An old classical approach defines pharmacy as "the art, science and practice of preparing, preserving, compounding and dispensing of drugs". This definition was sufficient to satisfy the expectations of professionals and the requirements of the society in the past. But in the 1990's the American Pharmaceutical Association (APhA) considering the emerging concepts and practice, suggested a new definition for pharmacy, according to which pharmacy "is a patient oriented health services that applies a scientific body of knowledge to improve and promote health through assurance of safety and efficacy in drug usage and drug related therapy". This definition gives due significance to the concepts of contemporary pharmacy practice activities like hospital pharmacy, community pharmacy and clinical pharmacy.
In Italy, France and some other parts of the world, public pharmacies began to appear during the 12th century. Obligatory examinations based on academic standards were instituted in Prussia in 1725. The first pharmacy college in the world - 'College de Pharmacie' - was established in Paris in 1777. In 1803, six schools for pharmacy were started in France and private institutions for pharmacy education arose in Bavaria of Germany in 1808. In America, the Philadelphia College of Pharmacy was founded in 1821 followed by Massachusetts College of Pharmacy in 1823 and New York College of Pharmacy in 1829. India is one of the latecomers in the area of pharmacy education.
The pharmacy education in India was started in Banaras Hindu University in 1932 by a 30-year-old youth, Mahadeva Lal Schroff popularly known as ML Schroff. He could initiate pharmacy education in the country because of the encouragement and support he got from Pandit Madan Mohan Malaviya, a national figure and vice chancellor of the Banaras Hindu University. In 1937 July, the course was re-named as B.Pharm and in 1940 April, the first M.Pharm course (as a research degree) was started in the University (BHU). Prof ML Schroff was the principal of Birla College, Pilani during 1949-52 and was the professor of pharmacy at Saugar University during 1958-60. In 1964, based on the invitation from Dr Triguna Sen, he organized the dept of pharmacy at Jadavpur University, Calcutta. In between he worked in few research institutions and manufacturing firms.
A chemists and druggists course was started in Madras Medical College roundabout 1874. However, the course became popular in 1898 when a separate department of chemists and druggists was organized there. In 1939, a 2-year BSc pharmacy course was started in Madras Medical College with the help and advise of Prof. ML Schroff and in 1946 a separate dept of pharmaceutics was started in the Medical College. In 1950 the Madras Medical College started 3-year B.Pharm course. In the beginning Prof. AN Ratnagiriswaran was the head of the dept and retired in 1954. He was succeeded by Prof KS Srinivasa Varadan.
The Punjab University started B.Pharm course in 1944 and the Bombay University started B.Pharm in 1947 at LM College of Pharmacy, Ahmedabad. In the beginning, the growth and development of pharmacy education was very slow. In 1947 there were only five pharmacy colleges in India with an annual intake of less than 130 students. By 2007, the number of pharmacy degree colleges risen to above 700.
Prior to 1932 some hospitals and institutions in India were training pharmacists for hospitals and medical stores who were then popularly known as "Compounders". Such courses were then known as compounder's training course. The Christian Medical College, Vellore, started in the year 1900, too initiated a compounder's training course in 1921 which was later converted into a D.Pharm course in 1958.
The first pharmacy course in Kerala was a PG 'Diploma in Pharmaceutical Sciences' started in 1945 at Maharajas College, Ernakulam. This course was the 3rd or 4th pharmacy course in India. It was intended to provide trained chemists for the pharmaceutical and chemical industries in India. Dr KN Menon, prof. of chemistry in Maharajas College and a close associate of prof. M.L. Schroff at Banaras Hindu University (BHU) in the 1930s was responsible for starting the course. In 1932, when ML Schroff started the first pharmacy course at BHU, Dr Menon was with him. It was from Schroff that Menon got the inspiration to start the pharmacy course in Kerala. Dr KN Menon managed to get a donation of Rs one lakh in 1945 from the philanthropist and industrialist, Dr RM Alagappa Chettiyar for starting the course. Dr Chettiyar was also responsible for starting the Electro Chemical Research Institute at Karakudi and the AC College of Technology Madras as he had given generous donations for them.
