It's a Wonderful Pharmaceutical Life

Joe hated Monday mornings. At 7am he’d been dreaming he was on a Caribbean island with Rhianna singing something about him shining bright like a diamond. Now, a couple of hours later, Joe sighed and picked up the stack of mail he’d thrown into a corner as he’d arrived to the baying crowds this morning. He took a swig of his coffee, now cold, as he shuffled bill after bill to the back of the pile.  He raised an eyebrow as he came to the last letter in the pile, an official looking brown envelope addressed to “the responsible pharmacist”. ‘S’pose that’s me’ he thought, as he wearily slid a nail under the flap and pulled out the enclosed sheets of paper. He scanned the mailshot suspiciously as words and phrases swam into his vision: “research ready”, “medicines optimisation”, “innovation and evidence”, “clinical study” and “principal investigator”.  Joe shook his head and gave himself a stout palm slap, his cynicism going up several notches to exasperation. 

 

‘Talk about being out of touch with reality.  How could they even think about involving us with all this research malarkey when we pharmacists are up to our eyes in targets; when hub and spoke and all these new schools of pharmacy are threatening to hit our profession with the worst unemployment crisis it has ever seen; when nurses and pharmacy technicians have their act together way more than we do; when the contract doesn’t even acknowledge that we’re saving NHS money- and lives- every day?’   With that, his mood went up another 5 notches to anger and incredulity; before it toppled back 10 into profound malaise.  In the end, he resolved to ignore the letter, dismissing it like those flashing signs on the motorway warning about queues on the M6, which tend to crop up when you’re actually on the M1 and about to come off at Rotherham.  Just as he was sculpting the letter into a projectile shaped perfectly for filing in the wastepaper basket, the dispenser, who had grudgingly introduced herself that morning, slapped her mug on the bench. 

“Right, we need to ‘ave the controlled drugs done by 1230 so t’delivery driver can tek ‘em.  E’ll not be wuckin in ‘is lunch hour, you know” growled Joyce, who shuffled around the dispensary like an extra from the set of Downton Abbey.  ‘Oh yes but I will, I bet’, thought Joe.  Joyce handed over the prescriptions. “CD cupboard’s down’t stairs in t’ basement”, she said, mouth set into a stubborn straight line. “SOPs in t’ book”, she continued.  Joe made his way to the stairs and was confronted by a dark and dank abyss.  ‘Oh, one of those shops’, he thought, as he gingerly placed his foot on the first step.  Joe only had time to grasp wildly for the light switch as he tumbled down the stairs. 

 

 

He opened his eyes and was struck by the brightness of it all. ‘Oh, I’m dead’, thought Joe.  ‘That’s just my luck, to die in a branch of Expharm whilst on the locum from hell’.  Just then, he heard his name being called from what seemed a long way away.  “Joe?  Are you Joe?  Joe the pharmacist?”

 

  He realised with relief that the voice was nearby but at least, still outside of his own head, as a face resolved in front of him. 

 

“Are you Joe, a pharmacist from the past?”

Joe shook his head.  “Not sure”.  He said.  “One minute I’m getting some controlled drugs and then the next minute……..”. 

 

“I am Mab” said the face.  “I read your name on your Royal Pharmaceutical Society membership card.  A pharmacist from the past, how exciting! Take this intelligent dose form and you will feel as fit as a fiddle”. 

 

Joe took what appeared to be a small green plastic bead and eyed it suspiciously.  “What is it?” he asked. Mab smiled enigmatically.  Joe slowly lifted the bead to his mouth and gasped as it turned into what appeared to be a blackcurrant flavoured jelly baby.  “Ahh, so you like Jelly babies then”, said Mab.  “I think you’ll find that it contains a perfectly adjusted dose of the SWEL-2 inhibitor flamtuzumab which will be activated exclusively by chemotactic enzymes currently accumulating in your cerebral cortex and the osteoclastic enzymes we have detected in your broken distal ulna.  The active ingredient will then be harmlessly metabolised away according to your unique profile of hepatic mixed functional oxidoreductases which will be excreted at your leisure despite there being a slight moderation in gut flora due to a recent misadventure with a chicken vindaloo.”

