[e-drug] Dispensing Doctors Monitor article (cont'd)

[Richard Parrish <RParrish@su.edu>]

E-drug: Dispensing Doctors Monitor article (cont'd)
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Dear colleagues:

The birth of European pharmacy can be traced to a fiat decision of
Germanic emperor Frederick II between 1231 and 1240. This
decision separated the professions of medicine and pharmacy
(apothecary) with official supervision of the practice of drug
preparation by duly sworn practitioners (Sonnedecker, Kremers
and Urdang's History of Pharmacy, 1986, pp. 34-35). The decision
applied to much of middle Europe as well as extending south to the
Sicilies, and was likely transplanted with Anglo-Saxon migration to
the British Isles. In Africa and Asia, this did not occur.

Later, in the Americas, there was a hodgepodge of attempts to
apply European mechanisms for the control of drug preparation
and use. In the late-nineteenth century, a movement began to
replace "therapeutic nihilism" (ala Oliver Wendell Holmes Sr.) and
empiricism with a "rationalized" approach to medicine. The empirics
(eclectics, homeopaths, Thomsonians, apothecaries and the like)
were both "diagnosticians" and "dispensers." Many could make a
living only by being both and selling a physical product as the
charge for one patient visit. (Remember they were not paid at the
time of service - practitioners sent out bills annually for their care.)
With the application of scientific principles to drug action and
discovery of the germ theory, many began to question the ethics of
making diagnoses and selling drugs to remedy those complaints. A
division of labor began to emerge in conjunction with individual
state licensing laws that identified the "jurisdiction" of professional
boundaries.

That said, there is nothing inherently unethical about selling drugs
(regardless of time or place in history) to patients who present with
complaints that (1) you have knowledge about, and (2) you know
what you are doing. If there are laws or regulations CURRENTLY
on the books that govern the practice, that's one thing. I do not
recommend violating the law. However, to ask for additional law
and regulation that circumscribe and restrict voluntary exchanges
between consenting parties by statute is not appropriate in my
judgment. The patients I see are sent to me because I know what I
am doing, and I have more-or-less contractual arrangements with
other practitioners that guide (but not dictate) my care.

Regarding the situation in Africa, the WHO advocated the
de-professionalization of health care many years ago in order to
reach and care for the ill and dying. Is this still the WHO policy?

Regards,

Richard
 
Richard H. Parrish 
Assistant Professor of Pharmacy Practice
Shenandoah University
Bernard J. Dunn School of Pharmacy
1775 North Sector Court
Winchester, VA  22601
tel: +1-540-678.4392
e-mail: RParrish@su.edu

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