Many committees were constituted by the central/state governments during the post independence period to study various aspects of pharmacy including the education. The Pharmaceutical Enquiry Committee (1954) under the chairmanship of Gen. SL Bhatia, the Expert Committee on Hospital Pharmacy (1967) under the chairmanship of Dr HS Sastry in Mysore, the Hospital Review Committee - Delhi (1968), the Committee on National Drug Policy which is popularly known as the 'Hathi Committee (1975), the Bajaj Committee (1980), the Lentin Commission (1987) are examples of such committees which made detailed study of various aspects of the profession of pharmacy and their relationship with pharmaceutical education.
In 1953, the "Pharmaceutical Enquiring Committee" which is popularly known as "Bhatia Committee" observed - "the profession of pharmacy in this country is mostly represented by a set of people known as compounders whose status, functions and duties are ill defined and improperly understood. They carry on compounding, dispensing and sale of drugs including poisons in the private pharmacies and hospitals. Their pharmaceutical education is deplorably inadequate. In many states the profession of pharmacy has been the last resort of those who could not complete their high school education or who have found to be intellectually unfit for any other career." Today the pharmacy education in India is of world-class quality. We have hundreds of pharmacy colleges for D.Pharm, B.Pharm, M.Pharm and PhD programmes in pharmacy. About 50,000 students come out of the pharmacy colleges every year. By 2010, the annual output from the pharmacy institutions may be around 65,000 or more.
The Pharmacy Act 1948 helped considerably for the overall development of pharmacy practice in India. The PCI was constituted through the provisions of the Pharmacy Act 1948. According to the existing Education Regulations of the Pharmacy Council of India (ER 1991), 10+2 is the minimum qualification for getting admission to the pharmacy course. The minimum qualification for registering a person as pharmacist in India is presently Diploma in Pharmacy (D.Pharm) which is a two-year programme after 10+2. The pharmacy diploma students have to study hospital pharmacy and clinical pharmacy as separate subjects. Universities had already also introduced hospital pharmacy, community pharmacy and clinical pharmacy as separate subjects for their B.Pharm courses. The All India Council for Technical Education (AICTE) has fixed the norms for the pharmacy degree course in 1990 in which hospital pharmacy, clinical pharmacy and pharmacy management are included as separate disciplines. These norms were made based on the provisions of the AICTE Act 1987.
Emergence of Pharm D programme
Pharmacy education in US has changed drastically by the end of 20th century. The 5-year baccalaureate level (BS and B.Pharm) was replaced with a 6-year curriculum that confers a professional doctorate degree known as Pharm D (doctor of pharmacy). This programme right from the beginning is designed with the objective of moulding practice oriented pharmacists. The Pharm D curriculum gives importance to practice oriented aspects of pharmacy with emphasis on modern aspects of hospital, clinical and community pharmacy.
The Pharm D programme was introduced in University of California at San Francisco in 1955. Till 1998 both B.S (Pharmacy) and Pharm D programmes of 5-year duration were conducted in America. In 1998 orders were issued to all American Universities to replace their B.S (Pharmacy) and B.Pharm with Pharm D focused on clinical and community pharmacy practice. The American pharmacy professionals initiated a project in this line in the early 1980s itself. All their pharmacists with B.Pharm qualifications were provided sufficient opportunities with a practicable approach to take Pharm D through various modules in the 1990s. In 1992, the American Association of Colleges of Pharmacy (AACP) house of delegates voted "to support a single entry level educational programme at the doctoral level (Pharm D)". The Accreditation Council for Pharmaceutical Education (ACPE), the national organization that accredits pharmacy degree courses, also endorsed the decision.
The five-year (in addition to one year pre-professional) Pharm D programme curriculum is designed to give educational preparedness in the area of patient care and disease management accepting the professional responsibility of providing pharmaceutical care. The course helps to mould a new generation of pharmacists capable of collaborating with other health care professionals and to share in responsibility for the out comes of drug and related therapy. They can take active role on behalf of patients in making appropriate drug choices by assuming direct responsibilities to empower patients to achieve the desired results of therapy. The programme helps to promote the knowledge, skills, abilities, attitudes and values necessary for the practice of pharmacy in hospital and community set ups.
Because of their commitment and vision, the American Pharmacy professionals could successfully implement Pharm D through out USA by 21st century. Though the course content of the Pharm D programme of various universities differ considerably in certain aspects, all institutions are required to secure accreditation through the American Association of Colleges of Pharmacy (AACP). Once the training programme is completed, pharmacists have to obtain licensure through examination in order to enter practice. Licensure is adjudicated by the respective states. US hospitals in general set higher qualifications like post graduation and experiential training for their professional hospital pharmacists.
