Rx'ers juggle professionalism, business - Clozaril monitoring program by Sandoz Pharmaceuticals angers many pharmacists - Inside Pharmacy - editorial

Rx'ers juggle professionalism, business

For as long as my career in pharmacy spans, some 25 years, retail pharmacists have tried to answer the same question over and over: Is it possible to mix the business of running a drug store with the professionalism expected of a registered pharmacist? The answer I always give is a definitive "maybe."

It is a complicated question, and one that has been given considerable thought by pharmacists, academicians and consumers over the years. I think if you polled most retail pharmacists today, the answer would be "yes." But when push comes to shove, do they really mean it? I'm not sure.

The question of professionalism has been handled easily by scores of colleges of pharmacy offering a Pharm.D.-only curriculum. It always seems to me their inference is that without the Pharm.D. degree in your hands upon graduation, professionalism in any pharmacy setting goes right out of the window. Does a Pharm.D. degree prepare a retail pharmacist to be any more professional in a drug store setting than a B.S.? I'm not sure.

But, there is apparently no question about professionalism in the minds of consumers. Just look at the latest Gallup study. Pharmacists once again ranked as the most trusted health professional. But does being the most trusted professional mean being the most professional? I'm not sure.

I think before the question of professionalism can be argued there has to be a definition of "professionalism" on the table. Does it mean coming to work in a shirt and tie and a white jacket? Does it mean being available to answer consumers' question in a timely manner with intelligible answers? Does it mean accepting prescriptions that have to be compounded, even if it does take extra time? Or does it mean doing blood screenings? To me, I think it means all of them and more.

Maintaining a balance

While I believe that most pharmacists would like to practice pharmacy with the highest degree of professionalism, the reality is that they are still working in a business setting and the balance between professionalism and business must be maintained. To put it simply, the prescriptions still have to be filled while the questions keep coming. It is a difficult juggling act and probably the single most disturbing factor in practicing retail pharmacy today.

The question of professionalism is once again under the spotlight when Sandoz Pharmaceuticals told retail pharmacists that they would not be able to handle the company's drug for schizophrenia, Clozaril. The drug requires close monitoring, the kind of monitoring that Sandoz believes cannot be done at your average retail drug store. Instead, Sandoz chose to go to a closed distribution system when it hired Caremark, a division of Baxter Labs, to do the necessary screening. Several national associations and dozens of state associations immediately came to the aid of hurt retail pharmacists by condemning Sandoz's action. While I understand retail pharmacy's point of view, I also understand Sandoz's.

A juggling act

You see, Sandoz is also doing a juggling act. There is no doubt that the company knew a closed distribution system would get the hairs of every retail pharmacist in the country standing on end. But it also knew that not every pharmacy in the country was, or is, prepared to handle the extra workload necessary in the Clozaril screening process. They needed assurances that Clozaril would be available in every geographical area of the country. It would have been a nightmare to survey every pharmacy to see if they could handle the product and the extra time it would take to properly tract blood levels, etc. From a business and professional point of view, it was just easier to let one company nationwide handle the screening process. Many pharmacists, and their associations saw the action as a black eye for pharmacists. I did not.

In fact, I'm puzzled by the ire being vented by retail pharmacists over the Clozaril issue. One just has to look at Florida for a perfect opportunity thrown away. Several years ago, when a law was passed in Florida that allowed pharmacists to dispense a very selective group of prescription drugs without a prescription, I took a trip down to the Sunshine State to see how things were progressing. I was dismayed to learn that with very few exceptions, most pharmacists were staying away from prescribing. I argued then that it was a golden professional opportunity being thrown away. My sources in Florida tell me that little has changed. The law is still on the books but not terribly effective. The reasons cited over and over again for not prescribing are the same: liability, lack of time to properly counsel patients, and extra paperwork.

I am sure there are many stores that can easily handle the requirements set forth in the Clozaril screening process. But if we really have the patients' interests at heart, this is one time I think professionalism must win over business.

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