Bezençon, J.

Borchard, G.

Geissbühler, A.

Ledermann, F.

Locca, J.F.

Mühlebach, S.

Widmer, N.

Serveur académique lausannois

20THE FUTURE OF PHARMACYINTERNATIONAL PHARMACY JOURNALby the many pharmacopoeia and formularies that appear in Switzerland and elsewhere.In the early 19th century, when alkaloids appeared, the daily work of the pharmacist was altered by these new molecular substances. Most of the active ingredients were indeed isolat-ed by pharmacists for the first time. Since 1850, new medicines arrived, especially the first products of organic chemistry which are initially antipyretic analgesics and sleeping pills. This phenomenon led to many changes: new formulations such as capsules, tablets and injectables, a more pharma-cological vision of medicine and the take-off of pharmaceu-tical industry. The latter grew rapidly, often from community pharmacists’ laboratories. Gradually, and especially during the 20th century, the proprietary medicine took over magistral formula, in particular as a result of major changes in thera-peutic approaches and dosage forms.  Antibiotics, psychiatric medicines, hormonal products and many other medicines, developed since the early 20th century, were thus sold as proprietary drugs.The pharmacist, who was still mostly developing tradi-tional dosage forms such as pills and decoctions from whole extracts in 1900, lost his predominance in the manufacture of medicines. The advent of industrial society has therefore radically transformed the work of the pharmacist as well as his social image.The new information technologies 4,5Industrial society now seems to give way to a so-called information or knowledge society. What about then of the new professional world in which the pharmacist will evolve? Health systems are undergoing strong demographic, societal, economic and qualitative pressures. The medication  circuit represents therefore a major financial and security issue. Medicines professionals have throughout history regularly witnessed their activities changing and evolving. The pharmacy  profession is currently facing new  challenges in a changing world. In 2011 the Swiss Young Pharmacists Group (swissYPG) organized an educational and reflective symposium on this theme on the occasion  of the first Swiss congress of pharmacists in Interlaken1. This article provides a compre-hensive summary of the content of this symposium.4The manufacture of medicines: from apothecary to industry 2, 3Driven by the three pillars of traditional pharmacy, which are manufacturing, storage and administration of medicines, the pharmacist appeared in Europe in the 12th century under the impulse of change within Arab sciences. Galenics was then driving expansion of the profession. The apothecary manu-factured many preparations, such as electuaries, pills and troches within the practice of polypharmacy. The pharmacist of the Middle Ages, and then of the Renaissance, found a legal and institutional basis supported by multiple regulations. Both the access to the profession and the education of the future apothecary were codified and emphasized two aspects: the book knowledge and the practical knowledge, reflecting the role of pharmacists in the manufacturing of medicines. Despite several paradigm shifts that affect treatment, such as spagyric medication of Paracelsus or new drugs from the Americas, the central place of the apothecary in manufactur-ing continued until the 19th century. It is also established THE SWISS YOUNG PHARMACISTS GROUP PREPARING FOR THE  FUTURE BY EXAMINING THE PASTFrançois Ledermann, Antoine Geissbühler, Gerrit Borchard, Stefan Mühlebach,Jean-François Locca, Jacqueline Bezençon, Nicolas Widmer21VOL 28, NO.1 - JUNE 2012In this context, the roles of health professionals are clearly destined to evolve. In parallel, patients are  increasingly  interconnected and want to have a voice. The future seems to be in the regional, national and international networks and expectations are high towards computer tools to improve medicine in the 21st century. These tools tend thus to become the nervous system of public health. We must be able to com-municate, understand, decide, manage and develop our health systems in a world where information is becoming a real strategic issue, more and more every day.In hospitals, for instance, computerization can reduce  complications, mortality rates and costs. However, poor adop-tion or use of computer tools can be dramatic  (e-iatrogeny).  A prerequisite for optimal benefit is the design of programs that are simple and ergonomic, connected and mobile, context-aware (localization, activity, vital signs, emotional status) and relying on a robust infrastructure (security, etc.). For outpatients, integrated, personalized and local IT services could also allow a better care of patients at home (e.g. Ambient Assisted Living program; AAL), given the aging population and growing incidence of chronic diseases.  Telemedicine is also gaining importance and seems to improve patient comfort and care within regions with few health care providers. Finally, health information networks projects (e.g. e-toile in Geneva) could improve the quality and efficiency of care by efficiently sharing information among all health care providers while actually putting the patient at the center of the process.Thus, like their medicine and nursing confreres, community pharmacists (including those involved in home care), as well as hospital or industry pharmacists, are expected to integrate these new paradigms and tools in their practice, while remain-ing able to judge their actual usefulness for optimal manage-ment of the patient.Pharmaceutical industry’s development strategies 6,7Forced by the high attrition rate of late stage medicine  candidates, and increasingly empty pipelines, several strategies are being followed by pharmaceutical industries to increase the number of candidates. Among them is the  establishment of high throughput