In 1984-85 Thailand signed an agreement with 9 American universities paying a sum of US$ 15 million to train their teachers in pharmacy schools in USA with the objective of starting Pharm D courses in Thailand. Many other countries too initiated steps to introduce Pharm D programmes in their universities and academic institutions in the 1980s and 90s. Inspired from the American clinical pharmacy activities, UK introduced their first MSc clinical pharmacy course in 1976. It is sorry to note that India could not take seriously the matter in an organized manner.
Visualizing the global scenario, a postgraduate programme in the area of Pharmacy Practice was started in Delhi University (College of Pharmacy) by Dr BD Miglani who is known as the father of hospital pharmacy in India. In 1984 he started the M.Pharm Hospital Pharmacy with specialization in clinical and community pharmacy. In 1996 CMC Vellore started a postgraduate diploma course in clinical pharmacy and in 1997 JSS Hospital & College of Pharmacy, Mysore started a postgraduate programme (M.Pharm) in pharmacy practice giving importance to clinical pharmacy was started. Many institutions in India, majority of them being in the south, had initiated postgraduate educational programme in pharmacy practice in the next five years time. KM College of Pharmacy, Madurai; Periyar College of Pharmacy, Trichy; SRIPMS, Coimbatore; JSS Ooty; Govt. Medical College, Trivandrum; Annamalai University, Chidambaram, College of Pharmaceutical Sciences Manipal (MAHE), KLE's College of Pharmacy, Belgaum; Al-Ameen College of Pharmacy, Bangalore and Govt. College of Pharmaceutical Sciences Calicut are among the institutions that started M.Pharm pharmacy practice in the southern states of India. Many institutions like the Hamdard College of Pharmacy, Delhi and NIPER, Chandigarh also initiated pharmacy practice programme at masters level. A programme equivalent to the Pharm D is yet to be initiated in India though efforts are made at various levels during the last decade. It is high time to initiate the Pharm D programme in India. Universities can initiate Pharm.D programmes for B.Pharm and M.Pharm degree holders. In 1998 the writer of this article made an effort to start a Pharm.D programme at Government Medical College, Trivandrum under the University of Kerala with the help of a couple of American Universities. Though the proposal was accepted and progressed considerably, it could not materialize at that time.
The Indian universities with diverse geographic an infrastructure variations follow different curriculum structure and modules for the pharmacy undergraduate courses. In the curriculum there is no practice of incorporating mission statement with social and ethical context, goals and objectives of the education programme and practice aspects. The curriculum does not prescribe any training for practicing pharmacists either part of the course or after the course.
The pharmacy professionals who get the opportunity to take professionally useful decisions at the university level through their membership in academic bodies like Board of studies, faculty, academic council, senate and syndicate are often found to become orthodox and conservative. They forget to initiate timely actions which are useful for the profession and its development. As professionals we have to remember that one may not get the opportunity to do great things in a great way. We all have the chance to do small things in a great way. That great opportunity should not be left behind.
Only after a continuous and persistent effort lasting for a period of over five years, the author of this write up, could start an M.Pharm pharmacy practice programme in College of Pharmaceutical Sciences, Government Medical College, Thiruvananthapuram, which is affiliated to the University of Kerala, in 2000. When the proposal for starting the course was first made in 1996 to the authorities, there was no other college in India, both in government and private set up, imparting an M.Pharm programme in pharmacy practice (hospital and clinical pharmacy) other than the one in Delhi College of Pharmacy (of Delhi University), which was initiated in 1984 by Dr BD Miglani as M.Pharm in hospital pharmacy (incorporating clinical and community pharmacy). Dr Miglani, who is considered as the father of hospital pharmacy in India, too had to struggle for years to start the course in Delhi University.
The professionals of tomorrow have to be taught by the teachers of today using curricula that is designed for the future based on a thoughtful vision. The syllabus of the D.Pharm, B.Pharm and M.Pharm courses have to be revised regularly. Newer concepts and emerging trends have to be incorporated in the curriculum. If we don't do it pharmacy education will become a mere process by which professionals of tomorrow are taught by teachers of today using the curricula of yesterdays.
(The author is principal, School of Pharmacy, Amrita Deemed University, Kochi, Kerala).