Column originally published in the September 1996 edition of Pharmacy Post.While in a trance-like state not long ago (induced, he claims, by reading yet another article about cost-cutting in health care), pharmacist Ken Burns of Errington ID A Pharmacy in Chelmsford, Ont., was struck with two visions of pharmacy, 14 years from now.He offers them here under the guise of satire, as news articles in some future edition of Pharmacy Post, circa 2010.College closes door to pharmacyThe Ontario College of Pharmacists closes its doors today after well over a century as the body regulating the practice of pharmacy in Ontario.Eusta B. Sumwun, the registrar, is philosophical about the demise of her historic organization. "There was a time when the college was an integral part of pharmacy. Our purpose was to regulate and improve upon the profession for the benefit and protection of the public. This was to ensure that the contribution of the pharmacist in health care was proficient and professional.""We became redundant when the profession became little more than the "lick, stick, and pour" image it had projected 30 years ago. All drug information is now distributed by the manufacturers of pharmaceuticals, and with direct distribution pharmacists employed by these companies aren't asked to provide any professional input into the process of prescribing; they merely fill bottles. The last of the independent pharmacists who were trying to be professional were simply outnumbered, and couldn't compete with the zero fees and free goods provided by the direct dispensers. Since pharmacists were no longer asked to be professional, there was no reason to regulate them as a profession."The College's offices will be converted to a museum; the building has been sold for $1 to a group of retired pharmacists called the Corporation of Archival Pharmacists of the University of Toronto (CAPUT). Nomor Dispen Singh, CAPUT's vice-president, states, "Although pharmacists are no longer an integral part of the healthcare system, their contributions in the past should not be forgotten, and the lesson learned about failing to seize opportunities and not living up to potential could warn other professions to avoid the pitfalls of self-indulgence."The premier of the province of Ontario, Richard Less, gives this opinion on the closing of the College of Pharmacists: "There are enough schools for kids to go to, and we spend enough on universities and colleges. I'm sorry those people lost their jobs, but we have to get the economy back on track."The last president of the College of Pharmacists, Hugh Siess, perhaps sums it up best. "When I graduated from the University of Toronto in 1983, we were told we were an integral part of the healthcare system. And we were, but it looks like we took it for granted, and we got left behind."Faculty relegated to oblivionIn a related story, the Faculty of Pharmacy at the University of Toronto officially closes this month. Although it ceased operations in 2008, its charter with the University of Toronto will be formally closed by University president Cora Porate-Stooge."The profession of pharmacy has outlived its usefulness, and the faculty had become an academic curiosity, more of a history course than anything," says Porate-Stooge. The outgoing dean, Dr. Evian, appears to be both resigned and defensive about the faculty's fate. "We began in the late 1980s to try to give our graduates a greater sense of professionalism and to encourage them to integrate themselves into the healthcare system and contribute in the ways only a pharmacist can. As educators we can only provide the tools and the knowledge; we can't provide the motivation. We did the best we could."Mega merger seals monopolyOn the pharmaceutical news front, the purchase of Mal-Wart by Merck-Frosst-Giaxo-Wellcome-Ciba-Geigy-Wyeth-Ayerst-Pharmacia-Upjohn-Eii-Lilly-Ortho-McNeil made news as the second largest buyout in history (second only to the merger of Merck-Frosst-Ciba-Geigy-Wyeth-Ayerst with Glaxo-Wellcome-Pharmacia-Upjohn-Eli-Lilly-Ortho-McNeil last year). The chief executive officer of the company, Ivana O'Nitall, states that the first order of business would be "to fix our name. It has become quite cumbersome in meetings, to say nothing of the price of stationery."The company sees a great fit for the two arms of the corporation. "We enjoyed unparalleled growth when the direct supply business took off, and our profits increased as we were able to provide our products directly to the consumer without the interference of the pharmacists, who were attempting to cut into our bottom line. The mergers over the past seven years have enabled us to provide virtually any product to our customers. In the past two years, however, as drug benefit costs topped 55% of all health benefit costs, we've noticed a flattening of the growth curve. We see the acquisition of a large retailer as a bonus. As the supplier of over 90% of the drugs available, we have almost saturated the market. Our presence in a retail market will draw in consumers for prescriptions, and hopefully they will leave with other purchases. The future looks good for our shareholders."Mr. Michael Flowers, president of Shoppers Drug Emporium, the last of the holdout drug chains, offers only one comment: "First we lost tobacco, and it was downhill from there."Editor's Note: This being the final issue of Pharmacy Post, we feel it's appropriate to take a look back at how the profession of pharmacy disappeared. It began in 1996, when the co-pay were initiated in the final Canadian province, Ontario. We contacted then-premier Mike Harris at his golf course in Florida and asked him to look back."The way we saw it, pharmacies were overcharging. We started an optional co-pay to put pressure on that over-charging. Some pharmacists panicked, and the fee started to slide. We must have been right," says Harris.We also asked former premier Harris if he thought he had been ill-advised to follow the urging of drug companies to attack the pharmacist's fee instead of the real villain, drug costs."I don't remember speaking to any drug companies," Harris