screening methods to search large libraries of chemical structures and to identify potential medicinal candidates. However, high expectations of this approach have not entirely been met and the  human  experience may prove to be as efficient (e.g. thanks to the Lipinski «Rules of 5» to evaluate drug likeness). Another approach is the development of biologicals (proteins and  antibodies). They have been the driver of innovation for the last few years, made possible by the advancement of stud-ies on their basis of action, stemming from proteomics and genomics. Another buzz-word in current medicines develop-ment is “Individualized Medicine”, which takes into account the impact of differences between patients on drugs’ efficacy (target expression, pharmacokinetics, pharmacogenetics, etc.). Trastuzumab is an example. More and more, therapeutics will be accompanied by so-called “companion diagnostics”. Last but not least, portfolio management, i.e. the search for additional indications for the same medicine (by various  approaches such as reverse genetics) or acquisition of biotech companies to obtain access to new medicines candidates are other opportunities for “Big Pharma”.However, such novelties must be knowledge-based, which  demands a close interaction between academia and  industry. This cooperation is yet not easy to manage  (different assump-tions, conflict of interests, etc.). Academia is interested in creating and diffusing knowledge, although it is also slowly moving to market activities (papers publication to acquire funding, patenting, etc.). Academic scientists are yet often being focused too much on the fundamental side of drug discovery and development, neglecting the translational approach in which their findings should be translated into a real-world product. To the contrary, drug development in the corporate world is designed to create revenue for the com-pany. In an industrial environment, scientific creativity is often suppressed. Industrial organizations are aware of these limita-tions and strive to either implement “biotech-like” structures in drug discovery and early development, or seek interaction with academic institutions (called a “collaboration bubble”). In addition, multilateral “open innovation” models do exist, in which knowledge is shared between several partners from academia and industry, often using “Web 2.0” tools (e.g. “Open Source Drug Discovery” network, for novel anti-tuberculosis drugs). For community and clinical pharmacy, such new de-velopments should have a significant impact (e.g. diagnostic/ monitoring kits, etc.).Fig. 1. Round tableTHE FUTURE OF PHARMACY22THE FUTURE OF PHARMACYINTERNATIONAL PHARMACY JOURNALRound table and discussionThe Swiss YPG symposium tracked past and present evolu-tions of the pharmacist, by giving us the opportunity to think about the future of this profession. A historical perspective has first allowed following the impressive developments and changes in the pharmacy profession throughout the last centuries. In the new environment of information techno logies and of a health system confronted with major demographic changes, the drug is now considered also in terms of costs and risks. Therefore, the pharmacist can, and has to, significantly contribute to teams and networks of care. The situation in the pharmaceutical industry was finally presented from the scientist’s viewpoint with experience in both industry and academics. Pharmaceutical companies are seeking new collaborations with universities to bring more medicines into the pipeline.The roundtable (Fig. 1) also allowed addressing the issue of education of pharmacists. Given the employment market, the question arises whether it meets the changes observed (Fig. 2). Are young pharmacists able to make the right career choice at the end of their studies? Are graduates “fit for use”?In addition to preparing to federal exam, the fifth year of study is also the crucial period of career orientation. The studies’ reform had an “assessment area” much larger and wider in time that is possible in Switzerland today. One should consider the duration of studies of natural and medi-cal sciences in the context of international competition for work. This raises the question whether the strength and excellence of Swiss dual education system (both academic scientific studies and university of applied sciences, profes-sional practice-oriented) can be applied to the pharmacy. At any rate, social and practical skills, poorly transmitted during university studies, should also be provided to a generation that already generates new social interaction via the Internet. These capabilities are often crucial for the job’s success and satisfaction. However, unlike in the past, individual career orientation will often be modified, notably by the influence of the balancing between work and family activities. All this highlights the importance of lifelong learn-ing, i.e. continuing education; one speaker also talked about the need for a professional realignment every ten years.Comments from young pharmacists, faced with the crucial period between graduation and first job, are very important. They provide reflection on the effective adaptation of educa-tion and training in pharmacy, both in term of content and of their arrangement, as well as in their durability against the evolving needs of the profession8. This symposium showed in this regard that an important responsibility lies on the swissYPG because of the reflection platform it provides. In  concert with other health professionals and peers, it can help to build better pharmaceutical roads and to define the future of pharmacy, ultimately for the benefit of the patient.AcknowledgmentsTo the other members of the 2011 swissYPG committee  (Barbara Lüscher, Jean-Marc Krähenbühl, Nicolas Riethmann and Florian Sarkar) for the help to organize the symposium.1ST YEAR OF STUDYTHEORYBasic natural and medical sciencesBasic natural and medical