Hands-on experience should not be dismissed lightly

Pharmacy prescriptions

Source: © M-H Jeeves

Hands-on chemical manipulation is an important way to connect to chemistry

Chemicals are chemists’ raison d’etre. A chemist handles chemicals with authority and confidence, gazing at them with eyes so penetrating that they perceive the innermost nature of the things. Pharmaceuticals should be pharmacists’ raison d’etre. But recent changes mean this may no longer apply. As a pharmacist who has journeyed through chemistry, pharmacists seem to be losing interest in empirical medicines and gaining it in clinical aspects of those medicines.

I have always loved chemistry. When young, I grew alum crystals in the airing cupboard, heated iron filings and sulfur together until they glowed. Splashing vinegar on the resultant sulfide was gratifying. Later, banished to my garden shed laboratory, I observed as yellow phosphorus in sodium hydroxide solution bubbled and plopped phosgene gas into a pneumatic trough. Each bubble expanded into a ring of revolting white smoke. I threw a chunk of sodium into a bowl of hot water; a little crater resulted. This was in the innocent 1950s, long before today’s safety regulations. Despite such youthful and thoughtless irresponsibility, I lived to tell this tale.

The results of my three science A levels were too low for entry to medical school but adequate for a school of pharmacy. I remember a six-hour long practical chemistry examination in which any visit to the toilet was invigilated to avoid collusion. After three years of degree-level study in pharmaceutical aspects of chemistry, biology and physics and a little mathematics, I earned a diploma. After one year’s supervised practical training I registered as a ‘pharmaceutical chemist’ or ‘pharmacist’, both titles controlled by law. I felt so proud. Today, pharmacist training, including a master’s degree, lasts five years.

I have worked in hospitals, ‘chemists’ (shops) and industry. Many licences have named me as a Qualified Person (QP)—someone who can certify the quality of medicines, in my case for humans, other animals and for investigational medicinal products.

I believe that I have worked with mutual respect and collegiality with many chemists. I watched as production became more automated and analysis instrumentalised. Highlights included being in a bunker when an explosive was detonated. That site manufactured a drug that I helped to develop. I audited medical gases being distilled from the atmosphere. In short, chemistry has drenched my life.

The 1843 royal charter of the Pharmaceutical Society stated as a purpose, ‘advancing Chemistry and Pharmacy’. However, the 2004 charter mentioned only pharmacy, because, by then, many ‘medicines derive(d) from the biological sciences’. Chemistry and pharmacy, intertwined since the time of alchemy or before, seem to be drifting apart. Why?

For both pharmacists and chemists, chemicals, metaphorically, are in their scientific marrows

Firstly, until about the 1960s, people bought chemicals from many chemists’ shops. More recently, fewer and fewer sold. If everything in a chemist’s shop is a ready-made drug, there seems less connection between pharmaceuticals and chemicals. Wannabe pharmacists are more likely to see their role only as prescribing compounds and not making them.

Secondly, the compounding of extemporaneous medicines from drugs in pharmacies changed from routine to rare. Fewer hospital pharmacists manufactured terminally-sterilised injections, eye drops and so on. Manufacturing pharmacists were called dinosaurs. Chemists and biologists replaced pharmacists as QPs. All contribute particular strengths. Chemists for example know more about analysis; pharmacists, privileged by face-to-face experience with patients, more deeply appreciate their vulnerabilities.

Finally, pharmacy emphasises a more patient-centred approach of ‘pharmaceutical care’, focusing on medication therapy management and patient counselling. Today, advising on a greater range of illnesses, injecting vaccines and so on offers pharmacists working conditions dissociated from grocer shopkeepers (one antecedent). The title clinician turbocharges prestige. Many pharmacists have migrated from their shops into another sort of small business: GP surgeries. Some consultant (hospital) pharmacists earn substantial salaries. A return to the mid-nineteenth century situation when chemists were the general (medical) practitioners, except for the wealthy, seems afoot.

The result is that, although pharmacists can still make careers in pharmaceutical manufacturing, they seldom do. They have left to prescribe, advise, dispense or administer medicines.

But crucially, that is useless unless the corporeal medicine itself is available. Pharmacists used to routinely make medicines. Today in the UK, they seldom do; chemists and others manufacture instead. Pharmacists are forgetting how to make medicines.

For both pharmacists and chemists, chemicals, metaphorically, are in their scientific marrows. During training, especially, chemicals were manipulated and closely observed. Even the heft of their mass was felt on a spatula stencilled from the real.

Reflect upon those changes that are remoulding pharmacists. If you want tomorrow’s chemists to be chemists-as-you-know-them, cling to personal manipulation of chemicals like a limpet. For example, computational simulations of possible molecular syntheses using AI may be fascinating but future adventures may not need a chemist. Do not ‘look down’ on hands-on laboratory work. Be careful what you wish for.