# Pharmacy: A Look Back at the First 1000 Years and a Vision for the Future



## JeanG (Oct 20, 1999)

The URL for this article is: http://www.medscape.com/Medscape/pharmacol...03.almu-01.html Medscape PharmacotherapyPharmacy: A Look Back at the First 1000 Yearsand a Vision for the FutureVirna Ignacio Almuete, RPhIntroductionOne of the ubiquitous items on a modern pharmacy shelf is psyllium, perhaps betterknown by the brand name Metamucil. However, psyllium is not a new drug. Itslaxative and antidiarrheal properties were known at the beginning of the millenniumand even earlier. The Ebers Papyrus, which dates to about 1500 BC, describesthe use of psyllium in various medicinal products. In the Middle Ages, it was usedfor conta constipacionem ventris. If we can find ancient drugs in the modernpharmacy, has pharmacy evolved significantly from its ancient roots? As weapproach the end of this millennium, what can be said about the accomplishments ofpharmacy in the past 1000 years and what challenges will pharmacy face in the newmillennium?Pharmacy has a long history. Fossils from plants with medicinal properties havebeen found with the remains of Neanderthals, indicating that early man used theseplants as drugs around 50,000 BC. The earliest historical record for the preparationof drugs comes from Babylonia, circa 2600 BC. Clay tablets were inscribed withthe description of an illness, a formula for the preparation of the remedy, and anincantation to impart or enhance the healing quality of the medication.The intertwined role of the physician, herbalist, and priest is found throughout theearly history of pharmacy. It was in the Middle Ages that these roles started todiverge. In 1240, the German Emperor Frederick II issued an edict that essentiallyseparated the practice of medicine and pharmacy, giving rise to the professionalpharmacy. In addition, the edict provided official supervision of pharmacy practiceand ordered pharmacists to prepare drugs "reliably, according to skilled art, and ina uniform, suitable quality." In America, the development of pharmacy took a stepforward when Benjamin Franklin appointed an apothecary to the PennsylvaniaHospital in 1752. Jonathan Roberts was the first person to hold that auspiciousposition. His successor, John Morgan, went on to become a physician and the firstprofessor of medicine, materia medica, pharmacy, and pharmaceutical chemistry inAmerica. Dr. Morgan's life-long pursuit was to establish pharmacy as a professionindependent of that of medicine.Concern over the quality of drug products has been the impetus for changethroughout the history of pharmacy. In 1821, the deterioration of pharmacy practicein Philadelphia was one reason why the first college of pharmacy in America wasfounded. The American Pharmaceutical Association was formed over the concernof pharmacists regarding the import of adulterated drugs. Concern over the safetyand efficacy of drugs in the 1900s spurred the development of the Food and DrugsLaws in the United States. Today, the quality of drug products is regulated on manylevels from drug development, manufacturing, and marketing to the licensing ofpharmacists and authorized prescribers.In the 19th century, pharmacy began a transformation from an art to a science.Natural products that were long a staple in the pharmaceutical armament were beinganalyzed for their chemical makeup. Scientist began exploring the structure of drugs,linking structure to the activity of compounds, and they began to synthesizecompounds with similar structures. Industry was in its infancy but the massproduction of drug products had started.It is in the 20th century that we see a virtual explosion in drug development. This isperhaps most evident in the proliferation of antibiotics. In 1928, Alexander Flemingobserved the inhibitory effects of a mold contaminate in a plate culture ofstaphylococcus bacteria. The mold culture was Penicillium notatum, hence thename penicillin. Ten years later, a group at Oxford refined a technique to extractsufficient quantities of the drug for testing. By the onset of World War II, penicillinwas being mass-produced. In 1999, the number and types of available antibioticshave grown exponentially. Besides penicillin, we have extended spectrum penicillins,cephalosporins, sulfas, aminoglycosides, tetracyclines, erythromycins, quinolones,vancomycin, and clindamycin, to name a few.With the rapid growth in the number and classes of medicines, it would be difficultto pick key drugs that have changed healthcare dramatically. However, it is possibleto list the top drug categories that have had a great impact on worldwide society. Class Significance Vaccines In the last half of the 20th century, vaccines have prevented millions of deaths from diseases such as smallpox and measles. Antibiotics At the beginning of this millennium, infection was one of the major causes for premature death. In the last decades of the millennium, we speak in terms of the causative organism in an infection and whether it is sensitive to an array of anti-infectives. Contraceptives This class has had major effects on the social dynamics of our society and medicine. Antineoplastics Cancer is no longer an automatically terminal disease. Some types of cancer are now curable. Analgesic/Anesthetics Use of anesthetics has contributed greatly to the development of surgical medicine. Analgesics have not only relieved the pain of injury, arthritis, and headache, but they have also improved the quality of life for many sufferers. Cardiovascular agents Along with lifestyle modifications, these agents have improved the quality of life, decreased the chances of the development of other cardiovascular problems, and decreased the occurrence of early death and disability for many patients. Mental health drugs Before the discovery and development of these drugs, individuals suffering form depression, bipolar disease, schizophrenia, obsessive compulsive disorder, and other mental health illnesses that were refractory to conventional medical therapy had no other recourse.Concluding CommentaryThe face of pharmacy may have changed since the beginning of the millennium, butits traditional role remains the same. Although the preparation and preservation ofdrug products have moved from the pharmacy to the pharmaceutical industry, thepharmacist continues to fulfill the prescriber's intentions by not only dispensing amedication but also by providing a quality product, providing advice andinformation, and monitoring drug therapy.The 20th century has been called the Information Age. In the case ofpharmaceutics, with each new drug or novel drug delivery system, a plethora ofinformation is generated about it. The situation will be even more acute in the newmillennium. The majority of currently available medication has been developed in thelast 80 years. In another 1000 years, the wealth of drug and drug information thatwill be available is almost inconceivable. As the drug information resource on thehealthcare team, the pharmacist must be able to keep current on new developments.Expertise in information technology will be mandatory.Drug research has traditionally gone by the premise that more is better. Agents aregiven to subjects until the side effects become intolerable. The amount of drug that isright before the intolerable dose becomes the "right amount" to give all patients.Scientists are starting to explore other approaches, such as looking for the lowestdose that gives a desired effect. They are exploring the factors of age, gender,genetic makeup, and their effects on the metabolism and excretion of medications.Perhaps in the future, dosing may not go by a simple recommended dosage range.An individual's drug dose may be titrated according to biologic factors andconcurrent medications.Pharmacy has come a long way in the past 1000 years. At the beginning of thismillennium the herbalist prepared compounds as written by a physician. In the 18thand 19th centuries, pharmacists were discovering the active components in naturalproducts. Today, the pharmacist is responsible for dispensing a medication,providing advice and information, and monitoring drug therapy. As we enter thenew millennium, the role of pharmacy in dispensing and providing advice andinformation will continue to expand. As drug information experts, pharmacists canbe the major factor in the delivery of rational drug therapy. New informationtechnologies will enable a pharmacist to extract clinical information for an individualpatient, examine concurrent medications, look at a group of potential drug therapies,and tailor the dosing of a particular medication to meet the needs of individualpatients. Perhaps the goal of pharmacy in the future is to have a prescriber write thefollowing prescription: Joe Smith (medical history attached) Dispense: antihypertensive medicationWouldn't that be something to look forward to?


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## moldie (Sep 25, 1999)

I especially like those last two paragraphs Jean. My feelings are that there has been a big flaw in "monitoring drug therapy."


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