APhA's Gans: 'Our responsibility is to the patient.'

Drug Store News, Jan 22, 1990 by Harold Cohen

APha's Gans: `Our responsibility is to the patient'

John Gans took over as executive vp and CEO of the American Pharmaceutical Association (APhA) in June 1989 during a difficult period for pharmacy and the association. Before his appointment, he served as dean of the Philadephia College of Pharmacy, president of the Pennsylvania Society of Hospital Pharmacists and president of the American Society of Hospital Pharmacists. Harold Cohen interviewed Gans to get his opinion of the state of the profession and APhA's role for pharmacists as we approach a new century.

IP: There is no question that retail pharmacy has changed considerably over the past several decades. In fact, there are those that say community pharmacies are going the way of the pill roller and manual typewriter. The same critics are quick to point their fingers at the APhA for not doing anything about it. Is retail pharmacy, and in particular, community pharmacy in trouble?

Gans: I feel very strongly that strength is coming back to community pharmacists, but the profession will have to be practiced differently. We must expand our practice to include being responsible for the drug therapy outcome in a patient.

IP: Isn't that a conflict with medicine?

Gans: No. Our responsibility is to the patient. Pharmacists must do whatever it takes to make sure that the patient is getting the maximum benefit out of a drug.

I clearly see the day where pharmacists will be drawing blood to manage new, complicated therapies. In the case of a chain, I can see a lab associated with a chain to examine a patient's blood. That obviously requires a change in practice laws. That's where we need our state associations. These kinds of changes don't occur in Washington, they occur in state capitals.

IP: What else to you envision the pharmacist of the '90s doing?

Gans: Another area would include the starting of IVs. Don't misunderstand me, pharmacists would have to be trained to do these things. It's cost effective and don't forget, these new drug therapies on the horizon are going to require this kind of expansion.

IP: APhA membership has declined somewhat over the past several years. Are you planning to do anything to involve special interest groups such as chain pharmacists, independents, or even mail order in the APhA to help reverse the slide in membership?

Gans: First of all, pharmacy cannot be practiced by mail. You have to interface with the patient. Mail order has evolved because we haven't moved toward a new and expanded mission for the pharmacist.

As far as other associations are concerned, I believe we can work in concert with other special interest groups.

IP: Do you agree with critics that say pharmacy associations in general aren't doing the job for today's pharmacist?

Gans: Yes sir. It's clear. There are probably around 160,000 pharmacists in the U.S. and only about 60,000 belong to national organizations. I think that's a clear indictment of associations.

IP: While I don't think anybody questions the professional side of pharmacy, there is an economic side as well. How do you plan to address it?

Gans: In many instances the economics of the profession are closely related to the professional aspect of the profession.

IP: Can you give me an example?

Gans: I believe very strongly we should have two additional classes of drugs in the U.S. First, a third class of pharmaceuticals that I would call a "transitory" group. These would be legend drugs that would be in a pharmacist-only dispensing pattern, which is essentially what they have in the Florida. These drugs would have to be reviewed. Depending upon the data a pharmacist and the FDA can collect, these drugs would become OTCs or remain prescription only.

I also believe there should be a fourth class of drugs. Drugs in this class would be by prescription only. If a doctor were to write for a fourth class of drug, the pharmacist would use his or her professional judgment to refill it without making the patient continually going back to the doctor for a checkup. I think this is very cost-effective.

IP: What are your biggest challenges as ceo of APhA?

Gans: Streghten APhA financially, stabilize the staff, and to begin an effective dialogue and relationship between us and our state affiliates.

I tell people that I realize that they have two four-letter words to deal with, dean and ASHP [referring to his position as dean of the Philadelphia College of Pharmacy in 1988 and president of the American Society of Hospital Pharmacists, 1986-87 - Ed.] That's fine as long as they don't feel that Gans is also a four-letter word.

IP: How do you answer those critics who say that your clinical background will cloud the business issues facing today's retail pharmacist?

Gans: I have educated many of those people holding jobs in retail pharmacy and trained them for twenty years. I know what they were trained to do. I know the professional practice philosophy I instilled in my students. What I would like to do now is unchain them and to allow them to practice the kind of pharmacy they dreamed about practicing.