THE CANADIAN VETERINARY JOURNAL LA REVUE VETERINAIRE CANADIENNE Volume 18
October-octobre 1977
No. 10
VETERINARIAN AND PHARMACIST YESTERDAY, TODAY AND TOMORROW Faye Kernan*
many veterinarians depended on drug sales for survivial (6). But even this did not answer all MANY VETERINARIANS AND PHARMACISTS in the needs. Remote areas often lacked both community practices today are prostituting veterinary and pharmacy services. To accomtheir professions. They exist side by side but a this situation, laws were established. world apart neither understanding nor re- modate In Canada, the Food and Drugs Act divided specting each other's roles and services. At best, Schedule F into Part I - prescription drugs and veterinarians and pharmacists in practice are in- Part II - nonprescription drugs for animal use. different to one another and in many instances As a result, "lay-outlets" for veterinary drugs they're downright antagonistic over role viola- originated allowing animal owners to obtain tions. certain drugs without a veterinarian or a pharMany veterinarians think pharmacists are no macist. And so the stage was set for role enmore than illegal diagnosticians and pill countcroachment and financial competition - the lay ers. Many pharmacists view veterinarians as outlet, dispensing veterinarian and the preillegal drug peddlers under the guise of doc- scribingthe - all claiming client service pharmacist tors. as their chief goal. But both are engaged in drugs and both In all this the drug manufacturer was in the profess public service. Actually both compete middle. disliked drug companies for the same market. And while both are be- who alsoVeterinarians sold to pharmacists and to lay-outlets; coming drug pushers more and more, they are pharmacists resented companies who sold professionals less and less. direct to veterinarians (15). To keep everybody happy and at the same time capitalize Background the distributive channels, drug through Where did it all begin this professional companiesalldeveloped lines of veterinary infringement which unfortunately caused this drugs: a "professional" two brand they sold lack of respect and lack of communication be- only to licensed veterinarianswhich a "lay" and tween these two eminent professions veter- brand which they sold to pharmacies and layinary medicine and pharmacy? outlets. On the basis of this sales policy, veterIts origin goes back to the horse and buggy inarians began to refer to drug companies as days when survival was the prime incentive "ethical" (if they sold only to veterinarians) distances were ominous; roads, qualified vet- and "unethical" (if they sold to erinarians and qualified pharmacists were and lay-outlets). In many cases thepharmacies "lay" propractically nonexistent. Because the nearest duct was identical or a slightly modified veterinarian was many miles away, to help the of the "professional" brand but bearingversion a diffarmer, veterinarians dispensed drugs, and be- ferent label and price tag. cause of staggering distances between calls, Today, although modern transportation eliminates distance as a barrier and although 'Chief Pharmacist, Department of Veterinarv Clinical Studies, Western College of Vetenrnary hundreds of highly qualified pharmacists and Medicine, University of Saskatchewan, Saskatoon, veterinarians are graduating from our universities, there has been little change in atSaskatchewan S7N OWO. Paper presented at the mid-winter meeting of titudes between veterinarians and pharmacists the Saskatchewan Veterinary Medical Association, and veterinary drugs in Canada continue to be Saskatoon, Saskatchewan, January 1977. legislated by an act, originally designed for 265
INTRODUCTION
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human drugs, which has been only minimally modified since its birth.
YESTERDAY
Concerns My main concern in all this is that while pharmacists and veterinarians engage in squabbles over territorial prerogatives, the sale of veterinary products goes on at a brisk pace in a variety of outlets with essentially no control or professional input (10). Twenty million dollars worth of animal health products are sold in Canada annually 28.8% through pharmacies, 28.2% through veterinary clinics and 43% through nonprofessional outlets (15.4% - feedstores, 10.3% hatcheries, 6.5% - farm co-ops, 10.8% - other) (15). What's more, sale through nonprofessional outlets is gaining ground at the expense of the two professional groups. I quote these figures not merely to evoke your businessman's concerns - but especially to evoke your professional concerns as drug experts and as scientists. Veterinary drugs are no longer the inocuous herbal galenicals and infusions concocted by the Indian medicine man - or the harmless cow manure poultices introduced by the Romans (16). Our scientific journals today are flooded with evidence of resistant pathogens from the indiscriminate use of antibiotics and concern over chemical and drug pollution of our environment (1, 2, 4, 8, 9, 12). A significant potential threat to public health is developing as the public becomes increasinglv aware (through Reader's Digest, Better Homes and Gardens and Playboy publications) that no real difference exists between human and veterinary preparations. Livestock owners, not uncommonly employ veterinary products for treating themselves and their families (3). The sophistication of today's veterinary therapeutic agents - their potential hazards, their judicious use - requires rational judgement based on professional guidance and expertise. Therein lies our responsibility to the public - yours and mine. Practitioners of our two professions are basically working for the same purpose and toward the same end - the preservation and betterment of animal and human well-being (14). Both pharmacist and veterinarian are thoroughly trained in the scientific college curriculums of each profession. And, in addition to functioning as practitioners, both serve as advisors on community health problems (3). Animal health is an essential and inseparable part of public health. My friends, is it not obvious that our relative roles should be complementary rather than competitive?
By no means do I pretend to be the first with this proposal. In the United States, the A.Ph.A. Commission on Pharmacy and Veterinary Medicine was established in 1965 for the purpose of developing a better rapport and understanding between pharmacy and veterinary medicine (18). Several universities (including the University of Iowa (14, 18), University of the Pacific (7) and Drake University (14) developed special courses (on agricultural pharmacy, veterinary drugs, etc.) to promote such understanding at the undergraduate level. Numerous publications have attested to the need for and the value of such an enterprise (3, 5, 6, 7, 10, 14, 18). But in Georgia, more recently an attitudinal study of pharmacy and veterinary medicine was conducted by using similar questionnaires to both practitioners (17). The results of this study indicated that there still must be vast improvement in communications and understanding before the triad of pharmacist-veterinarian-animal can be effective. Recent personal communications indicate a similar situation exists in South Africa. And on the home scene positive progress seemed to be underway when a Drug Committee, made up of members of S.Ph.A. and S.V.M.A. was formed in 1969. Its main objective was to outline legislation to insure some control over the handling of potentially hazardous veterinary medications. But presentation to cabinet of various proposals was indefinitely postponed on the grounds that funds were inadequate to enforce such legislation and that the Canada Feeds Act, by controlling drug levels in poultry and livestock feeds, adequatelv protected the consumer and although since then a number of drugs were moved to prescription status, many potent drugs still remain in Part II, Schedule F. In Ontario, Manitoba, Alberta and Saskatchewan some attempt has been made to acquaint veterinary and (or) pharmacy students with the problems. To date, most of these attempts have been limited to one or two lectures. At the University of Saskatchewan, in 1972, a Co-ordinating Committee was established to promote discussions and interchange of ideas between the faculties and students of the College of Pharmacy and the Western College of Veterinary Medicine. But unfortunately, due to committee members having heavy job priorities plus opinions that such a committee was "premature", meetings were discontinued temporarily. In October 1976, a new commit-
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tee was established to define research problems amendable to collaborative studies. It is hoped that such studies will pave the way to reactivation of the Co-ordinating Committees. TODAY
Problems Although all these joint efforts at national, provincial and academic levels are positive steps - we have only just scratched the surface. So much more needs to be done and it must be done at the community level where the actual action is. Today, possibly more than ever before, serious misunderstandings exist as evidenced by a recent survey conducted by Dr. Butler's pharmacy students (Western College of Veterinary Medicine) and by my own countless daily encounters with both professionals. I dare say often times misunderstandings have led to deliberate and unnecessary role infringements which perpetuate and further aggravate the problems between our two professions. Complaints are numerous and bitter on both sides. Some of these are as follows: 1. (a) A major complaint from veterinarians is that although pharmacists are "drug experts", they do not use this knowledge in handling veterinary drugs. They tend to be lax in their attitude involving things like proper storage, adequate information on reconstitution, dosages, etc. A veterinarian told me that he questioned a local pharmacist as to why his veterinary antibiotics, which required refrigeration, were on an open shelf. "Because", replied the pharmacist, "my fridge is full of human drugs and these are only for cows!" (b) A major complaint from pharmacists is that although veterinarians are "medical experts", they handle drugs unprofessionally - regarding dispensing, labelling, etc. They know little re choice of appropriate formulation, bio-availability, drug interactions, etc. A pharmacist told me he overheard a veterinarian on the phone say to his client, "The reason my veterinary medications are higher in price is because they are of a better quality - that stuff in the drugstore is garbage". 2. (a) Veterinarians claim that often when they do prescribe, many pharmacists are either unwilling or unable to fill veterinary prescription orders. (b) Pharmacists claim that when they do
