Historical background and development of profession of pharmacy

Pharmacy

Pharmacy is the art, science and economics of preparing and dispensing

medications and providing drug-related information to the public. It is concerned
with reading of prescriptions, compounding, packing in suitable/appropriate
container, labelling and dispensing of drugs. The mission of pharmacy is to serve
mankind and society.

The word “pharmacy” was coined from the Greek word “pharmakon”
meaning “medicine” or “drug“. Therefore, a pharmacist is a “medicine or drug
man“. While the classes of professionals legally permitted to prescribe medications
are physicians, dentists, veterinary doctors and senior registered nurses,
pharmacists are required by law to be experts in the preparation, preservation,
distribution, and handling of drugs.
A health profession that links the health sciences with the chemical sciences,
and it is charged with responsibility which ensures the safe and effective use of
medication.

Hence forth a pharmacist is the right person to look all these aspects because
he is educated and trained for this job. They are experts on medication.

Prehistoric Medicine links to Spirit World

The history of pharmacy is a recognized part of medical practice dating as far back
as Sumerian times, around 2,000 to 1,500 BC, from which cuneiform tablets
(writing style on clay tablets) have been preserved recording prescribed
medications. In which had list of animal, vegetable and mineral origin that were
used in the management of diseases and prescriptions with details of the
ingredients used in their compounding. Sumerians pharmacists were also priests
who worked and practiced in the temples.

Chinese (2000 BC) – The Chinese believed that diseases resulted from the
imbalance in forces acting on humans and animals, thus produced herbal drugs
with “spiritual” effects. They were credited to be first users of podophyllum,
rhubarb, ginseng, cinnamon etc. The text Huangdi Neijing listed the basic
principles of pharmaceutical drugs in the third century BC.
Indian (800 BC)- the Indians art of healing is almost as old as the religion of
hindiuism itself. Aurveda attained a state of reverence and is classified as one of
the Upa-Vedas- a subsection- attached to the Atharva Veda, it also deals with the
diseases, injuries, fertility, sanity and health. The main principle behind life or
essence of all life forms was five elements of creation the pancha-maha-bhuta
namely the earth, water, fire, air and ether form the basis. Out of these arise the
three doshas namely Vata, pitta and kahpa. These three doshas unfortunately have
been crudely translated as air, bile and phlegm. The Ayurveda incorporates all
forms of lifestyle in therapy. Thus yoga, aroma, mediation, gems, amulets, herbs,
diets, astrology, color and surgery etc are used in a comprehensive manner in
treating patients. The important contribution was by was Charaka Samhita,
Sushruta Samhita, Vaghbata

Egyptians (2900 BC) – Ancient Egyptians would be familiar with the idea of a
modern chemist and preparing specific medicine was known as Pastophor. The
Papyrus Ebers is oldest well preserved medical document from ancient Egyptian
record dated from approximately 1500 BC. It contains 800 prescriptions using 700
drugs; of particular note in the papyrus is inclusion of quantities of substances,
which were largely missing from Babylonian clay tablet. They are chiefly
botanical such as acacia, castor bean, fennel etc. the vehicles were beer, wine, milk
and honey. Egyptians commonly used mortar and pestles, hand mills, sieves,
balances for their compounding of suppositories, gargles, pills, inhalations,
torches, lotions, ointments, plasters and enemas. They used alcohol and milk as an
excipient for range of formulation included infusions, decoctions, teas gargles,
troches, pills etc. Records show that they used many preparations including
opium, cannabis, linseed oil and senna. Many modern drugs have originated from
the study and isolation of active ingredients from plants with healing properties.
Egyptian physicians generally specialized in one part of the body examples eye
physicians, ear physicians etc.

Greeks (1000 B. C.) – At the turn of the millennium, the Greeks had taken over
the knowledge, starting with superstition but later turned to intellectual and rational
use of drugs. “During the superstition era, Asklepios was believed to impact
healing by touching one with his staff or serpent. His daughter, Hygeia, was also
believed to have a healing portion and these emanated as the international symbol
of the pharmacy profession”. Notable Greek philosophers that contributed to the
development of the profession include Hippocrates, Theophrastus, Dioscorides,
Galenus, and Pythagoras.
Hippocrates went against this conventional thinking and looked on the body as
having a balance between four humors blood, phlegm, black bile and yellow bile.
If a person is ill, it meant that there was an imbalance in their humors and so they
would take a treatment to return the balance back to normal. This often included
bleeding or induced vomiting. This radical approach took medicine out of the
spiritual world and the four humors formed the basis of medical treatments well
into medieval times.

