THERAPEUTIC SUBSTITUTION: PHARMACISTS NOT SEEKING "AN INDEPENDENT ROLE,"

THERAPEUTIC SUBSTITUTION: PHARMACISTS NOT SEEKING "AN INDEPENDENT ROLE," the American Pharmaceutical Association's Communications Director Ronald Williams wrote in a Jan. 29 letter to the editor of the Journal of the American Medical Association. Although pharmacy has pushed for limited authorization to substitute therapeutic alternates, "the vast majority" in the profession seek such authority within physician-controlled protocols, Williams pointed out. Pharmacists desire "a closer relationship with physicians" and "more, not less, dialogue with their colleagues in the medical profession," Williams maintained. Cooperative interaction between the professions enhances the ability of both to use "their skill and expertise to mutually benefit the patient," he said. "In those cases in which such enhanced relationships have been accomplished, it has been demonstrated that better patient care results, and neither profession usurps the prerogatives of others." Williams was responding to a JAMA editorial rallying physicians to oppose pharmacy initiatives in order to gain therapeutic substitution authorization ("The Pink Sheet" Jan. 26, T&G-7). AMA's John Ballin, PhD, contended that such authority would be a "usurpation of [physician] prerogatives." Williams characterized as "unfortunate" the editorial's implication that "organized pharmacy is launching some kind of concerted campaign to usurp the prerogatives of medical practitioners." No pharmacy organization "advocates indiscriminate therapeutic substitution by pharmacists," he said. In states where pharmacists have greater roles in therapeutic decisionmaking, they work closely with physicians, Williams noted. In California and Washington, "pharmacists act under strict protocols jointly developed by the two professions, and in Florida community pharmacists are permitted to [prescribe] only a few drugs in five categories, all of which were selected by a committee on which both pharmacists and physicians are represented," he pointed out. Pharmacists are "much better trained than they were a few years ago" and consequently "deserve a greater role in drug therapy," Williams maintained; however, they do not want a territorial battle against doctors. "In these times when the nation's health care delivery system is changing so rapidly, the viability of all health professionals is threatened; it is therefore important that we put traditional 'turf' issues aside and examine, together, how the professions might best complement one another to provide the very best health care possible in the most cost effective manner," he said.