receive a veterinary prescription it is either illegibly written on a paper towel or it is for an irrational "shot gun" home-ready or for an "ethical" trade name not available to pharmacies. 3. (a) Something that really turns veterinarians off pharmacists are the popular radio commercials that go like this, "Get all your veterinary health needs at Joe Bloe's Pharmacy - Today's Special - with any $10.00 purchase, one free bottle of PenStrep" (5). Veterinarians think pharmacists are making money hand over fist and question the validity of the pharmacists' dispensing fee. They see no rationale for pharmacists stocking Carter's Little Liver Pills, truss supports, nuts and bolts and comic books. (b) Pharmacists believe that veterinarians are charging exorbitant professional fees and hence have no sympathy for the argument that the veterinarian needs to sell drugs to survive. And because prescription drugs are sold on demand through many veterinary clinics, pharmacists scoff at legislation assigning veterinary drugs to prescription status which theoretically protects a drug's therapeutic usefulness and minimizes its potential for harm. 4. Although there are numerous other complaints and annoyances between veterinarians and pharmacists - especially at the local level - the two that cause the greatest amount of friction and bad feeling are actually one - depending on the view and which hat you are wearing. I refer, of course, to the veterinarian who appears to be a part-time pharmacist and the pharmacist who appears to be a "moonlighting" veterinarian. When I speak to veterinarians today, they genuinely believe they are acting professionally but pharmacists are blatantly contravening the Veterinarians' Act by diagnosing and prescribing. When I speak to pharmacists today, they genuinely believe they are acting professionally but veterinarians are blatantly contravening the Pharmacy Act by dispensing and selling drugs. Rationale Let us briefly look at these two Acts: Although the Veterinarians' Act of Saskatchewan specifies in Section 12 that "no person shall practice veterinary medicine unless he is registered (or unless he is an assistant to a member and is practicing in conformity with the by-laws) ", in Section 3 it makes the follow267
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ing exemptions: "Nothing in this act applies to engage in autotherapy (or self-medication). to or affects: Although it is a controversial practice, most physicians that "minor" complaints may (a) the furnishing of temporary assistance to be treated agree satisfactorily by the layman and an animal in an emergency, thus remove a considerable burden from the (b) caponizing and the taking of poultry overloaded medical profession. Untold numblood samples, bers of individuals owe their health or even (c) dehorning, their lives to the advice received from a (d) castrating of calves, pigs or lambs" pharmacist who noted too frequent use of an and although the Pharmacy Act of Saskatch- apparently harmless medication, or some other ewan states in Section 94 that "no person signal that indicated the need for the attention other than a pharmacist or an apprentice of a physician. under the immediate supervision of a pharSo when a pharmacist is consulted in an macist shall prepare, compound, dispense or emergency by a stock owner or pet owner, sell by retail any drug, medicine or poison", reluctant to take upon himself the prerogatives in Section 107 it makes the following exemp- of the veterinarian, the pharmacist may urge tion: "Nothing in this Act prevents a veterinary a visit to the veterinarian, but if his advice is surgeon from providing drugs or medicines ignored, the pharmacist can not require it. In for animals, fish, or fowl". such a situation the pharmacist often finds no In the simplest of worlds, the veterinarian alternative to providing information on overwould diagnose and prescribe - and the phar- the-counter medications. There are dangers macist would compound and dispense. Yet and risks here of course. If the animal dies, frequently the ideal is not possible and we the irate unthinking owner may blame the must work with conditions as we find them. pharmacist, unmindful he was only doing his In other words we must recognize that in duty and forgetful that it is a pet or stock many instances such shifting of hats may not owner's responsibility to secure the best probe avoidable (14). fessional advice concerning the health of his The pharmacist should understand the ra- animals. tionale which makes it imperative that every With over-the-counter drugs, unfortunately large animal veterinarian have available cer- the pharmacist has no right to tell old John Q. tain drugs for farm "on-call" treatment. It is Public what he can or cannot buy - but the impractical to expect a farmer to interrupt his pharmacist does have an obligation to provide work to drive to a pharmacy with a prescrip- him with information which will allow him tion order for a drug to be administered by to make a sound decision. And although the the veterinarian or worse still, by himself pharmacist cannot insist that each and every without the veterinarian to assist him (13, 18). animal owner consult a veterinarian everyWhat's more, delay caused by the writing and time, the pharmacist can and should alert the filling of a prescription may not be merely owner to his responsibility for the creatures inconvenient, it may be fatal. If a seriously under his care. "Do-it-yourself" diagnosing sick steer could survive the physical ordeal of and self-medication are dangerous - opposed an examination and diagnosis, that steer could to the best interest of everyone involved. well die from the stress of a subsequent period Although many veterinarians have no desire of restraint for medication (3). to wield the pharmacist's mortar and pestle Pharmacists must recognize that the treat- and most pharmacists do not wish to wear the ment and immunization of animals by the veterinarian's stethoscope (14), doubtless one farmer (especially upon his own diagnosis) is of the major problems is economics. Veterinot merely the simple procedure of reading narians are expected to be multi-species exthe label or the availability of the instruments perts - treating colic in a horse, scours in a required (18). However, there are occasions calf, performing a tracheotomy on a dog, a when it is reasonable for a large animal caesarian on a cow. All this they're expected veterinarian to write a prescription, par- to do with little or no paramedical assistance, ticularly when he has diagnosed a disease with little or no professional fee. The point is within a flock or herd of animals. that unless Vetacare becomes a reality, the On the other side of the coin is the phar- average veterinarian will sell drugs in order to macist who acts as consultant to the public realize some of his professional fee. I'm not on a wide variety of questions within the saying this is right - merely that that's why realm of public health - including "over the he sells drugs (6). counter" remedies. It is essential for veteriSimilarly, the pharmacist does not have a narians to realize that the public has a right register of patients on which his salary is 268
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based and, therefore, his advice to customers is essentially free. The prescription pricing system, designed to keep the cost of high priced drugs down, is based on cost price plus a $2.75 dispensing fee, regardless whether the drug costs $30.00 or $3.00. A $2.75 dispensing fee does not insure an adequate return for purely professional services and hence today's average retail pharmacy can survive only by the sale of nonprescription products and nonmedical items. Again, I'm not saying this is right, merely that that's why the corner drug store sells Veterinary ADE and comic books! But in both situations one needs to ask, "How much is adequate?" for often both veterinarians and pharmacists allow the unsatiable desire for increased sales to obliterate their professional role as policemen in safe veterinary drug distribution (6). Respective Roles To foster respect and better understanding of the professional roles of the veterinarian and the pharmacist, it is necessary to review at least some of their respective areas of
responsibility. Have you ever considered how very vital veterinary medicine is to our existence? According to L. C. Zopf in a paper he published in the Journal of the American Pharmaceutical Association (18), a ratio of one domestic animal and one fowl per every individual comprising the world population is considered frighteningly inadequate based on the prediction that the human population will double by the end of the century. Can our livestock population be increased at the same rate? Since animals continue to be a very vital source of human nutrition, any hope for the future must lie with the veterinarian. As well as safeguarding the health and productivity of this vital livestock industry, veterinarians maintain the health of companion animals which enhance the emotional well-being of their owners; they protect man against diseases transmissible from animals to man (such as rabies, ringworm, human salmonellosis, brucellosis, etc.) and they maintain the health of experimental laboratory animals used to study disease syndromes in man and thus obtain insight into human diseases ( 18). Have you ever considered how very vital the profession of pharmacy is to our very existence? It is pharmacy's obligation to bring to the ultimate user medicinal products (the armamentarium of medical and veterinary doctors) of the highest possible quality,
