Clinical Pharmacy in the United States: Transformation of a Profession (review)

This ambitious and thought-provoking book traces the origins and development of clinical pharmacy in the United States from its roots in the 1920s to the present. The book also offers an intriguing glimpse into the future of clinical pharmacy with contributed pieces written by two of its leading thinkers William H. Zellmer and Janet Teeters. According to the authors, the book has three goals: "to examine the development of clinical pharmacy and document the ongoing transformation of pharmacy from a product-focused profession to one that is patient focused; to reflect on the impact that landmark events, publications, or trends have had on facilitating this professional transformation through the personal observations and commentaries of some of the people who provided leadership in pharmacy's transformation to date; and to provide a strategic perspective and recommendations for the future" (1). In order to address these goals, the authors selected an innovative format for the book, which is divided into eight chapters supplemented by two helpful appendices listing key health legislation and landmark studies and task forces. The chapters are chronologically organized from 1900 to 2009 with an emphasis on the development of clinical pharmacy since the 1960s, a pioneering time when theory began to meet practice. Several of the chapter layouts resemble a webpage type of format where multiple threads of historical topics are juxtaposed against one another to tell the larger story. For example, Chapter 1 begins with an introductory overview paragraph followed by sections on culture, politics, military actions, economics, technology, health legislation, health, and pharmacy. On the bottom of each page, there is an illustrated timeline highlighting major events in American history as well as in pharmacy history.

With the emphasis of the book on recent history, the authors handle this challenge well by supplementing each chapter's narrative with brief essays by experts, many of whom were participants and eyewitnesses to the pivotal transformations that advanced clinical pharmacy. These supplementary commentaries are titled, "Reflections on Clinical Pharmacy" and provide the reader with valuable and unique insights by the people who helped shape the profession at critical moments, including: Donald C. Brodie, Paul Parker, John A. Gans, Richard P. Penna, and several others. While there are several reasons why this is an important book, the first person accounts make this book shine.

In addition to providing insider accounts of pharmacy leaders and visionaries, the authors also do a commendable job of showing how far pharmacy has come: from pharmacists in shops selling soda fountain delights to present day highly skilled doctors of pharmacy with residency training and board certifications who are integral parts of clinical teams in research hospitals. The transformation of pharmacy from a product-based profession toward a patient-focused one has taken nearly a century and has not been without setbacks. For example, in 1915, Abraham Flexner refused to reprise his study of medicine for pharmacy on the grounds that he did not consider pharmacy to be a profession. That task would fall to W. W. Charters, whose report in 1927 argued that pharmacy was indeed a profession and recommended that the entry level degree for pharmacists should be a four-year Bachelor of Science degree. The next landmark study was conducted by the Millis Commission in 1975 and paved the way for competency-based education for pharmacists and opened the door for certified specialties in pharmacy. The Hilton Head Conference in 1985 proved to be a watershed event in the advancement of clinical pharmacy as it opened up a national conversation that sought consensus for the premise that pharmacy would be fundamentally a clinical profession. In the wake of the Hilton Head Conference, several state and regional conferences seemed to affirm the profession's move toward clinical pharmacy featuring the concept of pharmaceutical care. These landmark studies and conferences have had a significant impact in shaping the course of the pharmacy profession. The authors of...