sciencesPharmaceutical basisDeepening pharmaceutical basisMaster’s thesis AssistantshipPractice and patient- orientedBlock courses2ND YEAR OF STUDY 3RD YEAR OF STUDY 4TH YEAR OF STUDYSpecializationFederal exam of Pharmacy5TH YEAR OF STUDY ASSISTANTSHIP’S YEARIntroductory training: 4 (3) weeksBACHELOR MASTER FEDERAL DIPLOMAOF PHARMACISTBACHELOR’S DEGREE STUDIESBasel/Zürich/Geneva: Bachelor in Pharmaceutical SciencesBern/Fribourg: 1st/2nd year of studyNeuchâtel/Lausanne: 1st year of studyMASTER DEGREE’S STUDIESBasel: Master in PharmacyAlternative: Master in PharmaceuticalSciences = ‘Master in Pharmaceutical Industry’Zurich: 1st/2nd Master in Pharmaceutical Sciences Alternative: Master in Medicinal and Industrial Pharmaceutical Sciences = ‘Master in Pharmaceutical Industry’Geneva: Master in PharmacyCommunity pharmacistHospital pharmacistPublic health administration pharmacistIndustry pharmacist Teaching & ResearchUniversityPRACTICEFig. 2. Undergraduate and continuing education: fit for use? (courtesy of pharmaSuisse)23THE FUTURE OF PHARMACYVOL 28, NO.1 - JUNE 2012ACCOMPANYING COMMENTARY ON FUTURE PERSPECTIVES OF PHARMACYFlorian Sarkar, swissYPGThe Swiss YPG symposium highlighted a crucial fact that change in the pharmaceutical sciences is a continuum that presently appears to accelerate. Professional evolutions are however often a matter of great concern for pharmacists.Change is a natural process that occurs in virtually every part of life. We should therefore not fear change for the sake of loss and insecurity, but take it as a chance for improve-ment and new opportunities. Pharmacists should take advantage of the opening gaps in healthcare systems and demonstrate the value of their profession not just as medi-cines dispensers, but as medicines experts providing high quality services.In order to promote a role in health care that is both ben-eficial to society and gratifying for ourselves, we have to extend the duty of executing a physician’s therapy instruc-tions. Instead we have to learn to take personal responsibil-ity for therapeutic patient interventions. Instead of focusing on the legal limits defining our profession, we should rely more on our wide knowledge and develop practice in a way that matches both our true abilities and societal needs. We have to go ahead of political process and prove the value of our work to obtain a juridical and political position that ac-tually corresponds to what we can bring to the population.In parallel, we must also closely keep contact with other health care professionals. The more we cooperate and participate in joint therapeutic projects, the more will other professions know and appreciate our competence. By positively facing the challenges of future health  policy, we can provide useful and safe health care service to  patients together.At present, another challenge is to cope with the rapidly growing amount of medical and scientific knowledge. The pharmacist’s education has to adopt the newest trends of information technology. In our future, we will indeed regu-larly use connected computers, tablets and smart phones as quick and flexible tools of storing, transferring and sharing information. There is also a strong need that complete clinical patient data are quickly available to all involved care providers. Yet the establishment of a broadly accepted E-Health strategy will face a long political process in every country. Pharmacists can take influence here as health care experts with large experience in handling patient data for medicines management.The future of the pharmacy profession depends on the personal attitude of every single professional. The will to keep up with current pharmaceutical knowledge and tech-nologies has to be our mindset. If we believe in our abilities, we can lead our profession towards a bright future where pharmacists participate in creating a healthier world.AUTHORS’ INFORMATIONFrançois Ledermann*,  Institute for the History of Medicine, University of Bern and Schloss-Apotheke, BernAntoine Geissbühler*,  Service of Cyber Health Care and Telemedicine, Geneva  University Hospitals and University of GenevaGerrit Borchard*, School of Pharmaceutical Sciences, University of Geneva and University of Lausanne Stefan Mühlebach*,Vifor Pharma, Glattbrugg and Department of Pharmaceutical Sciences, University of BaselJean-François Locca, Pharmacie de Prilly and University Out-patients’ Clinic,  Lausanne, SwissYPG, Bern Jacqueline Bezençon, PharmaCenter, University of Basel, SwissYPG, Bern Nicolas Widmer, Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, SwissYPG, Bern* The 4 lecturers equally contributed to the symposium and to these proceedings.REFERENCES1  Widmer N, Bezençon J, et al.  La Pharmacie en mutation. pharmaJournal 2011; 149(16): 19.2  Chast F.  Histoire contemporaine des médicaments.  Paris: La Découverte; 2002.3  Helmstädter A, Hermann J, et al.  Leitfaden der Pharmaziegeschichte.  Eschborn: Govi-Verlag; 2001.4  Frist WH.  Shattuck Lecture: health care in the 21st century.  The New England Journal of Medicine 2005; 352(3): 267-72.5  Medicine goes digital: A special report on health care and technology. The Economist 2009: 1-14.6  Luessen HL, Borchard G.  Protein pharmaceuticals: Recent achievements and trends for formulation and delivery [Editorial] Injectable drug delivery 2010: Formulations focus: ONdrugDelivery; 2010. p. 4-7.7  Kling J.  Biotechs follow big pharma lead back into academia.  Nature Biotechnology 2011; 29(7): 555-6.8  Federal Act of 23 June 2006 on University Medical Professions (LPMéd) Section 2 Specific objectives for training,  Art. 9  Pharmacy; RS 811.11  http://www.admin.ch/ch/f/rs/c811_11.html [06.02.2012].

The Swiss young pharmacists group: Preparing for the future by examining the past

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The Swiss young pharmacists group: Preparing for the future by examining the past

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