therapeutically effective, accurately prepared according to label claims or prescription requirements, as well as stable in every sense. The formulation, preparation, and distribution of these medicinals, whether accomplished by a retail pharmacist at a prescription counter, or in a clinic by a hospital pharmacist or in a large manufacturing laboratory by an industrial pharmacist requires a comprehensive knowledge of drug dosage formulations, the physical nature, chemical composition and pharmacological action of the components, as well as the complex laws governing the purchasing, storing, recording and distributing of these drugs and chemicals. The pharmacist provides counsel on any of these aspects to medical (and veterinary) practitioners (5, 6). Yet it is the health professionals themselves who are most reluctant to respect each other's professional fees. At the Western College of Veterinary Medicine, we had to euthanize a dog belonging to a medical doctor. The dog had a systemic fungal infection which started in the knee joint. His owner treated it without a veterinarian until the condition was hopeless. Veterinarians are notorious for prescribing for themselves and their families and frequently pharmacists call me for "do-it-yourself" advice regarding their pets. If we want others to recognize our professional services and fees, shouldn't we start by respecting theirs? Ethics
What's more, today, specialization is invading all the health professions. With equine, bovine, porcine, specialties, with veterinary ophthalmology and theriogenology and with retail, industrial, clinical, administrative pharmacy specialties - our two professions should not need or desire to change roles. But who is to say when a pharmacist is illegally prescribing or legally furnishing "emergency assistance" to an animal - or - when a veterinarian is illegally dispensing or legally "providing medication" for animals - except your ethics and mine. The ethics of both professions are based on the Golden Rule and comprise a system of ideal behaviour, through voluntary self-discipline, which motivates the individual to render his services not only in compliance with legal requirements but also in the best interest of his colleagues, the other health professions and the public - all other motivations like social prestige and economic gain must necessarily always be secondary (13). To function effectively, a profession must police itself. To withhold or conceal knowledge of unethical practices is dishonorable (13). 269
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Co-operative Advantages But why should we, after all these years, desire to change the status quo? Honorable colleagues, the benefits to be derived from a closer co-operative association between our two professionals - veterinarians and pharmacists - are infinite. Let's review some of
these: 1. Safety and Economy: to the owner, consumer, pharmacist and veterinarian - In order to reduce livestock losses it is essential that the farmer be acquainted with the importance of animal health care. Am I naive to suggest that this be done best by the close co-operation of veterinarian and pharmacist in the community? But unfortunately often the pharmacist's attitude today is, "The vet has no business selling drugs so why should I send this client to him and lose a sale myself?" And unfortunately, the veterinarian's attitude often is "If I don't sell this drug to my client, he'll just go to the pharmacy and buy it!" Result - both professionals provide many veterinary drugs on demand allowing the client to decide what drug to use, how and when to use it. Both professionals create abuse, the client and the public suffer for the misuse (15). Educating animal owners concerning their responsibilities is a task that falls equally on the shoulders of both professions (14). But many members of the public have great faith in their local pharmacist and often prefer a visit to him or her rather than to the local practitioner. It is the pharmacist who is the liaison between client and practitioner. Co-operation would encourage that the benefits would accrue not solely to the two professionals but to the consumer in the form of safer, better and possibly cheaper foods (10), since costly expenses from incorrect treatment would be eliminated. 2. Increased Professional Prestige - Today both professions are struggling for identity. Unsatisfactory relations between veterinarians and pharmacists leads to a downgrading of both professions. Mutual respect would cultivate co-operation which in turn would result not onlv in better public and animal health services but would add stature to each profession. Small animal veterinarians are finding that prescriptions, which can be filled by the pharmacist and administered by the owner, are a convenience and a real assist in their practice. By omitting drug dispensing and inventory control, they can
devote all of their time to diagnosis and consultation. Prescriptions for narcotic and controlled drugs eliminate record keeping for the veterinarian and some veterinarians have reduced their drug accounts by writing prescriptions and actually earned a higher net income because less money is tied up in drugs and if the client fails to pay his bill, cost of the medicine is not lost. But possibly the most important advantage for prescribing, is that the veterinarian may prescribe the drug of choice commercially available rather than that limited to his own inventory. It is indeed such conflict of interests that first caused legal separation of pharmacy and medicine in Germany by Frederick II of Hohenstaufen in 1230 A.D. (11). (Was the condition real, or merely imaginery for the sole purpose of a drug sale? Is this not where veterinary medicine stands today?) 3. Information Exchange - Volumes of drug information are appearing at an accelerating rate. The pharmacist has considerable technical knowledge about drug incompatibilities, bio-availability, adverse drug reactions and interactions. The veterinarian has considerable knowledge in animal physiology and pathology, etc. Both veterinarian and pharmacist would benefit by exchange of such information and the producer would benefit from closer monitoring and rational drug use on his livestock. 4. Disease Control and Research - All drug studies begin with animals. Joint research projects would be funded more readily. The veterinarian is best suited for appraising effects of experimental drugs and biologics on animals. Using his experience and skills more fully would be in the best interest of the pharmaceutical industry and would significantly bolster veterinary medical achievement in research and disease eradication (14). 5. Legislation - One of the undeniable facts of life is the growing role of the Federal Government in every facet of our existence. Pharmacy and veterinary medicine are not excepted. It is usually true that when government acts unwisely it is because input has been inadequate or inappropriate. Pharmacy and veterinary medicine would do well to combine their lobbying efforts to push for desirable change rather than live with what is handed them (10). It is very much in the interest of our two professions to agree on common goals which can be
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made acceptable to the government reg- Recommendations With these facts in mind, my suggestions ulatory agencies for incorporation into future are: drug control programs (14). 1. More stringent regulations are necessary The December 31, 1976 issue of the Globe at least on pesticides, antibiotics, anaesand Mail, carried an article, "Antibiotics for thetics, anthelmintics, hormones, steroids, Dinner" - Quote: "Unqualified people treat biologicals and vaccines (5). animals excessively with antibiotics . . . to make them look healthy but not cure 2. Veterinary drugs should continue to be . Disease creating micro-organisms them. available through veterinarians and pharin the animals develop resistance to the drugs. macists but pharmacists should become The animals are slaughtered for food and the more involved (5). micro-organisms pass into human hosts . . . or 3. Veterinary drugs should also continue to . . . the drugs themselves pass in slow but be available through some lay outlets but steady quantities along the food line from only to accommodate isolated areas and animals to humans creating in humans resisonly through specially trained people autance to the drugs or allergies.... And when thorized by the provincial Veterinary and the antibiotics are ordered by a doctor, they Pharmacy Associations (5). are rendered either useless or dangerous.... If we start cracking down this could create 4. "Lay" label veterinary products serve no . It serious economic effects on industry. useful purpose and hence should be dismight be hard on the meat industry to stop continued (5). Is it too much to hope that amateurs from stuffing animals with antiand veterinary medicine might pharmacy biotics. It might be harder on the rest of us and say with one voice to all hands join if the stuffing isn't stopped." Unquote. Whole"We shall buy from you only companies: hearted co-operation between the pharmacist sell to both professional groups". if you and the veterinarian can only lead to better remove one of the cankers would That control over medicines and benefit the liveso irritating. is which stock and pet community - as well as the 5. Increased supervision and regulation of consumer. radio and T.V. merchandising is essential These are but a few of the advantages that in order to control some of the high presimproved co-operation would promote. In sure techniques now promoting self- and every instance the quality of total services owner-medication of drugs and biologics. rendered would be enhanced (10). 