Physicians medicine dispensing

For all the dmg wholesalers and fledgling manufacturing concerns, the bulk of pharmacy care took place in either the physician s office or, in more cosmopolitan settings, the apothecary shop. Even by the beginning of the twentieth century, the majority of physicians stiU dispensed their own medicines. 28 They prescribed and compounded a wide variety of vegetable, mineral, and animal substances, but a review of the 1860 United States Pharmacopoeia (USP) indicates that 587 (or 67 percent) of the total number of 871 medicinal substances listed therein were botanical.29 Some of the more popular were cinchona, sometimes referred to as Pemvian bark, and its refined counterpart, sulfate of quinine, both used as antiperiodics O opium from Papaver somniferum, the powerful narcotic and anodyne (i.e., pain reliever) of choice for many physicians of the day, as well... 

Pharmacy is the art or practice of preparing and preserving drugs, and of compounding and dispensing medicines according to the prescriptions of physicians. 

Following the 1911 revolution, the Ministry of Health of the nationalist government sought to curtail or eliminate traditional Chinese medicine. However, after the communist revolution of 1949, the new government reversed the ban on traditional medicine, establishing a number of traditional medical colleges and institutes whose role is to train physicians and further investigate the uses of herbs. Even in Western hospitals in China, apothecaries are available to dispense herbs upon request. 

The appearance of side effects in the course of medication treatment is inevitable. The old, paternalistic attitude displayed by many physicians toward their patients— Take the medicine, and you ll be just fine — provided little patient education and dispensed with patient autonomy. Fortunately, this attitude is gradually being abandoned, and for good reason. We have learned that for treatment to have the best chance of success, an alliance must develop between the physician and the patient, with each contributing to the effort to treat the disorder. A well-informed patient will fulfill his or her role in this alliance more efficiently. A discussion between the prescribing physician and the patient about potential side effects is a must in this context. Since side effects will almost always occur, patients should be aware of them and told what to expect. Such disclosure will generally promote treatment adherence (also commonly referred to as treatment compliance ). 

After the war, the ranks of the addicted were swelled as well-meaning but ill-informed physicians, many of them little more than quacks, dispensed morphine at the sound of the faintest moan. To the doctor, morphine was a panacea that relieved pain and earned him a patient s gratitude and respect. Other sufferers, too isolated or poor to see a doctor, could treat themselves, as many did, with a variety of nostrums, usually laced with morphine, opium, or alcohol, which were available through the mail or from travelling medicine men. 

Drugs.—Aftor all the references we have made to tho work of the chemist in industry, we do not need to labour the distinction between the man who practises chemistry and the man who practises pharmacy. Tho latter has to depend on the former for many of tho materials- he employs in dispensing, or tho physician may prescribe with very uncertain results, and the patient perish, or, in any caso, pay to no purpose. The subject of drugs and pharma-couticals, with all its ramifications into the substances compounded into medicines of all kinds, pills, powders, ointments, lotions, tinctures, and so forth, is too extensive for us to treat adequately, and we can only deal with tho subject by indicating a few developments in this important branch of industry. 

The distribution of medicinal products is regulated by the rules of GDP. According to that, only approved medicinal products may be distributed, and delivered exclusively to persons authorized for dispensing. In most countries, these persons are the pharmacists. However, in some countries radioactive compounds do constitute an exception to this rule, and have to be delivered directly to the physicians who use them for diagnostic or therapeutic purposes in patients (nuclear medicine physicians and radiotherapists). 

Another challenge appears, when a professional pharmaceutical decisimi has to be made when a patient or physician insists (Ml the preparation of a medicinal prcxluct that should not be made available e.g. because of lack of scientific evidence on efficacy or lack of safety. This scenario is not uncommon in a community pharmacy. The responsible pharmacist has to decide whether or not the prescription will be prepared and dispensed to the patient. 

Previous chapters have focused on cardiovascular safety in drug development and therapeutic use. In this final chapter, we provide a flavor of safety considerations in other aspects of integrated biopharmaceutical medicine, a discipline that encompasses drug development, commercial-scale manufacture, prescription by physicians, dispensing by pharmacists, and the administration of medicines (both by patients themselves and by caretakers, hospital staff, and residential care staff). 

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