Pharmacy (from Greek ‘pharmakeia’- ‘use of drugs’, from ‘pharmakon’ – ‘drug’) is the health profession that links the health sciences with the chemical sciences, and it is charged with ensuring the safe and effective use of medication. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to patient care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes. The term is also applied to an establishment used for such purposes.
In the field of pharmacy, the first drugstores were opened by Muslim pharmacists in Baghdad in 754, while the first apothecary shops were also founded by Muslim practitioners.
The advances made in the Middle East by Muslim chemists in botany and chemistry led Muslim physicians to substantially develop pharmacology. Muhammad ibn Zakariya Razi (Rhazes) (865-915), for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi (Abulcasis) (936-1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the 'simples' from which the complex drugs were compounded then generally used. Sabur Ibn Sahl (869), was, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailments. Al-Biruni (973-1050) wrote one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah (‘The Book of Drugs’), where he gave the detailed knowledge of the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Ibn Sina (Avicenna), too, described no less than 700 preparations, their properties, mode of action and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine. Of great impact were also the works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008-1074), both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by 'Mesue' the younger, and the Medicamentis simplicibus by 'Abenguefit'. Peter of Abano (1250-1316) translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq's contributions in the field are also pioneering. Living in the 10th century, he wrote The Foundations of the True Properties of Remedies, amongst others describing arsenious oxide and silicic acid. He made a clear distinction between sodium carbonate and potassium carbonate and drew attention to the poisonous nature of copper compounds, especially copper vitriol, and also lead compounds. For the story, he also mentions the distillation of sea-water for drinking.
The beginnings of pharmacy in China are ancient. It stemmed from Chinese alchemy. Shennong is said to have tasted hundreds of herbs to test their medical value. The most well-known work attributed to Shennong is the The Divine Farmer's Herb-Root Classic. This work is considered to be the earliest Chinese pharmacopoeia. It includes 365 medicines derived from minerals, plants, and animals. Shennong is credited with identifying hundreds of medical (and poisonous) herbs by personally testing their properties, which was crucial to the development of traditional Chinese medicine.
In ancient Japan, the men who fulfilled roles similar to those of modern pharamacists were highly respected. The place of pharmacists in society was expressly defined in the Taiho Code (701) and restated in the Yoro Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highlystable hierarchy, the pharmacists - and even pharmacist assistants - were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.
A pharmacy (commonly the chemist’s in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists – health professionals who are also retailers.
Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. The dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications, there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients.
All pharmacies are required to have a pharmacist on-duty at all times when open. In many jurisdictions, it is also a requirement that the owner of a pharmacy must be a registered pharmacist (R.Ph.). This latter requirement has been revoked in many jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.
Likewise, many pharmacies are now rather grocery store-like in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional household items such as cosmetics, shampoo, bandages, office supplies, candy, and snack foods.
Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues. Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of medications (i.e., drug interactions) and patient compliance issues (in the hospital and at home) many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize in haematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anticoagulation clinics, herbal medicine, neurology/epilepsy management, paediatrics, neonatal pharmacists and more.
Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding.
Clinical pharmacists provide direct patient care services that optimize the use of medication and promote 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. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They work collaboratively with physicians, nurses and other healthcare personnel in various medical and surgical areas.
Consultant pharmacy practice focuses more on medication regimen review (i.e. "cognitive services") than on actual dispensing of drugs. Consultant pharmacists most typically work in nursing homes, but are increasingly branching into other institutions and non-institutional settings. Traditionally consultant pharmacists were usually independent business owners. This trend may be gradually reversing as consultant pharmacists begin to work directly with patients, primarily because many elderly people are now taking numerous medications but continue to live outside of institutional settings. Some community pharmacies employ consultant pharmacists and/or provide consulting services.
Since about the year 2000, a growing number of Internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be a more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as Online Pharmacies) are also recommended to some patients by their physicians if they are homebound.
While most Internet pharmacies sell prescription drugs and require a valid prescription, some Internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from such pharmacies to avoid the ‘inconvenience’ of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication. There also have been reports of such pharmacies dispensing substandard products. Of course, as history has shown, substandard products can be dispensed by both Internet and Community pharmacies, so it is best that the buyer beware. Of particular concern with Internet pharmacies is the ease with which people, the young in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the Internet without a prescription issued by a doctor/practioner who has an established doctor-patient relationship. There are many instances where a practioner issues a prescription, brokered by an Internet server, for a controlled substance to a ‘patient’ she/he has never met. In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.
Canada is home to dozens of licensed Internet pharmacies, many of which sell their lower-cost prescription drugs to US consumers, who pay the world's highest drug prices. However, there are Internet pharmacies in many other countries including Israel, Fiji and the UK that serve customers worldwide.
The future of pharmacy
In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply dispensing medication, pharmacists will be paid for their patient care skills. This shift has already commenced in some countries; for instance, pharmacists in Australia receive remuneration from the Australian Government for conducting comprehensive Home Medicines Reviews. In the United Kingdom, pharmacists (and nurses) who undertake additional training are obtaining prescribing rights. They are also being paid for by the government for medicine use reviews. Pharmaceutical care or Clinical pharmacy has had an evolving influence on the practice of pharmacy. Moreover, the Doctor of Pharmacy (Pharm.D.) degree is now required before entering practice and many pharmacists now complete one or two years of residency or fellowship training following graduation. In addition, consultant pharmacists who traditionally operated primarily in nursing homes are now expanding into direct consultations with patients, under the banner of ‘senior care pharmacy’.