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Editorial: Crossroads or Crosshairs?

"Pharmacy is at a crossroads"�how many times have you heard that trite expression? It seems pharmacy was at a crossroads almost every year since I entered the profession back in the 1960s. I have heard it said regularly since that time, and here we sit (or stand) and are in the same position! It is almost as if the profession of pharmacy is like a checker or chessboard and we are on the lines, and every time we make a move, we are at another intersection or crossroads.

What holds the future? That's a good question, and I don't think anybody really knows the answer despite how forcefully they make their statements! We are not where we thought we would be 40 years ago; we are not where we thought we would be 30, 20, or even 10 years ago. Some things haven't changed as we still have the best distribution system for the best drugs in the world and get them to patients in a timely manner with associated explanations or discussions with the patient.

Community (e.g., independent, chain) pharmacy still is the largest employer and impacts the largest number of patients. Next would be the hospital pharmacies, followed by specialty and niche pharmacy practice sites. It seems that if community and hospital pharmacy were the largest employers of pharmacists that we should be training students specifically for that type of practice. Activities unique to these practices involve dispensing, compounding, technology, documentation, counseling, etc. However, at the present time, some of these topics are not covered in sufficient depth in academia by qualified faculty.

Niche and specialty practice sites play a great role in pharmacy today, but this is not where the emphasis should be if only a small number of pharmacists go into that type of practice.

Yes, the profession is at a decision-point; do we continue on as we have been going and have a glut of pharmacists in the very near future; or, do we take a hard look at what we are doing now and what it takes to better prepare students to move into the contemporary roles of pharmacy practice today? After all, with the multitude of forces acting on pharmacy from the government, third-party, Big PHARMA, generics, cost-cutting, etc., how are we going to financially exist and what will we be doing in the future? All one has to do is look back about 10 or 20 years and see what changes have occurred that we really had little to do with! The "crossroads," or "decision-point" can also be viewed as "cross-hairs" in the sight of these aforementioned forces to see how they can increase at our expense. Get involved and "Have a Happy New Year!"


Loyd V. Allen, Jr., Ph.D., R.Ph.
Editor-in-Chief

Largest U.S. Hospital Drug Shortage in Decades
Many patients are being turned away for potentially life-saving treatments in what may be the largest U.S. hospital drug shortage in over two decades. According to an editorial of the NEJM (August 2010), limited manufacturing, lagging production time, and lack of profits from these drugs are contributing to the shortage. Some companies state that the production cost outweighs the profits, and many firms would rather produce cheaper generic drugs.

Doctors at local hospitals are frustrated and many times they're not even informed of the shortage, according to survey results released in September by the Institute for Safe Medication Practices. Of those surveyed, 85 percent said they were given little to no information on how long the shortages would last.

This is causing hospitals to spend a great deal of physician and pharmacy time developing priority procedures to allocate available drug, as well as to scour suppliers for drug shipments.
http://abcnews.go.com/Health/CancerPreventionAndTreatment/largest-hospital-drug-shortage-decades/story?id=12452389&page=1

(Editors Note: Would it not be better to have uniform compounding monographs in the USP so compounding pharmacists can fill the need with preparations of the same formulation as those that are manufactured during the time of shortage of a drug?)

Sodium Bicarbonate and Dexamethasone Recalled by American Regent
American Regent has announced a recall of all unexpired 50-mL vials of 7.5% or 8.4% sodium bicarbonate injection and seven lots of 4-mg/mL dexamethasone sodium phosphate injection in 30-mL vials.

The company states that some of the vials contain particulates or have the potential to form particulates before the expiration date.
http://www.ashp.org/import/news/HealthSystemPharmacyNews/newsarticle.aspx?id=3453

A Push to Ease Prescription Drug Shortages
A proposal to ease restrictions on imports of medication from abroad was announced at a news conference to voice concern about a growing shortage of prescription drugs, including morphine and cisplatin, a widely used cancer drug.

According to the announcement, 150 drugs are now considered in short supply in the U.S.-twice as many as five years ago. As a result, there are plans to introduce legislation to speed up the availability of substitutes, including comparable drugs from other countries.

Shortages have been blamed, in part, on production problems as well as decisions by manufacturers to stop making inexpensive generic drugs. Also, a California plant that manufactures cisplatin was shut down by federal authorities earlier this year because of concerns about bacterial contamination.

The proposal would ease restrictions on importing foreign drugs from countries such as Canada, especially when medications are in short supply here. Foreign drugs cannot be imported legally into the U.S., although the FDA can allow exceptions in rare cases.
http://www.startribune.com/lifestyle/health/112639829.html?elr=KArks8c7PaP3iUMEaPc:E7_ec7PaP3iUiD3aPc:_Yyc:aULPQL7PQLanchO7DiUr

(Editors Note: As stated above, would it not be better to have uniform compounding monographs in the USP so compounding pharmacists can fill the need with preparations of the same formulation as those that are manufactured during the time of shortage of a drug?)

�that without pharmacists, the healthcare system in the world would be in a tragic state? We provide quality pharmaceuticals on an on-time basis to specific patients, whether they are manufactured or compounded!

Look-Alikes
A free list of look-alike drug names and their recommended tall-man-letter modifications is available from the Institute for Safe Medication Practices at:
http://www.ismp.org/Tools/tallmanletters.pdf