responded. "I have to leave now to give Ms. O'Nitall her golf lesson."We hope that all pharmacists have been working on their golf game, because that be be all they have left.College opens door to royaltyKing William of England, on a goodwill tour of Canada, visited the Ontario College of Pharmacists this past week.Iyam Sumwun, the college's registrar, was elated. "This visit is not just an honour for the College, but it is a credit to all of the pharmacists of Ontario. The full integration of pharmaceutical care into the healthcare system in Ontario and the rest of Canada has proven to be the salvation of medical care. Not only has it resulted in improved drug therapy and compliance, with the resultant improvement in quality of life for our clients, it has been chiefly responsible for the stabilization of healthcare costs," he says.King William paid regal compliments: "One could certainly be comfortable with the pharmaceutical care model employed by your pharmacists. It speaks volumes for the changes going on internationally in health care; it is the people in health care that will ultimately determine the successful use of our resources, not the tools and toys that are the resources themselves."The College's staff have outgrown their original offices, which will be converted to a museum. 'T"he building will be sold for $1 to the Pharmacists United for Museum Preservation and Understanding Pharmacy (PUMPUP). Indy Spence-Able, PUMPUP's vice-president, states, "Pharmacy may now be realizing its potential in pharmaceutical care, but it is always useful to remember where you come from. The museum will serve to document and preserve both pharmacy's successes and mistakes, with some interesting curiosities of the past thrown in."King William, during his tour of the museum, was particularly impressed with a demonstration of the production of glycerin suppositories using the ancient molds. "These may be useful for those corporate types who, no matter how often you tell them that their product is not the saviour of health care, seem to have a particular type of retention problem," he casually remarked.The premier of the province, Richard Head, offers this opinion on the royal visit: "This is proof that our government's commitment to the education system continues, and the accolades received by this College show that our programs do work. Educating our young people will help get the economy back on track."The College's current president, Trey lmporrante, perhaps sums it up best. "When I graduated from the University of Toronto in 1983, we were told we were an integral part of the health care system. We are, but we must never take it for granted, or we'll get left behind."Faculty elevated to new levelIn a related story, the Faculty of Pharmacy of the University of Toronto announces the institution of a six-year Doctor of Pharmacy program. "The program is a recognition of the specialization and abilities that pharmacists have always demonstrated. It was long in coming," says the president of the university, AI Trewistic.The dean of the faculty, Dr. Vichy, further explains: "As educators, it is our responsibility to not only uphold the academic tradition, but also to equip our graduates with the proficiency to realize their important place in health care. The motivation to do that is on their shoulders."Progressive partnerships heal patientsOn the pharmaceutical news front, Mal-Wart has decided to "get out of the pharmacy business," says chief executive officer Gree D. Nomor. "As a corporate entity, our philosophy has been to operate at a loss in order to gain market share. In the business of selling laundry baskets and lawn mowers, this works well. Unfortunately, this is not consistent with providing quality health care. The market is filled with providers of pharmaceutical care and the product they provide, and the manner in which they provide it, has left us at a competitive disadvantage. The old method of simply providing a prescription for a fee does not work in this market, and even a zero fee can't compete with the cost reductions brought about by pharmaceutical care."The Pharmaceutical Manufacturers Association of Canada (PMAC) also announces that it has begun to formalize its relationship with the Ontario College of Pharmacists. The president of PMAC, M.P. Former, states: "The improvement in compliance realized by pharmaceutical care has resulted in the optimum use of our products. We have officially eliminated drug samples and instead leave medication trials to the pharmacist, a process that not only decreases waste, but in some cases also prevents a premature discontinuation of a medication that may have some benefit.We are comfortable that the pharmacist will aid in the selection of therapy that will result in the greatest improvement in quality of life, and we look forward to working with pharmacy in the future to strive for the optimum use of drugs, the most cost-effective element of health care."Editor's Note: This is the final issue of Pharmacy Post in its current format. The new Pharmacy Post will put the emphasis on stories that demonstrate the integration of pharmacists' specialized knowledge into pharmaceutical care.At this time, we feel it's appropriate to take a look back at how the profession of pharmacy has evolved. The breakthrough came in 1996, when Ontario became the last province to implement co-pays. A large number of pharmacists stood up to show they were worth a co-pay, and more. Pharmacists began to find innovative ways to both improve health care and save money, and communicated these methods to payers of health care.We contacted then-premier Mike Harris at his golf course in Florida and asked him to look back. "We were convinced by others that the professional fee was the culprit in the increasing drug costs. When the private sector proved that the professional fee was worth paying because the pharmacist was the one best able to save money by suggesting appropriate drug therapy, we eventually had to follow," says Harris.When asked who the "others" were, Harris replied: "I don't remember speaking to any drug companies."
