George’s Corner: March/April 2014 


Historical Reflections 

Every now and then it is a good idea to stop and think about where we were and where we are. Thinking about how we got from there to here is worth pondering, if only to get a better understanding of ourselves and our surroundings. I hope the following reflections stir some memories of yours that need revisiting.

Electronics

I have been reading a book about the evolution of electronics over the last 50 years or so. It is by T. R. Reid and is titled The Chip: How Two Americans Invented the Microchip and Launched a Revolution. The two Americans in the title, Bob Noyce and Jack Kilby, both figured out how to make the microchip at about the same time — but went about it in opposite ways. The book also covers many side stories and has clear, layman-friendly explanations about how these things work.

My interest in what can now only be called the history of computers is strong for two big reasons: 1) I was fortunate to be a friend of Bob Noyce for a couple of years, and he was an amazing man; 2) When my brother and I put together the first stand-alone pharmacy computer system in 1972, we created it using one of the first microchips.

Just a few words about Bob Noyce. We both served on the University of California Board of Regents. He and I were the only members who had any science understanding. Things like light-years and nanoseconds flew right over the heads of some intelligent, in other disciplines, members. He was a kind, gentle, forceful, and brilliant gentleman. I was a fledgling pilot; he flew his own private jet. I was trying to keep financially solvent; he was a multimillionaire. We were good friends. If he had lived long enough he would have received the Nobel Prize. (He was also one of the founders of Intel.)

Now I see changes I used to dream about. Pharmacists are now performing, and getting paid for, more and more clinical functions. We’re using our education and brains for more than counting to 100 by 5s.

When I graduated from pharmacy school the most sophisticated calculating device was a slide rule. The primary manufacturer of slide rules gave the last one it made to the Smithsonian in 1976. Electronic calculators totally replaced slide rules and were faster, more accurate, and easier to use.

My father was a gadget nut. In his preteens he was one of the first ham radio operators in California. My brother Chad and I inherited his love of gadgets. My brother patented several electronic devices, all of them using the cutting-edge technology of the time. I am not the inventive type. I just like to use the gadgets.

We got together and decided that many pharmacy functions could be handled by a computer. Chad knew how to make the computer and how to program it. I knew what went on in a pharmacy. He proceeded to design and manufacture the computer components. I went to work charting out all of the things that happen between receiving the Rx and handing the completed prescription to the patient. His tasks soon turned out to require much more time than he had, so we hired a programmer.

I started out with an 8-1/2-by-11-inch sheet of paper and soon found that I needed long sheets of butcher paper to list and relate all of the things that go on in a pharmacy.
And that was when the only third party was the Medicaid program. Things have changed.

Pharmacy

When I became a pharmacist in 1960 things were a lot different. The name of the drug was never on the prescription container. No patient profiles. We could not refill an Rx without the patient giving us the Rx number. Manual typewriters. If you typed the wrong letter, you had to back up and hit the right one harder. When I paused to think about what I would type next, I always rested my hand on the keyboard, until I began to use an electric typewriter. Resting my hand resulted in the keys all flying at once and getting tangled up trying to reach the paper. Throughout life it seems little habits need to be modified to accommodate new technology.

If there were any questions from the patient: “Ask your doctor.” “What’s it for?” “Ask your doctor.”

Prices for prescriptions were chaotic. Cost of the drug, plus a percentage, plus a small fee. Prices were from $1.49 to $15.95. Notice they always ended in 9 or 5. If someone asked for a price quote, you would write your price quote on the prescription using the code PHARMOCIST. $1.49 was coded PRS. That way the next pharmacy could be friendly and quote the same price or be hungry and quote $1.39.

One day our programmer asked if he would have to program the computer to price prescriptions that were over $40.96. I said: “No. If one does come up the pharmacist will want to hand-price it instead of letting the computer do it.” Boy was I wrong. Do you know why he said 4096?

We used to do a lot of extemporaneous compounding — ointments, creams, suppositories, liquids, and capsules. Not much of that anymore. I remember making capsules that had Dexamyl granules (the little beads emptied out of the manufactured capsule) mixed with thyroid powder and dextrose. We mixed the ingredients and punched out the capsules. How many pharmacies even have the empty capsules on the shelf?

We also dispensed a lot of placebos. You could do that because the name of the drug never appeared on the label. We had placebos for most of the Schedule II drugs. The physician would call us and ask if we had placebos for Percodan. We would say yes, and he would say, “Give her 20 tabs; 1 prn pain.” Can’t do that today. I think the current AMA position on placebos is that the prescriber needs to tell the patient that he or she is prescribing a placebo. That sounds self-defeating to me.

There were no technicians. There were no computers. And most importantly, there were nowhere near as many drugs and therapeutic options. We have come a long way.

Drug interactions were just beginning to be thought about. But that’s another long story.

Now I see changes I used to dream about. Pharmacists are now performing, and getting paid for, more and more clinical functions. We’re using our education and brains for more than counting to 100 by 5s.

I frequently meet with pharmacy students. I tell them that I wish I was just starting. There is so much to look forward to. CT

George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. The author can be reached at george.pennebaker@sbcglobal.net; 916/501-6541; and PO Box 25, Esparto, CA 95627.


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American Pharmacists Association

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National Community Pharmacists’ Association

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