Galen was a Greek physician who immigrated to Rome and became the principal
of doctor for many of the professional gladiators. He dissected animals to find out
how their bodies worked. This knowledge helped Roman doctors to improve their
techniques in surgery. Sought to restore humeral balances within a patient by the
use of medicine of opposing qualities. E.g. inflammation would be treated with
cucumber, a cool drug. His methods followed about 1500 years. Today also they
serves as basis for preparing many medicaments.He is 1st, described the process of
creating extracts of active medicine from plants (Galenicals).He is the first
pharmacist and setup the first pharmacy known as Galenical pharmacy

King of Pontus, Mithridates experimented with poisons and antidotes, tried

them on him and prisoners of war.

Among the best known early pharmacists came around 400 BC. Diocles of
Carystus was a Greek member of the “rhizotomoi,” a specialized branch of medical
experts on the uses of medicinal plant. During this time, Pedanius Dioscorides
wrote a five volume work entitled, “De Materia Medica,” meaning Concerning
Medicinal Substances. It is the source for medieval pharmaceutical medicine in
Europe, as well as in the Islamic World.

The Arabs separated the arts of apothecary and physician, in the eighth century.
They have the first Pharmacy shop in the world was in Baghdad about 792 A.D.
They preserved the medicines with the help of their natural resources syrups,
confections, conserves, distilled waters and alcoholic liquids. Moving into 750
AD, the first “drug stores” as we know them were established in Baghdad during
what is known as the Islamic Golden Age. By 1200 AD drug stores began to move
into Europe. Previously, pharmacy was largely practiced in monasteries, where
various medicinal plants were cultivated by monks for use inside and outside the
monastery. By 1605 AD Louis Herbert, a Parisian who traveled to the New World,
became one of the best known pharmacists in the world. He aided explorers and
learned of new remedies and new plants from native tribes people.
It slowly spread to Europe as alchemy and finally developed into chemistry. The
first known chemical process was carried out by the artisans of Mesopotamia,
Egypt, and China.

Separation of pharmacy and medicine

Pharmacy always existed, but not so for pharmacist. A person uses to made
diagnosis also provide medicines and he hired assistants to collect herbs for him
and make preparation under his supervision known as pharmacopolae but they are
not pharmacists.

Arabs were of thought that those who prepare medicines could do as independent
profession. The first pharmacy scope was opened in a Baghad in 770 under Calip
Al- Mansoer. Pharmacists don’t have much that time knowledge of drug this
situation was changed by Al Mamoen who ruled Baghad from 813 to 833 and
pharmacist started acquiring professional education.

The profession of pharmacy was honourable called as Sayadilah (Arabic)

and Sandaliin (Latin). They also pharmacy as pharmaceutical armamentarium, the
Arabs and the Mohammedans met each other on their pilgrimage to Mecca, for the
exchange of ideas as well as of goods between people from India, China and Spain
that introduced many new drugs in the field of medicine. Arabs develop number of
new drug delivery forms such as syrups, pellets, preserves, confections,
marmalades.

In European countries exposed to Arabian influence, public pharmacies began to

appear in the 17th century. Frederic II in 1231 made constitution with legal norms
in relation to medicine which had been established by the Arabs. He divided
medicine into dogmatic medicine (diagnoses), manual medicine (surgical
intervention) and pharmaceutical medicine (collects mixes and conserve
medicines).In the year 1240 Emperor Frederick II issued an edict regulating
medicine. This edict is known as the Magna Carta of pharmacy.