6. Government veterinary drug programs and TOMORROW veterinary group practices are "missing the boat". They should seriously consider hiring Facts a pharmacist - as consultant, administrator, However, before maximum benefits from teacher. such co-operation could be achieved, there are some facts we have to face: 7. Joint training programs between schools of veterinary medicine and pharmacy should 1. While pharmacists are knowledgeable about be pursued for the purpose of developing drugs in general they are not presently as a specialty in Veterinary Pharmacy. On well qualified to serve veterinary needs as our own campus, plans are currently under needs (10). to serve human are they way for a formal course on Veterinary 2. Although some schools of pharmacy are beDrugs and for a Clinical Veterinary Pharcoming involved, there are few, if any, commacy program offering practical experience prehensive programs in veterinary pharmacy. in veterinary clinics to senior students. 3. If veterinarians were to start full-scale 8. Practitioners of both professions should prescribing today - pharmacists do not become involved in continuing educastock professional brand name products tion - pharmacists in Veterinary Medicine because of manufacturers' policies. Besides, and veterinarians in Pharmacy - to denot all pharmacies will desire to engage in velop interprofessional liaison and to be veterinary drugs. more effective in farmer and client education regarding animal medicines. 4. The present uncontrolled system of disI heartily congratulate the Saskatchewan tributing drugs is not without its supporters. Veterinary Medical Association for taking It is a multi-million dollar enterprise that the initiative in paving the way for the six will not disappear because we wish it to (10). 271
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regional programs we have just completed and for this program - the first of its kind in the history of this province. 9. Public and client education programs should be jointly sponsored. 10. Saskatchewan now has a drug information service to which physicians and pharmacists have direct access by phone (Dial Access). These services should be expanded to include veterinarians - which would put even the most remote veterinarian into quick contact with the most up-to-date information about drugs. If implemented, these recommendations would assure that pharmaceutical service of high quality would be available to both the veterinarian and the producer, and at the same time, controls would be placed in the hands of those best qualified to oversee the safe management of potentially dangerous drugs. SUMMARY
Although there are some harmonious veterinarian-pharmacist relationships today, they are an exception. Most veterinarians and pharmacists have not yet begun to appreciate the mutual advantages of working closely together at the practitioner level. To continue to remain complacent and immune to each other today is professionally and humanly irresponsible, because the pharmacist-veterinarian relationship is more than a man-to-man relationship, more than an interprofessional rapport, there is involvement of community and public health. Our potential to serve mankind is limitless in service, in research, in teaching. Our two roles should be complementary instead of competitive. Both of us are engaged in drugs. Both of us are concerned with their effect on public health and over their availability on the Canadian market. But because veterinary drugs are big business and big business is intimate with politics, each of our profession's single efforts are rendered ineffec-
REsuNiE
Bien qu'il existe actuellement des relations harmonieuses entre certains veterinaires et pharmaciens, elles n'en demeurent pas moins exceptionnelles. La plupart d'entre eux ne semblent pas encore avoir realise les avantages mutuels d'une collaboration etroite, surtout au niveau de la pratique. Le fait qu'ils s'entetent a s'ignorer mutuellement represente aujourd'hui un manque de responsabilite professionnelle et humaine. En effet, les relations entre veterinaires et pharmaciens representent beaucoup plus qu'une relation d'homme 'a homme ou entre professionnels; elles ont un impact sur la societe et la sante publique. Notre potentiel envers l'humanite ne connait pas de limites en ce qui a trait aux services, 'a la recherche et 'a l'enseignement. Nos roles respectifs devraient etre complementaires plutot que competitifs. En effet, les deux professions s'occupent des medicaments; elles sont egalement impliquees en ce qui concerne les effets de ces medicaments sur la sante publique et leur disponibilite sur le marche canadien. EJtant donne que les medicaments veterinaires representent un marche important et que tout marche important se trouve intimement relie a la politique, les efforts individuels des deux professions demeurent sans effet. Nous devons d'abord eduquer les eduques, c'est-'a-dire nous-memes, a resoudre nos divergences de vue. L'initiation des contacts de cette nature incombe tant aux veterinaires
qu'aux pharmaciens. En second lieu, nous devons faire abstraction du signe de piastre, reevaluer nos responsabilites professionnelles et scruter les problemes actuels. Les veterinaires et les pharmaciens doivent finalement deployer un effort ultime de collaboration qui leur permettra de s'engager dans une orientation professionnelle, benefique pour tous et chacun. REFERENCES
1. GOLDBERG, L. Safety of environmental chemicals: The need and the challenge. Fd Cosmet. Tox. 10: 523. 1972. 2. HUBER, W. G. The impact of antibiotic drugs and their residues. Adv. vet. Sci. comp. Med. 15: 101-132. 1971. 3. JONES, L. M. Professional interrelations. J. Am. pharm. Ass. N56: 144-146. 1966. 4. JUKES, T. H. Antibiotics in meat production. J. Am. med. Ass. 232: 292-293. 1975. 5. KERNAN, F. Veterinary drugs - their use, misuse and abuse. Western Horizons 10: 14-18, National Drugs Ltd. Winnipeg 1975. Seminar National Meeting of the Canadian
tive. First, we must "'educate the educated," ourselves, to resolve our differences. Initiation of such communication is equally the obligation of both professionals. Second, we must set the dollar-sign aside, re-evaluate our professional responsibilities, investigate the existing problems and finally, in an all-out, whole-hearted effort, the veterinarian and pharmacist, working together, must give professional direction for everyone's
benefit. 272
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Pharmaceutical Association, Moncton, N.B., May 1975. 6. KERNAN, F. Veterinary pharmacy: Another field of service. Can. pharm. J. 108: 132-136. 1975. 7. MCCULLOCK, W. F. Socio economic aspects of pharmacy - Veterinary Medicine relations. J. Am. vet. med. Ass. 149: 1518-1524. 1966. 8. MEDENWALD, H. Metabolite and residue research. Stoffwechsel - und Ruckstunds forschung. Vet.-med. Nachr. 1: 32-42. 1973. 9. MUSSMAN, H. C. Drug and chemical residues in domestic animals. Fedn Proc. Am. Soc. exp. Biol. 34: 197-201. 1975. 10. NELSON, R. B. The interface between the pharmacist and veterinarians. Symposium on Pharmacology in the Animal Health Sector, Fort Collins, Colorado. September 1975. 11. NORTHWOOD INSTITUTE PRESS. Separation of Pharmacy and Medicine. Great Moments in Pharmacy: The Stories and the Paintings in the Series. George A. Bender. Detroit, Michigan. 1966.
12. POWERS, T. E. Antimicrobial therapy in Veterinary Medicine. Feed additives and drug residues. Chapter XIV: 1-31. T. E. Powers. Columbus, Ohio. 1976. 13. REMINGTON'S PHARMACEUTICAL SCIENCES. Fifteenth Edition. pp. 20-27. Eston, Penn.: Mack Publishing Co. 1975. 14. SCHROEDER, R. J. Veterinarians and Rx men can help each other. Am. prof. Pharm. 34: 31-35. 1968. 15. SLINGER, J. E. The interrelations of pharmacy and veterinary medicine. Seminar, Ontario Veterinary College, Guelph, Ont. 1976. 16. STOWE, C. M. History of veterinary pharmacotherapeutics in the United States. J. Am. vet. med. Ass. 169: 83-89. 1976. 17. SUNINER, E. J., J. A. KOTZAN and D. N. ESTREKIN. Pharmacy - veterinary medicine. J. Am. pharm. Ass. NS15: 454-456. 1975. 18. ZOPF, L. C. Pharmacy - veterinary medicine relations. J. Am. pharm. Ass. NS11: 168-170. 1971.
BOOK REVIEW First Steps in Veterinary Science. K. Aspinall. Published by Bailliere Tindall, London. 1976. 222 pages. Price £2.95. One of the problems often facing the instructor of courses in applied science is the absence of a text entirely suitable to the course of study. One of the common and attractive solutions is for the instructor to assemble his own notes (revised and reorganized over the years) into a publishable manuscript. This undoubtedly accounts for the recent and welcome proliferation of assembled notes such as: Habel's Anatomy, Thomson's Pathology, Morgan's Radiography and Sawyer's Anesthesiology. Another such work, in more regular text book format, is now available in Aspinall's First Steps in Veterinary Science. This welcome addition to veterinary literature begs but one question, "Where does it fit?" The majority of such books require for optimum benefit, a teacher, a course, and a definite target level of student. First Steps in Veterinary Science could prove to be an excellent introductory level and reference text for pre-veterinary, Animal Science and Animal Health Technician students. In addition it could prove easy and informative reading for the assistant in veterinary practice and the interested lay person.
