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Good drug, bad drug

The revise code of Washington (RCW) lists a number of qualifications for becoming a pharmacist in the state. Among those requirements you’ll find this:

“Has satisfied the board [of Pharmacy] that he or she is of good moral and professional character, that he or she will carry out the duties and responsibilities required of a pharmacist …”

Note that will carry out the duties and responsibilities. And what exactly are those?

That’s the crux of a big debate Friday in Kent, Washington, which as the Seattle Times noted, “was supposed to be a simple informational meeting about whether to allow pharmacists to deny medication based on their moral or religious convictions. But more than 100 people showed up at a state Pharmacy Board meeting in Kent on Friday to speak emotionally about highly charged social issues — from abortion to gender discrimination and even assisted suicide.”

Most of them argued loudly that pharmacists should not be required to dispense drugs whose use they strongly disapprove. States including Arkansas, Georgia, Missouri, and South Dakota have done just this, allowing pharmacists to deny service under a “conscience clause.” (Oregon’s Death with Dignity law was a major prompt for this too.)

Less heard was the voice of patients arriving at the counter of their local pharmacy only to be told – as growing numbers of patients around the country have been – that their pharmacist doesn’t believe in (fill in the blank), so no meds will be forthcoming there.

An insoluable matter? Our basic take is that the preference of a professional should run a distant second place to the need of a patient. But a middle ground, acknowledging some merit on both sides, may be available.

We think of pharmacies as all being of one stripe – interchangable save for the personalities of the people behind the counter – but it’s not quite that simple. In 1976 the American Pharmaceutical Association established the Board of Pharmaceutical Specialties, which has approved five specific subcategories of pharmacies so far:

Nuclear Pharmacy (recognized in 1978) – Specialists seek to improve and promote the public’s health through the safe and effective use of radioactive drugs for diagnosis and therapy.
Nutrition Support Pharmacy (recognized in 1988) – Specialists promote the maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to the needs of the patient.
Oncology Pharmacy (recognized in 1996) – Specialists recommend, design, implement, monitor and modify pharmacotherapeutic plans to optimize outcomes in patients with malignant diseases.
Pharmacotherapy (recognized in 1988) – Specialists are responsible for ensuring the safe, appropriate, and economical use of drugs in patient care and frequently serve as a primary source of drug information for other health care professionals.
Psychiatric Pharmacy (recognized in 1992) – Specialists address the pharmaceutical care of patients with psychiatric disorders.

These are specialized by medical field (as are physicians, for that matter), but why note other categories – call them, say, “traditional” or “full service” pharmacies, in which different categories of medication are provided. The tradeoff would be, of course, that pharmacists would have to note up front which sort they are – and physicians would need to keep track of which is which, so that prescriptions are sent to the right place.

It’s obviously not a perfect solution, especially for people in rural areas where the pharmacist options may be few.

At least something like this would put the information up front and accessible pre-emergency . . . where it belongs.

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