• The three announcements of the Magna Carta are:

 The pharmaceutical profession was to be separated from the medical
profession.
 The pharmaceutical profession should be supervised officially.
 Pharmacists should take an oath to prepare drugs reliably, according
to skilled art, and in a uniform suitable quality
 During the Renaissance period of the middle ages, Pharmacy went
through many changes.
  Pharmacy became an independent profession.
 Pharmacy as a profession achieved status and became socially
accepted.
 University education of pharmacists were required. New chemical
medicines were introduced that gave pharmacists broader expertise.

The term apothecary, often used between the 16 and 18, for individuals
living in London who had passed the examinations of the Worshipful
Society of Apothecaries of London, founded in 1617. The role of the
apothecary developed out the role of the spicer who involed in trading crude
drugs and preparing medicines. Apothecaries were strongly involved in
dispensing but they were supposed to do all work including handling of
drugs and chemicals, examining and treating patients. But they don’t paid
for their services but only for medical supplied. Following a ruling in the
Rose Case apothecaries’ became legally ratified members of the medical
profession to prescribe and dispense medicines.

Retail pharmacies started popping up in the United States in 1729, with the first
one founded in Philadelphia by Irish immigrant Christopher Marshall. The first
pharmacy attached to a hospital also came about in Philadelphia shortly after, in
1752. By 1852, the American Pharmaceutical Association, now known as the
American Pharmacists Association, was founded. The first attempt to standardize
pharmaceutical medicines also was made in this year.

Moving into the 20th century, after World War II, pharmaceutical manufacturing
took on a modern, industrialized form in the United States. Electronic prescribing
systems began in 1990, used to automate the prescribing, supply and
administration of medicines in hospitals. And now, Forbes has stated that being a
pharmacist is the “best healthcare job” due in part to a high average salary and
projected growth. And, we need them, as there were 44.6 million prescriptions
filled at pharmacies in 2014, amounting to a $236 billion dollar industry.

History of pharmacy profession in India

Pharmacy practice includes traditional practice of compounding and dispensing of

medications. History of pharmacy profession in India can be divided in to three
parts

Ancient history
Pre-independence
Post -independence

Ancient Pharmacy Profession

In India the source of drugs were of vegetables, animal and mineral origin. They
were prepared empirically by few experienced persons. Knowledge of that medical
system was usually kept secret within a family. There were no scientific metods of
standardization of drugs. The Ayurveda work on internal medicine whereas
Sushrute-Samhita deals with surgical medicine. Charaka and Sushruta were
physicians and pharmacists who studied more than 1000 herbs.
In Tamil Nadu during 900 AD discovered organized practice of hospital
activity for the treatment of patients with diseases. India, being rich in flora and
fauna, wide variety of herb was mainly used to treat disease like jaundice,
haemorrhage etc. In 1563 Portuguese practitioner Garcia de Orta reported use of
Indian herbs in this treatise. British traders brought the practice of allopathic
system to India in 15th century.
The Indian system of medicine declined during the Muslim rule while the
Arabic or the Unani-Tibbi system flourished

Pre-independence Pharmacy Profession

The first chemist shop was opened by Scotch Bathgate at Calcutta in 1811.
The pharmacy activities were performed according to London Pharmacopoeia.
This situation forced back traditional practice in Indis and compelled to import
drugs from European countries
1840- Goa medical college was started at Panjim
1841- Bengal Dispensatory and Pharmacopoeia was published
1870- The Madras Medical College were first to train the students to gain skills in
pharmacy practice
1878- The Opium Act was implemented the dealt with cultivation of poppy and the
manufacture, transport, export, import and sale of opium
1889- Indian Merchandise Act was implemented to avoid misbranding of goods in
general
1894- Indian Traiff Act passed for levy of customs duty on goods including foods,
drinks, drugs, chemicals and medicines import to India or export
1909- Bengal Excise Act was implemented
Dug in India were mostly exported in crude form and imported in finished
form. During World War-I the imports of drugs was slowed down but after war it
was resumed to regular. There was no any restrictions on the quality of drugs
imported, thus manufactures abroad took advantage of the situation. Market were
full of all sorts of useless and deleterious drugs and were sold by unqualified men.
In response to this situation and to control pharmacy practice in 1930 Dangerous
Enquiry Committee (DEC) under the chairmanship of Late Col R N Chopra to see
into the problems in India and recommend the measures to taken to avid unethical
practices. Up to 1940 all the allopathic drugs were imported from Europe but in
later years some of these drugs begun to be produced in India
Pharmaceutical Education