The sections on Anatomy and Physiology, Animal Behaviour, Animal Production and so on, are all excellently handled, and for the most part, with a minimum of ambiguous or disputable statements. They may however require some interpretation here and there, and the practitioner who buys this book for his lay assistant should be prepared to spend several coffee breaks explaining passages which, in an institution, would be discussed and clarified in the classroom. Some phrases which may defy explanation are . . . venous blood is blue.", ". . . shock is a result of prolonged stress . .", ". . . when animals are placed at night in a Khola, Bhoma or Kraal, they should be released as soon as possible in the morning." and (with reference to strychnine) "It is quite useless to apply antidotes." However whilst the terminology, and the orientation towards third world agriculture may limit somewhat the application of this text in North America, neither should detract from its value. All in all this book should prove a worthwhile addition to the libraries of large animal practices, technician training institutions, agricutural colleges and pre-veterinary faculties. The various university and college book stores may also find it a saleable item to the lay public. W. B. Ramsay. 273
October-octobre 1977
No. 10
VETERINARIAN AND PHARMACIST YESTERDAY, TODAY AND TOMORROW Faye Kernan*
many veterinarians depended on drug sales for survivial (6). But even this did not answer all MANY VETERINARIANS AND PHARMACISTS in the needs. Remote areas often lacked both community practices today are prostituting veterinary and pharmacy services. To accomtheir professions. They exist side by side but a this situation, laws were established. world apart neither understanding nor re- modate In Canada, the Food and Drugs Act divided specting each other's roles and services. At best, Schedule F into Part I - prescription drugs and veterinarians and pharmacists in practice are in- Part II - nonprescription drugs for animal use. different to one another and in many instances As a result, "lay-outlets" for veterinary drugs they're downright antagonistic over role viola- originated allowing animal owners to obtain tions. certain drugs without a veterinarian or a pharMany veterinarians think pharmacists are no macist. And so the stage was set for role enmore than illegal diagnosticians and pill countcroachment and financial competition - the lay ers. Many pharmacists view veterinarians as outlet, dispensing veterinarian and the preillegal drug peddlers under the guise of doc- scribingthe - all claiming client service pharmacist tors. as their chief goal. But both are engaged in drugs and both In all this the drug manufacturer was in the profess public service. Actually both compete middle. disliked drug companies for the same market. And while both are be- who alsoVeterinarians sold to pharmacists and to lay-outlets; coming drug pushers more and more, they are pharmacists resented companies who sold professionals less and less. direct to veterinarians (15). To keep everybody happy and at the same time capitalize Background the distributive channels, drug through Where did it all begin this professional companiesalldeveloped lines of veterinary infringement which unfortunately caused this drugs: a "professional" two brand they sold lack of respect and lack of communication be- only to licensed veterinarianswhich a "lay" and tween these two eminent professions veter- brand which they sold to pharmacies and layinary medicine and pharmacy? outlets. On the basis of this sales policy, veterIts origin goes back to the horse and buggy inarians began to refer to drug companies as days when survival was the prime incentive "ethical" (if they sold only to veterinarians) distances were ominous; roads, qualified vet- and "unethical" (if they sold to erinarians and qualified pharmacists were and lay-outlets). In many cases thepharmacies "lay" propractically nonexistent. Because the nearest duct was identical or a slightly modified veterinarian was many miles away, to help the of the "professional" brand but bearingversion a diffarmer, veterinarians dispensed drugs, and be- ferent label and price tag. cause of staggering distances between calls, Today, although modern transportation eliminates distance as a barrier and although 'Chief Pharmacist, Department of Veterinarv Clinical Studies, Western College of Vetenrnary hundreds of highly qualified pharmacists and Medicine, University of Saskatchewan, Saskatoon, veterinarians are graduating from our universities, there has been little change in atSaskatchewan S7N OWO. Paper presented at the mid-winter meeting of titudes between veterinarians and pharmacists the Saskatchewan Veterinary Medical Association, and veterinary drugs in Canada continue to be Saskatoon, Saskatchewan, January 1977. legislated by an act, originally designed for 265
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human drugs, which has been only minimally modified since its birth.
YESTERDAY
Concerns My main concern in all this is that while pharmacists and veterinarians engage in squabbles over territorial prerogatives, the sale of veterinary products goes on at a brisk pace in a variety of outlets with essentially no control or professional input (10). Twenty million dollars worth of animal health products are sold in Canada annually 28.8% through pharmacies, 28.2% through veterinary clinics and 43% through nonprofessional outlets (15.4% - feedstores, 10.3% hatcheries, 6.5% - farm co-ops, 10.8% - other) (15). What's more, sale through nonprofessional outlets is gaining ground at the expense of the two professional groups. I quote these figures not merely to evoke your businessman's concerns - but especially to evoke your professional concerns as drug experts and as scientists. Veterinary drugs are no longer the inocuous herbal galenicals and infusions concocted by the Indian medicine man - or the harmless cow manure poultices introduced by the Romans (16). Our scientific journals today are flooded with evidence of resistant pathogens from the indiscriminate use of antibiotics and concern over chemical and drug pollution of our environment (1, 2, 4, 8, 9, 12). A significant potential threat to public health is developing as the public becomes increasinglv aware (through Reader's Digest, Better Homes and Gardens and Playboy publications) that no real difference exists between human and veterinary preparations. Livestock owners, not uncommonly employ veterinary products for treating themselves and their families (3). The sophistication of today's veterinary therapeutic agents - their potential hazards, their judicious use - requires rational judgement based on professional guidance and expertise. Therein lies our responsibility to the public - yours and mine. Practitioners of our two professions are basically working for the same purpose and toward the same end - the preservation and betterment of animal and human well-being (14). Both pharmacist and veterinarian are thoroughly trained in the scientific college curriculums of each profession. And, in addition to functioning as practitioners, both serve as advisors on community health problems (3). Animal health is an essential and inseparable part of public health. My friends, is it not obvious that our relative roles should be complementary rather than competitive?
By no means do I pretend to be the first with this proposal. In the United States, the A.Ph.A. Commission on Pharmacy and Veterinary Medicine was established in 1965 for the purpose of developing a better rapport and understanding between pharmacy and veterinary medicine (18). Several universities (including the University of Iowa (14, 18), University of the Pacific (7) and Drake University (14) developed special courses (on agricultural pharmacy, veterinary drugs, etc.) to promote such understanding at the undergraduate level. Numerous publications have attested to the need for and the value of such an enterprise (3, 5, 6, 7, 10, 14, 18). But in Georgia, more recently an attitudinal study of pharmacy and veterinary medicine was conducted by using similar questionnaires to both practitioners (17). The results of this study indicated that there still must be vast improvement in communications and understanding before the triad of pharmacist-veterinarian-animal can be effective. Recent personal communications indicate a similar situation exists in South Africa. And on the home scene positive progress seemed to be underway when a Drug Committee, made up of members of S.Ph.A. and S.V.M.A. was formed in 1969. Its main objective was to outline legislation to insure some control over the handling of potentially hazardous veterinary medications. But presentation to cabinet of various proposals was indefinitely postponed on the grounds that funds were inadequate to enforce such legislation and that the Canada Feeds Act, by controlling drug levels in poultry and livestock feeds, adequatelv protected the consumer and although since then a number of drugs were moved to prescription status, many potent drugs still remain in Part II, Schedule F. In Ontario, Manitoba, Alberta and Saskatchewan some attempt has been made to acquaint veterinary and (or) pharmacy students with the problems. To date, most of these attempts have been limited to one or two lectures. At the University of Saskatchewan, in 1972, a Co-ordinating Committee was established to promote discussions and interchange of ideas between the faculties and students of the College of Pharmacy and the Western College of Veterinary Medicine. But unfortunately, due to committee members having heavy job priorities plus opinions that such a committee was "premature", meetings were discontinued temporarily. In October 1976, a new commit-
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tee was established to define research problems amendable to collaborative studies. It is hoped that such studies will pave the way to reactivation of the Co-ordinating Committees. TODAY
