Pharmacy Practice & Ethics

Tareq Mukattash, PhD

 Course Content
Week Topics

1 Pharmacy history

1-3 Pharmacy services in different sectors

4 -5 Social and behavioral aspects of pharmaceutical work

6-7 Selecting, supplying and managing medicines

8 Ethics in healthcare
Ethics & practice 1:
-Patient rights
9 - 11 -Confidentiality
-Different patient groups (i.e, patients with terminal illness)
-Capacity & patients consent
Ethics & practice 2:
-Pharmaceutical work ethics
12 - 13 -Pharmaceutical research ethics
-Availability of medicines
-Unlicensed and off-label drugs
14 - 15 An introduction to laws governing pharmaceutical practices in Jordan

NB: all references are available at the University’s library

 (1) A glance at history
• Cavemen almost certainly rolled the first
crude pills in their hands

• The earliest known prescriptions date back to

at least 2700 BC and were wri)en by the
Sumerians.

• Chinese pharmacy traces its origins to the

emperor Shen Nung in about 2000 BC.
• Egyptian pharmacists were priests, and
they learnt and practised their art in the
temples.

• Greek philosophers began to influence

medicine and pharmacy - not only
observed nature, but sought to explain
what they saw, gradually transforming
medicine into a science

• Greek medicine continued with the rise

of the Roman Empire
• The transition of
pharmacy into a
science received a
major boost with the
work of Dioscorides in
the first century AD.

• In his Materia Medica

he describes nearly
500 plants and
remedies prepared
from animals and
metals, and gives
precise instructions
for preparing them.
• The greatest influence on
pharmacy was Galen (130 to 201
AD)

• He introduced many previously

unknown drugs, and was the first
to define a drug as anything that
acts on the body to bring about a
change.

• He gave his name to

pharmaceuticals prepared by
mechanical means (galenicals).
• The first privately owned drug stores were
established by the Arabs in Baghdad in the
eighth century.

• They built on knowledge acquired from

both Greece and Rome, developing a wide
range of novel preparations, including
syrups and alcoholic extracts.

• One of the greatest of Arab physicians was

Rhazes (865–925 AD).

• His principal work, Liber Continens, was to

play an important part in Western
medicine.
• These new ideas became
assimilated into the practice of
pharmacy across western Europe
following the Moslem advance
across Africa, Spain and southern
France.

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• The greatest figure in the science
of medicine and pharmacy during
this period was the Persian, Ali ibn
Sina (980 to 1037 AD), who was
known by the western world as
Avicenna.
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• His Canon Medicinae is a synopsis of Greek and Roman
medicine.

• His teachings were treated as authoritative in the West

well into the seventeenth century and they remain
dominant influences in some eastern countries to this day
• In European countries exposed to Arab
influence, pharmacy shops began to appear
around the eleventh century

• Frederick II of Hohenstaufen provided a key

link between east and west, and it was in Sicily
and southern Italy that pharmacy first became
legally separated from medicine in 1231 AD.

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• European countries, pharmacy emerged as a
separate occupation over the centuries which
followed. German pharmacists, for example,
formed themselves into a society in 1632
(Basel Oath).

• The first official pharmacopoeia, to be

followed by all apothecaries, originated in
Florence. Published in 1498
• The organisation of pharmacy

• In France, the pharmacien received official recognition with the establishment of

the College de Pharmacie in 1777, which ushered in modern French pharmacy.

• During the 17th and 18th centuries many people in con>nental Europe passed the
examinations for both pharmacy and medicine, and practised both.

• Early American pharmacy was heavily influenced by immigrants from Europe.

• An Irish pharmacist, Christopher Marshall, established the first such shop in

Philadelphia in 1729.

• The American Pharmaceutical Association, open to ‘all pharmacists and druggists

of good character’, was established some >me later, in 1852.

• Establishment of Pharmaceutical association around Europe, followed by the

establishment of pharmacy schools and faculties.
• The practice of pharmacy

• Problems:
– Chain pharmacy & multiples!!
– The nature of retailing was changing
– The first dental register appeared in 1879
– World wars
– Poor people

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• Steps forward:
– health insurance
– Separating dispensing and prescription
– Strength of societies

• Pharmaceutical industry, Branding.

• Professionalism versus commercialism

• The conflict between trade and profession has been a

central issue throughout pharmacy’s history

• Pharmacists have always been paid for the products

they sell, not the advice they give, and almost all
engage in retail trade stretching beyond the strict
confines of pharmacy

• It was undesirable for nonprofessional business to

predominate in a pharmacy, and that the extension of
this kind of business in pharmacies should be
controlled
• THE EMERGENCE OF ‘THE NEW PHARMACY’: 1986 TO PRESENT

• By the early 1980s there was widespread uncertainty about the

future of pharmacy, particularly community pharmacy.

