Secundum artem. Yeah, not so much

imageMerriam-Webster defines secundum artem as "according to the accepted practice of a profession or trade". In pharmacy it typically goes hand in hand with the preparation of extemporaneous compounds, i.e. when you have to make something from scratch. Pharmacists have been doing this since the profession began. Unfortunately it’s a dying art not only because of lack of interest from younger pharmacists, but secondary to increased regulation and bureaucratic red tape as well. It’s a real shame. To put it in perspective it would be like surgeons no longer performing surgery by hand because of the invention of the da Vinci Robot.

I have enjoyed compounding throughout various stages of my career. One of the best jobs I ever had was as a compounding pharmacist at a small community pharmacy in San Jose, California. The job was challenging, fun and centered on patient care. For many years I dreamed of having my own compounding pharmacy, but I was never able to make it a reality for numerous reasons. And because of this I was disheartened to read a recent editorial by Dr. Loyd V. Allen, Jr. writing about the lack of compounding content at the recent ASHP Midyear in New Orleans.

In the editorial Dr. Allen writes:

Having just returned from the 2011 ASHP Clinical Midyear Meeting in New Orleans, promoted as the largest gathering of pharmacists in the world, one wonders what the programming committee considers as important topics.

In a year where the number of drugs in short supply exceeds 250, and profiteering rampant among those greedy companies that can purchase and then resell at up to 4000% profit, one wonders why there was no dedicated programming on compounding of drugs in short supply or criteria involved in selecting a compounding pharmacy for outsourcing, both nonsterile and sterile.

Actually, there appeared to be only about 3 posters related to compounding and only one podium presentation. There were untold numbers of sessions on therapeutics, automation, administration and other topics that are covered in detail every year.

With hospitals implementing USP <797> and many actually outsourcing compounding to those pharmacies that can service them, one wonders what is the reason for the lack of programming related to pharmacy compounding. Is it that many pharmacists have not been trained in compounding and realize its importance? Or, they are so busy with distributive, administrative and clinical duties they don’t have time to worry about the drugs that are required for their patients? After all, without the drugs, there is not much need for pharmacists. Or, is it that many consider the highly technical and scientifically based compounding practice can be done by technicians; some of which are good but they do not have the background necessary for formulation, quality assurance, etc. And none have the knowledge base or the responsibility of final approval that a pharmacist has.

It was a very disappointing meeting from the standpoint of educational sessions. There were a significant number of compounding support companies in the exhibit hall and their presence was quite significant. However, to me it seems that there is a disconnect between ASHP programming and the critical needs of patients for their pharmaceuticals.

The profession, she’s a changin’.