Audemus jura nostra defendere.
We dare to defend our rights.In the wake of a congress;
Dear colleagues, the INTERNATIONAL PHARMACEUTICAL AND PHARMACY CONGRESS, organized by the İVEK Association on November 28-30, 2014 at the Istanbul Haliç Congress Center, has gone down in the history of our profession as one of the most outstanding meetings of recent years, both in terms of participation and richness of content. I wanted to share the presentation I made at this congress—which I attended with a poster and a twenty-minute presentation—along with some topic headings and my observations, with my colleagues who were unable to attend.
Since the subject of our session was brand creation, I must confess that I truly struggled to explain the answer to the question of how to become a brand by compounding magistral formulas within the twenty minutes allocated to me. When I received the congress program summary, being one of the final speakers on the last day came as no surprise to me. Haven’t we always left the work of compounding magistral formulas until the very end? Or rather, haven’t we forgotten it? This is not actually a reproach, but a reminder… because ”FORGETTING IS LOSING”… Therefore, regardless of who speaks at professional congresses, if the topic is magistral compounding, it should take its place in the opening sessions and enrich our professional definition.
We must realize that in the face of any project where we are absent—meaning where the pharmacist is ignored—we can only stand tall with a mortar in our hands. In the presentation, we spoke of the immense power of the mortar and mentioned that the sound of the mortar must once again resonate in pharmacies. However, we emphasized the word “mortar” so strongly that we must have confused even a revered doyen of our profession who was waiting for his turn to speak in the session. When it was his turn, our colleague said, “I have abandoned the mortar; I prepare my ointments in a beaker in my pharmacy.” This time, our minds were baffled. Yet what we intended to emphasize here was the power of preparing magistral formulas as a symbolic object.
In a time when professional expectations and hopes are so shattered today, I wanted to explain how one can build a brand through magistral compounding by sharing excerpts from the lives of two community pharmacists who lived at the end of the 1800s. What they had in common was that both were community pharmacists, along with their success stories achieved despite all the impossibilities of their era. In a period when communication techniques were virtually non-existent, without computers or even telephones, and when accessing information was extremely difficult, the stories of Ahmet Hamdi Bey and William Martindale are quite fascinating. Ahmet Hamdi Bey was one of us, living in this geography, a modest community pharmacist. While he gained fame as the pharmacist of the first pharmacy opened by Turks in Istanbul, the other was a daring community pharmacist living in England of that time, whom we would still consider one of our own regardless of language, religion, or race, despite being thousands of kilometers away.
Ahmet Hamdi Bey worked on methods for good pharmaceutical manufacturing, published his observations and studies in journals of the period, took a close interest in the students he trained in his laboratory, and in return for these efforts, rightfully earned titles such as Honorary Chief Pharmacist (Fahr-i Eczacıbaşı), Dean of Pharmacists (Şeyh-ül Eczacıyan), and the Imperial Insignia (Arma-i Hümayun), and was admitted to the royal palace. Ahmet Hamdi Bey not only operated a pharmacy but also conducted research and published in this field. As an example, we can point to his research and publication aimed at eliminating the turbidity and precipitate occurring between tinctures of Hydrastis Canadensis (GOLDENSEAL) and Hamamelis Virginiana (WITCH HAZEL).
After numerous experiments, he wrote that adding a drop of hydrochloric acid to the formula prevented the turbidity, that this single drop of hydrochloric acid would cause no change in the composition of the medicine, and that in this way the patient would not suspect that the medicine had been improperly prepared. While Pharmacist P. Apery argued that, according to current regulations, a pharmacist could not add any substance to a formula prepared by a physician, Pharmacist Jurescu contended and defended the view that the issue was not adding a substance to the prescription formula, but was related to the technique of drug preparation, and that a pharmacist could adjust the formula as needed to create a proper medicine, which was a necessity of the art of pharmacy. This debate, emerging at the beginning of the 1900s, is very intriguing in that it demonstrates the high level of professional knowledge attained by Istanbul pharmacists of that period. Today, however, we carry on our profession with the worry of how to dispense our prescriptions without exceeding the boundaries of the Medula system and without facing deductions from the SSI.
Our other pharmacist, William Martindale, was truly extraordinary. While spending his days in modest work at his pharmacy, lightning suddenly struck in Martindale’s mind. With years of professional experience and accumulated knowledge, he would write a pharmacopoeia. This was a decision taken by a bold community pharmacist who did not take one of the most important references in pharmaceutical science, the British Pharmacopoeia, as sufficient, underestimating its adequacy and resolving to write a better one. He set out to write an “Extra” to the British Pharmacopoeia, realizing this vision with a first edition of 313 pages, and by the 4th edition in 1885, he expanded it to 4,160 pages. Yet when Martindale decided to write the work he named “THE EXTRA PHARMACOPOEIA” or “MARTINDALE PHARMACOPOEIA,” he was ridiculed, belittled, and harshly criticized for this idea. However, that bold yet profoundly knowledgeable pharmacist never gave up, combining his research with the knowledge and experience accumulated over the years, ultimately producing the work entitled THE EXTRA PHARMACOPOEIA, which went on to reach its 29th edition. Even the British Royal Family invited this once-ridiculed, eccentric pharmacist to the palace from time to time to consult with Queen Victoria and seek his expertise in the treatment of illnesses.