• ‘one knew there was a future for hospital pharmacists, one knew
there was a future for industrial pharmacists, but one was not sure
that one knew the future for the general practice pharmacist’

• Pharmacy needed to re-invent itself. Some important initiatives

were taken. In 1982, for example, the Na>onal Pharmaceu>cal
Association (UK) began its ‘Ask Your Pharmacist’ campaign, in
which it promoted the use by the public of their local pharmacy.
But what was really needed was an independent and far-ranging
inquiry into the profession.
• The Nuffield Report 1986 (UK):

• ‘to consider the present and future structure of the

practice of pharmacy in its several branches and its
potential contribution to health care and to review the
education and training of pharmacists accordingly’.

• ‘we believe that the pharmacy profession has a

distinctive and indispensable contribution to make to
health care that is capable of still further development’

• ‘every prescription for a medicine must be seen by a

pharmacist, and a judgement made by him as to what
action is necessary’
• The extended role of the pharmacist:

• increasing the range of medicines available for sale by pharmacists

• the maintenance of patient medication records by pharmacists
• the extension of needle and syringe exchange schemes
• participation in health promotion campaigns
• having separate areas for providing advice and counselling.

• New age:

• Four key areas for pharmacy involvement were identified:

– the management of prescribed medicines
– the management of chronic conditions
– the management of common ailments (diseases)
– the promotion and support of healthy lifestyles.
• Is pharmacy returning to its roots?

• The ‘Ask Your Pharmacist’ campaign, the extended

role, and the Pharmacy In A New Age initiative can be
seen collectively as an attempt to draw pharmacists
out of the dispensary (which was usually at the back of
the shop), to the front of the shop where they would
be more accessible to the public.

• Here they would be the

– ‘first port of call’ for the public seeking medical attention
– they would be a source of advice and information about
medicines to the public
– they would prescribe from an increasingly long list of
recently deregulated medicines.
• At the same time as pharmacists were
becoming more accessible, doctors were
becoming less accessible.

• The changes in pharmacy practice in the last

quarter of the twentieth century represented
a shift away from a product-oriented
approach to medicines towards a patient-
focused one
• A BRIEF HISTORY OF HOSPITAL PHARMACY

• Pharmacy practice in hospitals can be traced back

over many centuries, and the history of hospital
pharmacy is closely allied to the history of
hospitals.

• The history of hospital pharmacy can be

considered within three time frames:
– An emergent period up to 1897
– a period of standardisa>on up to 1948
– a period of expansion and consolidation since then.
• The first hospitals in which it is known pharmacy
was practised were the Roman military hospitals
known as valetudinaria.

• As Europe converted to Christianity, so the Church

began to care for the sick and needy.

• Many employed an apothecary and contained a

dispensary. The apothecary usually combined the
roles of resident medical officer and dispenser of

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medicines.

• Hospital pharmacy was never immune. It was

nevertheless able to establish new activities which
contributed to cost control, such as formulary
development, and many pharmacists began to
specialise in a particular area of clinical pharmacy,
such as paediatrics or cardiology.
• Clinical pharmacy

• Clinical pharmacy is the branch of Pharmacy

where pharmacists provide patient care that
optimizes the use of medication and promotes
health, wellness and disease prevention.

• Clinical pharmacists care for patients in all health

care settings but the clinical pharmacy
movement initially began inside hospitals and
clinics.

• Clinical pharmacists often collaborate with

physicians and other healthcare professionals.
• Within the system of health care, clinical pharmacists
are experts in the therapeutic use of medications.

• They routinely provide medication therapy evaluations

and recommendations to patients and other health
care professionals.

• Clinical pharmacists are a primary source of

scientifically valid information and advice regarding the
safe, appropriate, and cost-effective use of
medications
• A more appropriate definition for clinical pharmacy is, "Clinical pharmacy is the
branch of pharmacy which deals with
– various aspect of patient care
– dispensing of drugs
– advising patient on the safe and rational use of drug

• Basic components of clinical pharmacy practice:

– Prescribing drugs
– Dispensing and administering drugs
– Documenting professional services
– Reviewing drug use
– Communication
– Counselling
– Consulting

• Scope of clinical pharmacy:

– Drug Distribution
– Systems Drug Information
– Drug Utilization
– Drug Evaluation and Selection
– Medication Therapy
– Management Formal Education and Training Program
– Disease State Management