Pharmacy education in India traditionally has been industry and product oriented.
In contrast to the situation in developed nations, graduate pharmacists prefer
placements in the pharmaceutical industry. To practice as a pharmacist in India,
one needs at least a diploma in pharmacy, which is awarded after only 2 years and
3 months of pharmacy studies. These diploma-trained pharmacists are the mainstay
of pharmacy practice. The pharmacy practice curriculum has not received much
attention. In India, there have been number of institutions offering pharmacy
degrees at various levels and a practice-based doctor of pharmacy (Pharm D)
degree program was started in some private institutions in 2008. However,
relatively little information has been published describing the current status of
complex pharmacy education of India.
D Pharm Program. In India, higher secondary study is concluded by a terminal
examination, the higher secondary examination, at the end of 12 years. Admission
to the first year D Pharm program in any government college is based on
performance on the higher secondary examination. However, private colleges have
their own admission procedures that comply with the education regulations of the
PCI. Students generally may choose to undertake the D Pharm program as their
second or third choice, having been unable to obtain a place at the college in
another degree program that was their first choice. The D Pharm curriculum is
framed through the education regulations of the Pharmacy Act. The present
education regulations framed way back in 1991 (ER91). The curriculum is the
same throughout the country. In the 1990s, the efforts of the pharmacy council of
India for upgrading the minimum qualification for registration from D Pharm to B
Pharm failed due to lack of consensus.12
B Pharm Program. Admission to the first-year B Pharm program is made
directly from higher secondary school on the basis of marks obtained in the higher
secondary examination or on the basis of a merit list rank prepared based on scores
on an entrance examination administered by a state or individual institution.
Administering an entrance examination as an admissions requirement is used
mainly by public institutions. For example, admission to the first-year B Pharm of
Banaras Hindu University (BHU) is made through the joint entrance examination
(JEE) conducted by Indian Institutions of Technology (IITs), a group of 13
autonomous engineering and technology-oriented public institutes of higher
education established and declared as institutes of national importance by the
government of India. The selected students opt for more rewarding bachelor of
technology (B Tech) programs; therefore, most of the 40 seats open in the B Pharm
program at BHU remain vacant. The practice regarding preparing a merit list of
applicants also differs. Some states and institutions place emphasis on entrance
examination scores and use this as the only criterion in the selection process. A few
private universities and at least 1 Indian state (Tamil Nadu) have abandoned
entrance examinations and use grades scored in the higher secondary examination
instead. Many government institutions adopt a middle ground and use a
combination of grades and entrance examination scores in their selection process.
The merit list rank preparation or the entrance examination conduction for
admission to the first-year B Pharm and bachelor of engineering programs is
undertaken jointly in all states except Tamilnadu and Karnataka, where it is
combined with the medical degree programs. In general, applicants who rank lower
on the list enter a B Pharm program. In 2008, more than 35,000 students completed
an entrance examination in West Bengal, a northeastern Indian state. The 25,000
students who ranked highest on the list chose to enter engineering programs, while
students below this rank selected B Pharm programs in private institutions. There
were reports in 2008 that institutions were having difficulty attracting suitable
candidates to fill openings in their pharmacy programs.
M Pharm Program. The criterion for entry to an M Pharm program is academic
performance in the B Pharm or an entrance test or both. Currently, there is more
demand for the M Pharm program than the availability of places in the country. An
important criterion, a high Graduate Aptitude Test for Engineering (GATE) score,
qualifies a student to receive government scholarship during the period of their M
Pharm study. This criterion is optional for admission to the first-year M Pharm
program. However, many public institutions require both past academic
performance and GATE score for application to the M Pharm program.
Pharm D Program. Admission to a Pharm D degree program is on the basis of
successful completion of the higher secondary examination or the D Pharm
program. Passing the higher secondary examination with physics, chemistry, and
biology or mathematics entitles a student to enter the Pharm D program. B Pharm
degree holders can join the Pharm D program in the fourth year.
