Pharmacieplus de la Tête Noire, Michel et Sophie Buchmann, pharmaciens

Pharmacists and physicians in the value chain

At the end of our symposium and following the interesting debates that have developed, due to your important participation and attention, I would like to conclude with a vision for tomorrow concerning the value chain and the role of pharmacists and physicians.

Do you remember the famous Philip Brown's question which shocked the entire pharmaceutical world? "Will we still need community pharmacists in the next century?"

This challenging question was raised in England in the nineties, but you will have realised that the effect of this question does spread around the world and may be divided into three categories: professional, economical and political

In every corner of the globe, the Managed Care philosophy is being installed and non-qualified distributors are trying to secure a part of the pharmaceutical market. As a consequence of their uncontrolled augmentation in the western world, as in Asia, physicians also want to profit by delivering themselves the medicines they prescribe. In fact, they are changing their role from independent health professionnals only working in favor of the patients to industry dependent actors interested in the growth of the market and the profits.

Deregulation prevails everywhere and new distribution channels, such as mail order, have been created. Pressure is being placed on decreasing margins and price and towards substitution with generics. Competition is claimed to be the new key of success. In short the pharmaceutical world seems to be rediscovering the Wild West.

Up until the present time, especially in Europe and recently in Asia, important measures have been included in the laws to guide and strengthen pharmacy practice, which include five basic protections:
Individual ownership, numerous clauses, monopoly of distribution, economic protection and a clear separation between prescribing and dispensing.
Certain countries, such as Switzerland, have tried to break all these barriers and, at the same time, Taiwan and Korea are implementing exactly the reverse and are now incorporating these measures into their laws.

In this new Wild West we have to sharpen our wits and pharmacists need to be able to answer the following three essential questions which are being put to us:
Which is your specific role in public health?
What potential savings can you offer?
How can the population benefit from your specific formation?

By answering these three questions, we can convince our social partners that our society needs pharmacists now and in the next century!

In order to have a clear vision of the problem, as our consumers or patients see it, I refer to an article which was published in the New England Journal of Medecine in 1961.

It presented in an original way the idea that in our public health systems, the patient is the boss!
In this article, it was demonstrated that in a group of a thousand people, about three-quarters suffer once a month from some kind of health problem. Out of these seven-hundred and fifty people, only two-hundred an fifty desire immediate contact with a physician and only five will end up in a specialist's consultation and one in a hospital with particularly difficult problems.

Thus five-hundred people decide themselves not to seek a consultation with a physician at first. They will first refer to publicity in the media, ask their close relatives and friends, remember their own past health experiences, look for alternative methods or, last but not least, see their pharmacist, the only health professional they can consult without an appointment.

My friend, Doctor Richard Nyffeler, president of the medical association of my canton in Switzerland agrees and says:"We have the same mission which consists of taking care of a suffering person or to reply to their questions, but not with the same education and competencies, nor the same objectives. But we cannot be competitors, as we do not have the same public. The patients you, pharmacists, receive have decided not to consult us, physicians."

Thus the mission of the pharmacist is clearly established: His first act consists of sorting out those who should consult a physician for a profound analysis from those who have slight troubles and to whom an OTC product can be recommended for a limited period or to whom can be provided with information and health education without any sale.

If the pharmacist then recieves a medical prescription, he has to validate it before delivering the medications, be sure the patient has well understood how to use them. The pharmacists must commit himself to implement pharmaceutical care in order to assure proper therapy outcomes. If well applied, all these acts can lead to important health expenditure savings. This is also to be proved in order to become as successfull in community pharmacy as our American colleagues are in the hospital sector.

At present, the attacks against pharmacists are obvious: various groups seek to modify the surface distribution inside the big rectangle as you can see on the left hand of the overhead, with strong political actions, for instance, by dispensing physicians, mail order organisations, and even supermarkets.

It is evident that pharmacy is of great interest for the vultures, not with the aim to reduce health costs but in order to conquer a part of this financially interesting market.

In order to succeed in this enterprise, they have to prove the incompetence of the pharmacists in the different professionnal functions shown on the right hand side of this overhead.

Thus, if pharmacists, all over the world, want to build up a sound future for themselves, they need to respond to the initial questions and increase positive collaboration with physicians. Pharmacists must work very hard and very quickly to develop and improve their professionnal functions, to define quality standards for all activities, and to gather hard scientific, social and economical data to prove their added value.

Let me conclude this presentation by citing Professor Sansom in "Australian Pharmacist" from April 94: "I have no reason to doubt that pharmaceutical sevices have a significant impact on health outcomes, but it is no longer acceptable to make such statements without hard data."

Dr Michel Buchmann
FIP Vice-President

Conference presented during the Pharmacy and Pharmaceutical Sciences World Congress, Singapore, september 2001