Unfortunately, Martindale could not reflect his professional success in his personal life. According to some historians, as a result of severe mental exhaustion, and according to others, a nervous breakdown stemming from a secret romance, he sadly ended his life by ingesting cyanide.
Indeed, what I have written are the success stories created by two community pharmacists living in the same era, perhaps unaware of each other, through sheer self-confidence. Can we all become an Ahmet Hamdi Bey or a William Martindale? That is the question…
Naturally, great duties fall upon us and our professional organization.
While we give due importance to our laboratories and prepare our medicines with the required meticulousness, our professional organization is responsible and mandated to fulfill our expectations in this regard. Unfortunately, the magistral revolution that took place in Europe in 1985 still seems very distant for us. How so? Take a look:
From the Turkish Medicines and Medical Devices Agency:
April 12, 2014
REGULATION ON PHARMACISTS AND PHARMACIESPART ONE
Purpose, Scope, Legal Basis, and Definitions
Purpose
s) Magistral medicine: The medicine specially prescribed for a patient by a physician and prepared in the pharmacy according to this formula…We are still not even aware of the terminology error we make; what do we say in item ”s”? Magistral medicine. This word was used for a period, but having realized it was an incorrect usage, it gave way tomagistral formula ‘. By literal definition, ‘magistral’ already means ‘that which is made by the master’. That is, ‘magistral’ itself describes and defines the medication. It is beneficial to begin change by correcting the language.
Exactly one and a half years ago, as the Editorial Board of Eczacının Sesi, we submitted a petition to our professional organization; you will see the relevant text below:TO THE CENTRAL COMMITTEE OF THE TURKISH PHARMACISTS’ ASSOCIATION
We would like to remind you, our esteemed colleagues who constitute the highest authorized governing board of our profession, once again of the challenges we face in preparing prescriptions containing MAGISTRAL FORMULAS in our pharmacy laboratories.
If we were to state these issues under specific headings;
1- The current magistral tariff is insufficient in its content to include the substances comprising today’s formulas. In this regard, an enriched tariff containing current active substances and excipients should be rearranged.
2- Likewise, the current magistral tariff must be reconstituted in a manner that protects the Pharmacist’s professional fee considering today’s economic conditions and takes into account the current prices of raw materials (produits).
3- The Turkish Pharmacists’ Association (TEB) must urgently implement the TURKISH DRUG FORMULAS as a reference book to be placed on the pharmacist’s laboratory counter and the prescribing physician’s desk.
4- EGAŞ must be restructured to meet our pharmacies’ needs for raw materials (produits) in terms of quality and variety. The instruments and equipment needed for modernizing our laboratories should be easily obtainable from EGAŞ.
5- KOSGEB support should be provided to our colleagues who will make the necessary renovations and equipment investments in their pharmacies, and if possible, this support should be in the form of grants.
6- Deductions made during magistral prescription audits by the SSI (SGK) should not be left to the interpretation of our colleagues working at this institution, and it is of great importance to take the necessary steps to establish a scientific committee without delay to evaluate disputes and appeals.
We hope that our call will be taken into consideration, in the hope of reaching the days when compounding magistral formulas is no longer seen as a pharmacist’s professional satisfaction or hobby, when our existing pharmacy laboratories become small pharmaceutical manufacturing units, when every drug in shortage can be prepared in our laboratories, when pharmacists receive their professional compounding fee for preparing these formulas, when our profession enhances its prestige through the power of production, and thus all scenarios that do not take the pharmacist into account will lose credibility.
Eczacının Sesi Editorial BoardYou can guess the reply received; I will not write it here now, but I must say this: It was a perfunctory letter along the lines of ‘we are aware of these problems and working to solve them, just mind your own business.’ Now one must ask, which of the problems above has been resolved? Far from solving problems, everything possible was done to restrict magistral compounding, virtually eliminating it in a sense. Quotas were even imposed under the pretext of misuse.Abusus non tollit usum
Misuse does not abolish proper use.(meaning, when something is misused, it should not prevent its proper use); this can only be answered with a Latin phrase…In conclusion, THE PHARMACISTS OF THIS COUNTRY possess the knowledge and equipment to fulfill their duty in extraordinary situations or in the compounding of medicines that are in shortage. In this sense, our pharmacies are not merely logistical drug distribution points, but medicine production centers.
Nil desperandum (Never give up)I concluded my remarks by saying:
Spec. Pharm. Ahmet Nezihi Pekcan
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657http://www.majistralformul.com/
