Monthly Archives: March 2019

Boost Your Professional Credibility & Contribute to your Profession with Research

Practicing pharmacy has proven for me to be much more than I had planned when I was accepted to Dalhousie University’s College of Pharmacy 30 years ago.  Of course it created a career where I used the most available evidence based treatments for just about any medical conditions that I was asked about.  This degree put myself and my colleagues on a level that resulted in more people listening to us and taking our recommendations than we had ever experienced in our lives before.  All of a sudden, with such a degree on our wall and a license to our name, people would follow our beliefs without question.  Pharmacy can be a powerful profession with regard to public credibility, even when it involves treatments that have very little evidence or no evidence (such as homeopathy).  The mere presence of a treatment in a pharmacy and the recommendation of a pharmacist is all the public needs to blindly follow us in many cases.

We normally aren’t asked or required to supply randomized placebo controlled trials to back up our recommendations in the front store nor is that commonly asked for in our prescription world either.  Most of us simply give recommendations without readily knowing off hand any particular study that backs up what we are saying at all.  Giving public presentations may be an opportunity to show an audience where the foundation of our claims come from in the scientific world.  It turns out that the public can be information nerds like we are sometimes and are quite interested in presentations like this.

As pharmacists, we are tied to the study designs of others when it comes to our recommendations.  The weakness of their designs becomes the weakness of our recommendations.  For years we recommended docusate sodium as a stool softener, only to hear that it really doesn’t do what we claimed all these years.  10 years ago I was lucky enough as an owner to pursue a niche in compounding, a subset of pharmacy I was exposed to as a student working in a pharmacy a block away from the College of Pharmacy in Halifax.  Pain compounding became the focus of my practice.  The evidence for these ingredients was positive but didn’t involve hundreds of thousands of patients.  It consisted of many smaller studies that together added up into a strong base from which to recommend this treatment modality.  Active ingredients like amitriptyline, clonidine, gabapentin, ketoprofen, ketamine and lidocaine were all mentioned in the literature, but something was missing for me.  In order to put some stronger faith from the public in this, I needed to show some way that I was in some way involved with the evidence base of treating people this way for pain.

Turns out, universities are eager to showcase their research and are very helpful in sourcing out grants to fund scientific studies.  It has always been a drawback for a situation to exist in scientific study whereby the “promoter” that stands to make money is funding and driving the study forward.  However when we consider that this is how most prescription meds came to market it becomes more acceptable.  I believed it would be a strong asset to show that I spearheaded a study through my pharmacy that proved for the first time the permeability of these six ingredients through the skin would happened simultaneously.  A visit to the local university and they helped us with the application procedure for a grant that covered the cost of the study, new equipment included.  The money went completely to the lab with our pharmacy handing over three sample creams in three different bases.  With very little effort on my behalf, I went from wanting to prove I could drive these molecules through the skin to having a typed manuscript with graphs showing flux over time that I could bring to prescribers and show to recipients of the cream to instill confidence in their medication.  This completed study is soon to be published.

As a follow up, we applied for and were accepted for a grant with the local pain clinic to use the same pain cream with the local pain clinic on 40 patients with nerve pain.  What better way to put your money where your mouth is than to put your own hand picked ingredients on the spotlight and test whether or not they actually work.  We were that confident based on hundreds of patient results.  

In another study, we partnered with The Propel Centre at The University of Waterloo to supply data on the aftermath of discontinuing the sale of sugary beverages at our pharmacy in 2014.  In this case they approached us on starting this study, which was finally published in 2016 and became the subject of a Thesis presentation after that. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947263/

My point is, based on the funding available out there, why not take a treatment concept you either feel strongly about or want to clarify that has been conventionally accepted for years (either prescription or non prescription) - lots of opportunities exist in the front store here without taking on big pharma. Meet with the university scientist that will design the study and share your thoughts on what you are trying to unveil. Allow them to introduce you to the grant application personnel, (or vice versa). It becomes an incredible strength to refine your knowledge of study design you’ve learned from your pharmacy degree. You don’t have to be an expert on study design. Allow the researcher you are collaborating with to develop the study with your input. Nothing beats having your name on a study that shows that you are so committed to your profession and your recommendations that you are willing to be involved in an actual study to clarify our understanding of a topic. Being known as a research pharmacist gives extra credibility to your commitment to your profession as well as increases your knowledge base for your recommendations to your patients and your physicians. Your contribution to your profession will not go unnoticed, and the next time a customer asks you if you are aware of any studies on a particular topic, you just might be able to quote one directly.

Graham MacKenzie Ph.C.