Pharmacy education in India is regulated by 2 organizations: the Pharmacy Council
of India (PCI), under the Pharmacy Act of 1948, and the All India Council for
Technical Education (AICTE), which was established under the AICTE Act of
1987. As mentioned previously, the PCI makes regulations regarding the minimum
standard of education required for qualification as a pharmacist. It is responsible
for registration of persons fulfilling the prescribed eligibility criteria (minimum D
Pharm) and issuing a license permitting them to practice in an Indian state.
Registration activity is decentralized and the state pharmacy councils are
responsible for registering pharmacists in their respective states. Thus, the PCI
regulates the D Pharm program and the recently introduced Pharm D program. The
B Pharm program needs to be recognized by the PCI for the qualifications to be
accepted for registration purpose only. The PCI has no jurisdiction over M Pharm
and other higher-level degree programs.
Pharmacy education at all levels excluding the Pharm D is regulated by the AICTE
and all these programs must be approved by it. The AICTE is primarily responsible
for planning, formulating, and maintaining norms and standards in technical
education, which include pharmacy. Besides the Pharmacy Act, pharmacy practice
is also governed by the Drugs and Cosmetics Act of 1940, which stipulates the
manufacture, distribution, and sale of drugs. Currently, there are no regulatory
body and regulatory control for clinical pharmacy practice.
The AICTE is also responsible for quality assurance of pharmacy programs
(DPharm, BPharm and MPharm) through accreditation by National Board of
Accreditation (NBA) constituted by the AICTE. However, only 8% of pharmacies
programs have been accredit. Accreditation is voluntary and also a stringent
process; thus, few institutions have applied for accreditation on their own. The
voluntary accreditation seems to serve little purpose for any of its stakeholders.
Unlike other countries, the current regulations do not require any continuing
education to maintain licensure once they are conferred. In addition, registered
pharmacists do not have any established norms on competencies or standards of
services. There is no categorization of practicing and non-practicing pharmacists.
Pharmacy education in India, both at the BPharm and MPharm levels, is taught as
an industry- and productoriented profession with a focus on the basic sciences.23
During the past decade, pharmacy education has expanded significantly in terms of
number of institutions offering pharmacy program at various levels. However,
pharmacy education in India continues to be one of the last options for students
aspiring to a university degree. The pharmacists with a BPharm or MPharm
generally seek avenues other than pharmacy practice. These pharmacists prefer
placements in production, regulatory affairs, management and/ or quality
assurance, and marketing with the pharmaceutical industry. Only small numbers of
these graduates and postgraduates opt to work in community and institutional
pharmacies. In India, diploma holders (DPharm holders) are practicing pharmacists
in the global sense as they engage in community or institution pharmacy practice.
A specialized MPharm in pharmacy practice program launched in the 1990s failed
to create employment opportunities in practice areas for these postgraduates. The
main change that is currently affecting pharmacy practice is the introduction of the
PharmD program in India. One thousand four hundred ten students have enrolled
in 47 colleges (mostly private sector) localized in a small geographical part (South
India) of India. Going by the experience of socioeconomic status of our country,
this steep increase in the required study period from the 2-year DPharm to the 6-
year PharmD for producing practicing pharmacists raises issues of PharmD-trained
pharmacists who seems to be ‘‘unavailable’’ to serve for India. In order to
demonstrate the requirements for pharmacists in India, it is necessary to undertake
a pharmacy workforce study, to review pharmacy education programs, and to
compare them with the roles that have been accepted internationally. Then, to
design and develop pharmacy degree programs—perhaps one program exclusively
for industry and another for practice.
Indian Pharmaceutical Industry
In 1930, in Calcutta the first pharmaceutical company called Bengal Chemicals
and Pharmaceutical Works, which still is today as one of 5 government-owned
drug manufacturers was started
The history of Indian pharmaceutical market in 1970s was almost non- existent.
Today, India has gained immense importance and carved a niche for itself in the
pharmaceutical domain. In fact, it has emerged as a big mart for the pharmaceutical
industry. Formulations, bulk drugs, generics, Novel Drug Delivery Systems, New
Chemical Entities, or Biotechnology, etc. Indian companies are dominating in the
marketplace which was traditionally manned by MNC.