices
shrouded in mystery. If GPs did not wish their patients to know the name
of their medicine, the box could be left without a tick.
Older pharmacists will remember when all dispensed medicines were issued
with no identifying names. Their labels read “The mixture”, “The
tablets” and so forth. Before 1980 most medical practitioners considered
it inappropriate to give their patients such privileged information as
the generic or proprietary name of their medicine. Many pharmacists held
similar views, myself included. We thought that lay people should be
kept in the dark. A popular saying of the time was: “A little knowledge
is a dangerous thing.” As a supporter, I lamely argued that knowing
the correct name of what your doctor had prescribed would lead to sharing
of the medicine with others. This attitude derived largely from the notion
that most people would never understand the science behind their drug
treatments. The credo was that professional activities were best kept
private.
We pharmacists preferred working in dispensaries hidden behind an ornately
carved screen using Latin terms to give added aura to our calling. Doctors,
in their turn, would write sick notes to say their patient was suffering
from coryza, this sounding more impressive than revealing here was a
case of the common cold. Critics of the system said such practices stemmed
from a need to justify physicians’ fees. It may have been true.
I took pleasure in dispensing prescriptions that read “Adeps lanae
hydras, more dicto utendus, mitte ounces iv”, and then presenting
an anonymous jar impeccably wrapped in white demy. Clinging to my apothecary
image, I could well have audibly muttered “fiat secundum artem”.
Ironically, defenders of Latin cited that, by learning its exact rules
of grammar, words acquired a clearer meaning and this would benefit the
way English was used. So why did we take such pains to cloud our public
pronouncements?
Such ideas had persisted for generations. Consider the opposition to
adopting metric measurements. The resistance prevailed throughout pharmacy
(indeed the entire medical profession) until the latter part of the 1960s.
Not until the end of that decade did those curious squiggles denoting
drachms and scruples and the use of Roman numerals disappear from doctors’ prescriptions.
The bilateral use of the avoirdupois and the apothecary systems was an
absurd anachronism. How can I begin to explain to present-day pharmacists
the logic of a 1 per cent aqueous solution consisting of one grain of
solute dissolved in 110 minims of water?
There followed another period of inertia. The implementation of typed
labels took a further 10 years. Have we forgotten the handwritten (often
indecipherable) prescriptions that prevailed into the 1980s? Many doctors
seemed to take a pride in their bad handwriting. Was this another device
to give the aloof medical fraternity the appearance of being learned
beyond the understanding of the masses? A scribbled prescription for “Tab
acid acetylsal” might serve to disguise that only a commonplace
aspirin tablet had been ordered.
But mysticism was under threat and eventually I became a convert to more
transparent communications. There was no room in medicine for old-fashioned
mumbo jumbo, I now declared. We must be scrupulously honest with patients.
After all we were belatedly being encouraged to offer clear advice to
the public on medical problems. How could I ever have simultaneously
embraced science and superstition? I had my pompous excuse ready. Had
not Isaac Newton and Robert Boyle, back in the 18th century, both supported
alchemy while making their singularly important contributions to mathematics
and physics? My hypocrisy was still intact.
But before disowning the old system entirely could I indulge in a few
nostalgic observations? When we pharmacy students passed that gruelling
Pharmaceutical Chemist examination some 50 years ago, I believe we emerged
with an exceptionally wide scientific education. We covered practically
all the accepted disciplines of the day. To study biology meant embracing
the subject from botany to zoology. Organic and inorganic chemistry were
taught alongside mechanics, refraction and electricity. Our practical
training involved quantitative and qualitative analyses. Microbiology
shared the syllabus with pharmacognosy and biochemistry. Dare I suggest
our curriculum was formidable? We had no free periods to break up our
timetable. For the final PhC examination we were required to sit 10 three-hour
theory papers on five consecutive days. A six-hour laboratory examination
in chemistry was accepted as reasonable, during which we were sustained
by a beaker of tea and a meat pie at the end of the bench.
Tutors were often martinets proudly possessing academic degrees along
with front-line industrial diplomas. We students flourished scalpels
and razors to bring forth specimens for microscopic study. We dissected
frogs, dogfish and rabbits, cascara bark, liquorice stolons and ipecacuanha
rhizomes. Perilous chemistry experiments were routine, conducted with
a minimum of safety precautions. Every student performed the classical
test for arsenic and happily set out to manufacture ether, the apparatus
shielded under a damp cloth. We all bore the marks of oil of vitriol,
shrugging stoically as our white coats disintegrated into holes. Admittedly,
when our careers went their diverse ways, some did ask to what avail
this wide-ranging study was. At least at the end of the course we knew
the difference between hypothesis, theory and law. Personally it left
me with a lasting respect for those who relentlessly pursue scientific
truths.
How easy to suggest that memorising British Pharmacopoeia monographs
gave us a respect for plain English, enabling us to identify platitudes
when we heard them. Recalling our past gullibility, it obviously failed
to do so. And yet the letters page in The Pharmaceutical Journal now
suggest that university-trained pharmacists are bothered by modern jargon
and spin.
Modern education allows more time to explore ideas and encourage creativity.
Candidly, students of my day were excessively concerned with memorising
facts, so we seldom challenged the status quo. But has the change of
emphasis in education led to total openness in communication on medical
matters? Misleading claims in advertising copy are still tolerated. Pseudo-science
(surely as unacceptable as old superstitions) appears to abound. Has
the fall in the number of university students pursuing laboratory-based
science subjects led to a breed of arts-based mountebanks posing as scientists?
The mumbo jumbo of my day may have disappeared but has it been replaced
by gobbledegook? |
The
Pharmaceutical Journal