Problems Although all these joint efforts at national, provincial and academic levels are positive steps - we have only just scratched the surface. So much more needs to be done and it must be done at the community level where the actual action is. Today, possibly more than ever before, serious misunderstandings exist as evidenced by a recent survey conducted by Dr. Butler's pharmacy students (Western College of Veterinary Medicine) and by my own countless daily encounters with both professionals. I dare say often times misunderstandings have led to deliberate and unnecessary role infringements which perpetuate and further aggravate the problems between our two professions. Complaints are numerous and bitter on both sides. Some of these are as follows: 1. (a) A major complaint from veterinarians is that although pharmacists are "drug experts", they do not use this knowledge in handling veterinary drugs. They tend to be lax in their attitude involving things like proper storage, adequate information on reconstitution, dosages, etc. A veterinarian told me that he questioned a local pharmacist as to why his veterinary antibiotics, which required refrigeration, were on an open shelf. "Because", replied the pharmacist, "my fridge is full of human drugs and these are only for cows!" (b) A major complaint from pharmacists is that although veterinarians are "medical experts", they handle drugs unprofessionally - regarding dispensing, labelling, etc. They know little re choice of appropriate formulation, bio-availability, drug interactions, etc. A pharmacist told me he overheard a veterinarian on the phone say to his client, "The reason my veterinary medications are higher in price is because they are of a better quality - that stuff in the drugstore is garbage". 2. (a) Veterinarians claim that often when they do prescribe, many pharmacists are either unwilling or unable to fill veterinary prescription orders. (b) Pharmacists claim that when they do
receive a veterinary prescription it is either illegibly written on a paper towel or it is for an irrational "shot gun" home-ready or for an "ethical" trade name not available to pharmacies. 3. (a) Something that really turns veterinarians off pharmacists are the popular radio commercials that go like this, "Get all your veterinary health needs at Joe Bloe's Pharmacy - Today's Special - with any $10.00 purchase, one free bottle of PenStrep" (5). Veterinarians think pharmacists are making money hand over fist and question the validity of the pharmacists' dispensing fee. They see no rationale for pharmacists stocking Carter's Little Liver Pills, truss supports, nuts and bolts and comic books. (b) Pharmacists believe that veterinarians are charging exorbitant professional fees and hence have no sympathy for the argument that the veterinarian needs to sell drugs to survive. And because prescription drugs are sold on demand through many veterinary clinics, pharmacists scoff at legislation assigning veterinary drugs to prescription status which theoretically protects a drug's therapeutic usefulness and minimizes its potential for harm. 4. Although there are numerous other complaints and annoyances between veterinarians and pharmacists - especially at the local level - the two that cause the greatest amount of friction and bad feeling are actually one - depending on the view and which hat you are wearing. I refer, of course, to the veterinarian who appears to be a part-time pharmacist and the pharmacist who appears to be a "moonlighting" veterinarian. When I speak to veterinarians today, they genuinely believe they are acting professionally but pharmacists are blatantly contravening the Veterinarians' Act by diagnosing and prescribing. When I speak to pharmacists today, they genuinely believe they are acting professionally but veterinarians are blatantly contravening the Pharmacy Act by dispensing and selling drugs. Rationale Let us briefly look at these two Acts: Although the Veterinarians' Act of Saskatchewan specifies in Section 12 that "no person shall practice veterinary medicine unless he is registered (or unless he is an assistant to a member and is practicing in conformity with the by-laws) ", in Section 3 it makes the follow267
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ing exemptions: "Nothing in this act applies to engage in autotherapy (or self-medication). to or affects: Although it is a controversial practice, most physicians that "minor" complaints may (a) the furnishing of temporary assistance to be treated agree satisfactorily by the layman and an animal in an emergency, thus remove a considerable burden from the (b) caponizing and the taking of poultry overloaded medical profession. Untold numblood samples, bers of individuals owe their health or even (c) dehorning, their lives to the advice received from a (d) castrating of calves, pigs or lambs" pharmacist who noted too frequent use of an and although the Pharmacy Act of Saskatch- apparently harmless medication, or some other ewan states in Section 94 that "no person signal that indicated the need for the attention other than a pharmacist or an apprentice of a physician. under the immediate supervision of a pharSo when a pharmacist is consulted in an macist shall prepare, compound, dispense or emergency by a stock owner or pet owner, sell by retail any drug, medicine or poison", reluctant to take upon himself the prerogatives in Section 107 it makes the following exemp- of the veterinarian, the pharmacist may urge tion: "Nothing in this Act prevents a veterinary a visit to the veterinarian, but if his advice is surgeon from providing drugs or medicines ignored, the pharmacist can not require it. In for animals, fish, or fowl". such a situation the pharmacist often finds no In the simplest of worlds, the veterinarian alternative to providing information on overwould diagnose and prescribe - and the phar- the-counter medications. There are dangers macist would compound and dispense. Yet and risks here of course. If the animal dies, frequently the ideal is not possible and we the irate unthinking owner may blame the must work with conditions as we find them. pharmacist, unmindful he was only doing his In other words we must recognize that in duty and forgetful that it is a pet or stock many instances such shifting of hats may not owner's responsibility to secure the best probe avoidable (14). fessional advice concerning the health of his The pharmacist should understand the ra- animals. tionale which makes it imperative that every With over-the-counter drugs, unfortunately large animal veterinarian have available cer- the pharmacist has no right to tell old John Q. tain drugs for farm "on-call" treatment. It is Public what he can or cannot buy - but the impractical to expect a farmer to interrupt his pharmacist does have an obligation to provide work to drive to a pharmacy with a prescrip- him with information which will allow him tion order for a drug to be administered by to make a sound decision. And although the the veterinarian or worse still, by himself pharmacist cannot insist that each and every without the veterinarian to assist him (13, 18). animal owner consult a veterinarian everyWhat's more, delay caused by the writing and time, the pharmacist can and should alert the filling of a prescription may not be merely owner to his responsibility for the creatures inconvenient, it may be fatal. If a seriously under his care. "Do-it-yourself" diagnosing sick steer could survive the physical ordeal of and self-medication are dangerous - opposed an examination and diagnosis, that steer could to the best interest of everyone involved. well die from the stress of a subsequent period Although many veterinarians have no desire of restraint for medication (3). to wield the pharmacist's mortar and pestle Pharmacists must recognize that the treat- and most pharmacists do not wish to wear the ment and immunization of animals by the veterinarian's stethoscope (14), doubtless one farmer (especially upon his own diagnosis) is of the major problems is economics. Veterinot merely the simple procedure of reading narians are expected to be multi-species exthe label or the availability of the instruments perts - treating colic in a horse, scours in a required (18). However, there are occasions calf, performing a tracheotomy on a dog, a when it is reasonable for a large animal caesarian on a cow. All this they're expected veterinarian to write a prescription, par- to do with little or no paramedical assistance, ticularly when he has diagnosed a disease with little or no professional fee. The point is within a flock or herd of animals. that unless Vetacare becomes a reality, the On the other side of the coin is the phar- average veterinarian will sell drugs in order to macist who acts as consultant to the public realize some of his professional fee. I'm not on a wide variety of questions within the saying this is right - merely that that's why realm of public health - including "over the he sells drugs (6). counter" remedies. It is essential for veteriSimilarly, the pharmacist does not have a narians to realize that the public has a right register of patients on which his salary is 268
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based and, therefore, his advice to customers is essentially free. The prescription pricing system, designed to keep the cost of high priced drugs down, is based on cost price plus a $2.75 dispensing fee, regardless whether the drug costs $30.00 or $3.00. A $2.75 dispensing fee does not insure an adequate return for purely professional services and hence today's average retail pharmacy can survive only by the sale of nonprescription products and nonmedical items. Again, I'm not saying this is right, merely that that's why the corner drug store sells Veterinary ADE and comic books! But in both situations one needs to ask, "How much is adequate?" for often both veterinarians and pharmacists allow the unsatiable desire for increased sales to obliterate their professional role as policemen in safe veterinary drug distribution (6). Respective Roles To foster respect and better understanding of the professional roles of the veterinarian and the pharmacist, it is necessary to review at least some of their respective areas of
responsibility. Have you ever considered how very vital veterinary medicine is to our existence? According to L. C. Zopf in a paper he published in the Journal of the American Pharmaceutical Association (18), a ratio of one domestic animal and one fowl per every individual comprising the world population is considered frighteningly inadequate based on the prediction that the human population will double by the end of the century. Can our livestock population be increased at the same rate? Since animals continue to be a very vital source of human nutrition, any hope for the future must lie with the veterinarian. As well as safeguarding the health and productivity of this vital livestock industry, veterinarians maintain the health of companion animals which enhance the emotional well-being of their owners; they protect man against diseases transmissible from animals to man (such as rabies, ringworm, human salmonellosis, brucellosis, etc.) and they maintain the health of experimental laboratory animals used to study disease syndromes in man and thus obtain insight into human diseases ( 18). Have you ever considered how very vital the profession of pharmacy is to our very existence? It is pharmacy's obligation to bring to the ultimate user medicinal products (the armamentarium of medical and veterinary doctors) of the highest possible quality,
