What is Compounding?

A HISTORY OF PHARMACY

The History of the Pharmacy and Pharmacology dates back to medieval times with priests, ministering to the sick often along with religious rites. Many people continue this close association of drugs, medicine, and religion or faith. Specialisation first occurred early in the 9th century in and around Baghdad. It gradually spread to Europe as alchemy, eventually evolving into chemistry as physicians began to abandon beliefs that were not demonstrable in the physical world. Physicians often both prescribed and prepared medicines; individual pharmacists not only compounded prescriptions but manufactured medicaments in bulk lots for general sale. Not until well into the 19th century was the distinction between the pharmacist as a compounder of medicines and the physician as a therapist and clinician generally accepted and the professions developed separately.
  

PHARMACY

The origin of the word "pharmacy" is generally ascribed to the Greek pharmakon ("remedy"). It has been suggested that there is a connection with the egyptian term ph-ar-maki ("bestower  of security"), which the god Thoth, patron of physicians, conferred as approbation on a ferryman who had managed a safe crossing. The notion of an Egyptian origin has a certain romantic appeal, but in all likelihood the word "pharmacy" and its many cognates derive, like so many other scientific terms, from the Greek.

Today's modern pharmacist deals with complex pharmaceutical remedies far different from the elixirs, spirits, and powders described in the Pharmacopeia of London (1618) and the Pharmacopeia of Paris (1639). In the Australia today, major medicines, those regarded as having the greatest therapeutic value, are selected for inclusion in the British Pharmacopeia. After the drugs have been chosen, the standards for quality and potency are often formulated by pharmaceutical chemists, working within the industry.

Pharmacy, is regarded as the science of compounding and dispensing medication; also, an establishment used for such purposes. Modern pharmaceutical practice includes the dispensing, identification, selection, and analysis of drugs. Pharmacy began to develop as a profession separate from medicine in the 18th century. For example in the United States in 1821 the first U.S. school of pharmacy was established in Philadelphia. This university has over that time produced the founders or co-founders of six out the ten largest pharmaceutical manufacturers in the world.

Pharmacists share with the chemical and medical profession responsibility for discovering new drugs and synthesising organic compounds of therapeutic value. In addition, the community pharmacist, apothecary or chemist, is increasingly called upon to give advice in matters of health and hygiene.

Pharmacists may practice their profession in a pharmacy located in a retail setting, hospital, nursing home, or a special area of a pharmacy. They may also be employed by a pharmaceutical company in scientific research or the development and production of new pharmaceutical products.

WHAT HAPPENED TO THE NEIGHBOURHOOD COMPOUNDING PHARMACY?

THE INDUSTRIAL REVOLUTION
The rapid change from manual methods to machine methods of production that characterised the Industrial Revolution found a ready application in pharmacy, especially under the impact of the scientific developments of the nineteenth century. Phytochemistry and synthetic chemistry created new derivatives of old drugs and new chemical entities of medicinal value that strained the capacity of the individual pharmacy. Large scale drug manufacturing had a strong hold on society with the advent of machines and patents.
The progress made by this new industry is demonstrated by the catalogue of the American firm G.D. Searle, which by the late 1880’s listed 400 fluid extracts, 150 elixirs, 100 syrups, 75 powdered extracts, and 25 tinctures and other drug forms.

THE DECLINING ART OF THE APOTHECARY
Industrialisation had an impact on every aspect of the activity of the pharmacist. First, it led to the creation of new drugs, drugs that the individual pharmacist’s own resources could not produce. Second, many drugs that the individual pharmacist was able to produce could be manufactured more economically, and in superior quality, by industry. Third, industry assumed responsibility traditionally vested in the pharmacist for the quality of the medication. The plethora of proprietary medicines, widely and often blatantly advertised, deprived the pharmacist of a market for private specialties; it forced the pharmacist to become a vendor of merchandise; it opened the way to much broader competition from merchants, grocers than the pharmacist had previously encountered.

THE COMMUNITY PHARMACY 
The nineteenth century did not see the end of the art of compounding, but the art did give way, however grudgingly, to new technology. It has been estimated that a "broad knowledge of compounding" was still essential for 80 percent of the prescriptions dispensed in the 1920s. 

Although pharmacists increasingly relied on chemicals purchased from the manufacturer to make up prescriptions, there still remained much to be done or Secundum Artem (according to the art). They spread their own plasters, prepared pills (of aloes and myrrh or quinine and opium, for example), prepared powders of all kinds, and made up confections, conserves, medicated waters, and perfumes. It is reputed that the drink Coca-Cola (originally as the name suggests containing cocaine) was formulated by a pharmacist. They put up tinctures (of laudanum, paregoric, and colchicum) in five gallon demijohns. And they frequently combined into a single dosage from several medicines, which normally today would be written and dispensed as separate prescriptions. Further more, they were often called upon to provide first aid and medicines for such common ailments as burns, frostbite, colic, wounds, poisoning, constipation, and diarrhoea.
In addition to maintaining a prescription laboratory, pharmacists usually carried the then disliked, but necessary patent and proprietary remedies along with herbs and locally popular nostrums of their own compounding.

THE TWENTIETH CENTURY PHARMACIST
The most notable change in pharmacy in modern times has been the virtual disappearance of the preparation and compounding of medicines. Whereas in the 1920s, 80 percent of the prescriptions filled in American pharmacies required a knowledge of compounding, by the 1940s the number of prescriptions requiring compounding had declined to 26 percent. As far back as 1971, only 1 percent, or less, of all prescriptions combined two or more active ingredients. Moreover, the pharmacist’s commitment to maintaining the quality of the drugs dispensed has been reduced to knowing such facts as the length of shelf life and the effect of exposure to light and judging the reliability and reputations of the manufacturer. 

All this meant that the pharmacist’s education and activities had to undergo change. At the same time that the scientific education of pharmacists was steadily becoming more demanding, their role in the provision of health care was becoming more and more circumscribed. Moreover, they were increasingly subject to governmental and institutional requirements that diminished the importance of the patient-pharmacist relation. And, especially in the United States and Great Britain, competition from prescription departments in chain and department stores tended to demean both the role and the dignity of the pharmacist as a health-care professional. The urban blight that attacked the neighbourhoods was inevitably a threat to the friendly neighbourhood pharmacist.
The reaction to these conditions was apparent in the drop in the production of graduates of American schools of pharmacy who were planning to go into the field of community pharmacy. In 1947, about 90 percent of graduates planned to go into some aspect of community pharmacy; in 1973, that figure had dropped to 76.6 percent; in 1988 it stood at 57.1 percent.

COMPOUNDING TODAY 
Compounding pharmacies are on the rise and physicians, medical institutions and patients are realising more than ever the importance of tailoring an individuals medications to specifically meet their needs. A majority of the pharmacists that are going back to compounding are doing so for the love of the science and interest in the patients well being. Being able to be in the role of a problem solver opens the doors to creativity and genius.