therapeutically effective, accurately prepared according to label claims or prescription requirements, as well as stable in every sense. The formulation, preparation, and distribution of these medicinals, whether accomplished by a retail pharmacist at a prescription counter, or in a clinic by a hospital pharmacist or in a large manufacturing laboratory by an industrial pharmacist requires a comprehensive knowledge of drug dosage formulations, the physical nature, chemical composition and pharmacological action of the components, as well as the complex laws governing the purchasing, storing, recording and distributing of these drugs and chemicals. The pharmacist provides counsel on any of these aspects to medical (and veterinary) practitioners (5, 6). Yet it is the health professionals themselves who are most reluctant to respect each other's professional fees. At the Western College of Veterinary Medicine, we had to euthanize a dog belonging to a medical doctor. The dog had a systemic fungal infection which started in the knee joint. His owner treated it without a veterinarian until the condition was hopeless. Veterinarians are notorious for prescribing for themselves and their families and frequently pharmacists call me for "do-it-yourself" advice regarding their pets. If we want others to recognize our professional services and fees, shouldn't we start by respecting theirs? Ethics
What's more, today, specialization is invading all the health professions. With equine, bovine, porcine, specialties, with veterinary ophthalmology and theriogenology and with retail, industrial, clinical, administrative pharmacy specialties - our two professions should not need or desire to change roles. But who is to say when a pharmacist is illegally prescribing or legally furnishing "emergency assistance" to an animal - or - when a veterinarian is illegally dispensing or legally "providing medication" for animals - except your ethics and mine. The ethics of both professions are based on the Golden Rule and comprise a system of ideal behaviour, through voluntary self-discipline, which motivates the individual to render his services not only in compliance with legal requirements but also in the best interest of his colleagues, the other health professions and the public - all other motivations like social prestige and economic gain must necessarily always be secondary (13). To function effectively, a profession must police itself. To withhold or conceal knowledge of unethical practices is dishonorable (13). 269
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Co-operative Advantages But why should we, after all these years, desire to change the status quo? Honorable colleagues, the benefits to be derived from a closer co-operative association between our two professionals - veterinarians and pharmacists - are infinite. Let's review some of
these: 1. Safety and Economy: to the owner, consumer, pharmacist and veterinarian - In order to reduce livestock losses it is essential that the farmer be acquainted with the importance of animal health care. Am I naive to suggest that this be done best by the close co-operation of veterinarian and pharmacist in the community? But unfortunately often the pharmacist's attitude today is, "The vet has no business selling drugs so why should I send this client to him and lose a sale myself?" And unfortunately, the veterinarian's attitude often is "If I don't sell this drug to my client, he'll just go to the pharmacy and buy it!" Result - both professionals provide many veterinary drugs on demand allowing the client to decide what drug to use, how and when to use it. Both professionals create abuse, the client and the public suffer for the misuse (15). Educating animal owners concerning their responsibilities is a task that falls equally on the shoulders of both professions (14). But many members of the public have great faith in their local pharmacist and often prefer a visit to him or her rather than to the local practitioner. It is the pharmacist who is the liaison between client and practitioner. Co-operation would encourage that the benefits would accrue not solely to the two professionals but to the consumer in the form of safer, better and possibly cheaper foods (10), since costly expenses from incorrect treatment would be eliminated. 2. Increased Professional Prestige - Today both professions are struggling for identity. Unsatisfactory relations between veterinarians and pharmacists leads to a downgrading of both professions. Mutual respect would cultivate co-operation which in turn would result not onlv in better public and animal health services but would add stature to each profession. Small animal veterinarians are finding that prescriptions, which can be filled by the pharmacist and administered by the owner, are a convenience and a real assist in their practice. By omitting drug dispensing and inventory control, they can
devote all of their time to diagnosis and consultation. Prescriptions for narcotic and controlled drugs eliminate record keeping for the veterinarian and some veterinarians have reduced their drug accounts by writing prescriptions and actually earned a higher net income because less money is tied up in drugs and if the client fails to pay his bill, cost of the medicine is not lost. But possibly the most important advantage for prescribing, is that the veterinarian may prescribe the drug of choice commercially available rather than that limited to his own inventory. It is indeed such conflict of interests that first caused legal separation of pharmacy and medicine in Germany by Frederick II of Hohenstaufen in 1230 A.D. (11). (Was the condition real, or merely imaginery for the sole purpose of a drug sale? Is this not where veterinary medicine stands today?) 3. Information Exchange - Volumes of drug information are appearing at an accelerating rate. The pharmacist has considerable technical knowledge about drug incompatibilities, bio-availability, adverse drug reactions and interactions. The veterinarian has considerable knowledge in animal physiology and pathology, etc. Both veterinarian and pharmacist would benefit by exchange of such information and the producer would benefit from closer monitoring and rational drug use on his livestock. 4. Disease Control and Research - All drug studies begin with animals. Joint research projects would be funded more readily. The veterinarian is best suited for appraising effects of experimental drugs and biologics on animals. Using his experience and skills more fully would be in the best interest of the pharmaceutical industry and would significantly bolster veterinary medical achievement in research and disease eradication (14). 5. Legislation - One of the undeniable facts of life is the growing role of the Federal Government in every facet of our existence. Pharmacy and veterinary medicine are not excepted. It is usually true that when government acts unwisely it is because input has been inadequate or inappropriate. Pharmacy and veterinary medicine would do well to combine their lobbying efforts to push for desirable change rather than live with what is handed them (10). It is very much in the interest of our two professions to agree on common goals which can be
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made acceptable to the government reg- Recommendations With these facts in mind, my suggestions ulatory agencies for incorporation into future are: drug control programs (14). 1. More stringent regulations are necessary The December 31, 1976 issue of the Globe at least on pesticides, antibiotics, anaesand Mail, carried an article, "Antibiotics for thetics, anthelmintics, hormones, steroids, Dinner" - Quote: "Unqualified people treat biologicals and vaccines (5). animals excessively with antibiotics . . . to make them look healthy but not cure 2. Veterinary drugs should continue to be . Disease creating micro-organisms them. available through veterinarians and pharin the animals develop resistance to the drugs. macists but pharmacists should become The animals are slaughtered for food and the more involved (5). micro-organisms pass into human hosts . . . or 3. Veterinary drugs should also continue to . . . the drugs themselves pass in slow but be available through some lay outlets but steady quantities along the food line from only to accommodate isolated areas and animals to humans creating in humans resisonly through specially trained people autance to the drugs or allergies.... And when thorized by the provincial Veterinary and the antibiotics are ordered by a doctor, they Pharmacy Associations (5). are rendered either useless or dangerous.... If we start cracking down this could create 4. "Lay" label veterinary products serve no . It serious economic effects on industry. useful purpose and hence should be dismight be hard on the meat industry to stop continued (5). Is it too much to hope that amateurs from stuffing animals with antiand veterinary medicine might pharmacy biotics. It might be harder on the rest of us and say with one voice to all hands join if the stuffing isn't stopped." Unquote. Whole"We shall buy from you only companies: hearted co-operation between the pharmacist sell to both professional groups". if you and the veterinarian can only lead to better remove one of the cankers would That control over medicines and benefit the liveso irritating. is which stock and pet community - as well as the 5. Increased supervision and regulation of consumer. radio and T.V. merchandising is essential These are but a few of the advantages that in order to control some of the high presimproved co-operation would promote. In sure techniques now promoting self- and every instance the quality of total services owner-medication of drugs and biologics. rendered would be enhanced (10). 6. Government veterinary drug programs and TOMORROW veterinary group practices are "missing the boat". They should seriously consider hiring Facts a pharmacist - as consultant, administrator, However, before maximum benefits from teacher. such co-operation could be achieved, there are some facts we have to face: 7. Joint training programs between schools of veterinary medicine and pharmacy should 1. While pharmacists are knowledgeable about be pursued for the purpose of developing drugs in general they are not presently as a specialty in Veterinary Pharmacy. On well qualified to serve veterinary needs as our own campus, plans are currently under needs (10). to serve human are they way for a formal course on Veterinary 2. Although some schools of pharmacy are beDrugs and for a Clinical Veterinary Pharcoming involved, there are few, if any, commacy program offering practical experience prehensive programs in veterinary pharmacy. in veterinary clinics to senior students. 3. If veterinarians were to start full-scale 8. Practitioners of both professions should prescribing today - pharmacists do not become involved in continuing educastock professional brand name products tion - pharmacists in Veterinary Medicine because of manufacturers' policies. Besides, and veterinarians in Pharmacy - to denot all pharmacies will desire to engage in velop interprofessional liaison and to be veterinary drugs. more effective in farmer and client education regarding animal medicines. 4. The present uncontrolled system of disI heartily congratulate the Saskatchewan tributing drugs is not without its supporters. Veterinary Medical Association for taking It is a multi-million dollar enterprise that the initiative in paving the way for the six will not disappear because we wish it to (10). 271
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regional programs we have just completed and for this program - the first of its kind in the history of this province. 9. Public and client education programs should be jointly sponsored. 10. Saskatchewan now has a drug information service to which physicians and pharmacists have direct access by phone (Dial Access). These services should be expanded to include veterinarians - which would put even the most remote veterinarian into quick contact with the most up-to-date information about drugs. If implemented, these recommendations would assure that pharmaceutical service of high quality would be available to both the veterinarian and the producer, and at the same time, controls would be placed in the hands of those best qualified to oversee the safe management of potentially dangerous drugs. SUMMARY
Although there are some harmonious veterinarian-pharmacist relationships today, they are an exception. Most veterinarians and pharmacists have not yet begun to appreciate the mutual advantages of working closely together at the practitioner level. To continue to remain complacent and immune to each other today is professionally and humanly irresponsible, because the pharmacist-veterinarian relationship is more than a man-to-man relationship, more than an interprofessional rapport, there is involvement of community and public health. Our potential to serve mankind is limitless in service, in research, in teaching. Our two roles should be complementary instead of competitive. Both of us are engaged in drugs. Both of us are concerned with their effect on public health and over their availability on the Canadian market. But because veterinary drugs are big business and big business is intimate with politics, each of our profession's single efforts are rendered ineffec-
REsuNiE
Bien qu'il existe actuellement des relations harmonieuses entre certains veterinaires et pharmaciens, elles n'en demeurent pas moins exceptionnelles. La plupart d'entre eux ne semblent pas encore avoir realise les avantages mutuels d'une collaboration etroite, surtout au niveau de la pratique. Le fait qu'ils s'entetent a s'ignorer mutuellement represente aujourd'hui un manque de responsabilite professionnelle et humaine. En effet, les relations entre veterinaires et pharmaciens representent beaucoup plus qu'une relation d'homme 'a homme ou entre professionnels; elles ont un impact sur la societe et la sante publique. Notre potentiel envers l'humanite ne connait pas de limites en ce qui a trait aux services, 'a la recherche et 'a l'enseignement. Nos roles respectifs devraient etre complementaires plutot que competitifs. En effet, les deux professions s'occupent des medicaments; elles sont egalement impliquees en ce qui concerne les effets de ces medicaments sur la sante publique et leur disponibilite sur le marche canadien. EJtant donne que les medicaments veterinaires representent un marche important et que tout marche important se trouve intimement relie a la politique, les efforts individuels des deux professions demeurent sans effet. Nous devons d'abord eduquer les eduques, c'est-'a-dire nous-memes, a resoudre nos divergences de vue. L'initiation des contacts de cette nature incombe tant aux veterinaires
qu'aux pharmaciens. En second lieu, nous devons faire abstraction du signe de piastre, reevaluer nos responsabilites professionnelles et scruter les problemes actuels. Les veterinaires et les pharmaciens doivent finalement deployer un effort ultime de collaboration qui leur permettra de s'engager dans une orientation professionnelle, benefique pour tous et chacun. REFERENCES
1. GOLDBERG, L. Safety of environmental chemicals: The need and the challenge. Fd Cosmet. Tox. 10: 523. 1972. 2. HUBER, W. G. The impact of antibiotic drugs and their residues. Adv. vet. Sci. comp. Med. 15: 101-132. 1971. 3. JONES, L. M. Professional interrelations. J. Am. pharm. Ass. N56: 144-146. 1966. 4. JUKES, T. H. Antibiotics in meat production. J. Am. med. Ass. 232: 292-293. 1975. 5. KERNAN, F. Veterinary drugs - their use, misuse and abuse. Western Horizons 10: 14-18, National Drugs Ltd. Winnipeg 1975. Seminar National Meeting of the Canadian
tive. First, we must "'educate the educated," ourselves, to resolve our differences. Initiation of such communication is equally the obligation of both professionals. Second, we must set the dollar-sign aside, re-evaluate our professional responsibilities, investigate the existing problems and finally, in an all-out, whole-hearted effort, the veterinarian and pharmacist, working together, must give professional direction for everyone's
benefit. 272
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Pharmaceutical Association, Moncton, N.B., May 1975. 6. KERNAN, F. Veterinary pharmacy: Another field of service. Can. pharm. J. 108: 132-136. 1975. 7. MCCULLOCK, W. F. Socio economic aspects of pharmacy - Veterinary Medicine relations. J. Am. vet. med. Ass. 149: 1518-1524. 1966. 8. MEDENWALD, H. Metabolite and residue research. Stoffwechsel - und Ruckstunds forschung. Vet.-med. Nachr. 1: 32-42. 1973. 9. MUSSMAN, H. C. Drug and chemical residues in domestic animals. Fedn Proc. Am. Soc. exp. Biol. 34: 197-201. 1975. 10. NELSON, R. B. The interface between the pharmacist and veterinarians. Symposium on Pharmacology in the Animal Health Sector, Fort Collins, Colorado. September 1975. 11. NORTHWOOD INSTITUTE PRESS. Separation of Pharmacy and Medicine. Great Moments in Pharmacy: The Stories and the Paintings in the Series. George A. Bender. Detroit, Michigan. 1966.
12. POWERS, T. E. Antimicrobial therapy in Veterinary Medicine. Feed additives and drug residues. Chapter XIV: 1-31. T. E. Powers. Columbus, Ohio. 1976. 13. REMINGTON'S PHARMACEUTICAL SCIENCES. Fifteenth Edition. pp. 20-27. Eston, Penn.: Mack Publishing Co. 1975. 14. SCHROEDER, R. J. Veterinarians and Rx men can help each other. Am. prof. Pharm. 34: 31-35. 1968. 15. SLINGER, J. E. The interrelations of pharmacy and veterinary medicine. Seminar, Ontario Veterinary College, Guelph, Ont. 1976. 16. STOWE, C. M. History of veterinary pharmacotherapeutics in the United States. J. Am. vet. med. Ass. 169: 83-89. 1976. 17. SUNINER, E. J., J. A. KOTZAN and D. N. ESTREKIN. Pharmacy - veterinary medicine. J. Am. pharm. Ass. NS15: 454-456. 1975. 18. ZOPF, L. C. Pharmacy - veterinary medicine relations. J. Am. pharm. Ass. NS11: 168-170. 1971.
BOOK REVIEW First Steps in Veterinary Science. K. Aspinall. Published by Bailliere Tindall, London. 1976. 222 pages. Price £2.95. One of the problems often facing the instructor of courses in applied science is the absence of a text entirely suitable to the course of study. One of the common and attractive solutions is for the instructor to assemble his own notes (revised and reorganized over the years) into a publishable manuscript. This undoubtedly accounts for the recent and welcome proliferation of assembled notes such as: Habel's Anatomy, Thomson's Pathology, Morgan's Radiography and Sawyer's Anesthesiology. Another such work, in more regular text book format, is now available in Aspinall's First Steps in Veterinary Science. This welcome addition to veterinary literature begs but one question, "Where does it fit?" The majority of such books require for optimum benefit, a teacher, a course, and a definite target level of student. First Steps in Veterinary Science could prove to be an excellent introductory level and reference text for pre-veterinary, Animal Science and Animal Health Technician students. In addition it could prove easy and informative reading for the assistant in veterinary practice and the interested lay person.
The sections on Anatomy and Physiology, Animal Behaviour, Animal Production and so on, are all excellently handled, and for the most part, with a minimum of ambiguous or disputable statements. They may however require some interpretation here and there, and the practitioner who buys this book for his lay assistant should be prepared to spend several coffee breaks explaining passages which, in an institution, would be discussed and clarified in the classroom. Some phrases which may defy explanation are . . . venous blood is blue.", ". . . shock is a result of prolonged stress . .", ". . . when animals are placed at night in a Khola, Bhoma or Kraal, they should be released as soon as possible in the morning." and (with reference to strychnine) "It is quite useless to apply antidotes." However whilst the terminology, and the orientation towards third world agriculture may limit somewhat the application of this text in North America, neither should detract from its value. All in all this book should prove a worthwhile addition to the libraries of large animal practices, technician training institutions, agricutural colleges and pre-veterinary faculties. The various university and college book stores may also find it a saleable item to the lay public. W. B. Ramsay. 273