  “Hey?” Joe narrowed his eyes defensively.  Mab smiled “It’ll get rid of the mother of all headaches you are currently experiencing and fix your broken arm.”

Half an hour later Joe had made a full recovery and was being led around the cavernous white room which turned out to be nothing other than a pharmacy.  A pharmacy on the moon, that is, in the 25^th century.  There appeared to be no medicines in evidence, only a series of what looked to be suspiciously like vending machines, each with a small red button in the top left hand corner and what appeared to be a metal funnel in the centre.  At that moment, a tall, elegant lady in a bright white coat dress sashayed confidently up to one of the machines and pressed the red button, causing a wafer thin slice of gleaming metal to slide soundlessly out of the upper quadrant of the machine.  With a fluid movement, this unfurled to reveal a digital display of data which highlighted the lady’s sculpted features with a hypnotic suffusion of light.  “That is Aurora, one of the registered pharmacy technicians we recruited to Moonbase Pharmacy after its inception in the year 2465” said Mab “or rather it is Dave, who let me say likes to use our gene technology to tamper with his appearance somewhat.  Dave has just passed his APPs (Automated Pharmaceutical Personalisation Software) for Pharmacy Technicians diploma, and he is quite hard to tear away from the genomic variation-induced drug compounding device.” he said somewhat affectionately, whilst motioning towards the first vending machine.  Joe looked bewildered.  “Ahhh, pharmacy is a little bit different in your age isn’t it?  Whilst you were recovering I consulted the history marbles in the eCloud and I was somewhat flabbergasted that pharmacists in the early 21^st century used to get a piece of paper from a doctor which told them to count tablets from a bottle, and that your role was to collect as many of these pieces of paper as you could in as little time as possible.”  But tell me Joe, how does one become a pharmacist in your age?”  Joe scratched his head and thought back to his university days and those interminable hours of lectures, tutorials and examinations.  He thought about the day he’d graduated with his MPharm, how proud he’d felt that day and how frustrated he’d felt subsequently.  “Well, I did Pharmaceutical and Medicinal Chemistry, Pharmacology, Cell Biology, Pathology and Therapeutics, Food and Nutrition……..” Joe’s voice trailed off.

 

Mab looked puzzled. “But tell me, did pharmacists not tell anyone they were the experts in medicines? Did they not get a bit….bored?”

 

Joe felt a familiar pang as he considered that most well trodden path of pharmaceutical conundrums.  “Well, some of us talked about evidence, or a new contract……but we needed special training to show what we could do……and most of us didn’t bother”, said Joe apologetically.  “After all, we didn’t really get paid to do anything but dispense and whenever we tried to do something more for patients we just ended up ticking boxes….so after a time, if anything new came along we didn’t really believe we could do it...” he trailed off.

           

Mab smiled.  “Then it is time I showed you my dispensary”, he said, as a door appeared on the opposite wall and slid smoothly to one side. Joe stood aghast as Mab led him into another white, ultramodern room that appeared to be a high tech laboratory.  “Let me introduce you to my pharmaceutical engineering team.  They are headed by my chief pharmacist investigator Professor Maisie Goodpill. A small lady with a big grin and a halo of pink hair gave a little wave.  “And this is Professor Goodpill’s’ team of research pharmacists, who are able to manufacture smart-phone activated intelligent inhaler devices that release neutrophil activated beta agonists into the lungs according to their genetic disposition, lung disposition; and if they have a sweet disposition, a palatable flavouring of their choice.”  When we became research ready in 2014, we got the clinical trial bug.  To think, it all started with a new cough medicine and now we’re leading on patient-centric biopharmaceutical nanobots.  It’s like science fiction, isn’t it?”

 

 

Just then, a tall, thickly built man with a ginger beard and an animated tattoo depicting a spinning pestle and mortar on his forearm walked tottered into the laboratory on his high heels “Ahh Dave” said Mab, “Can you send a laser signal to Dr Procter at the Royal Manchester and tell him we are able to transfer our prescription response paradigms over to his patient summary mainframe?”  Mab lowered his voice to a tactful whisper “Oh, and Dave? You might need a top up”.

 

Mab steered Joe through another sliding door into another laboratory. “These days, what you call prescribing is nearly always done by pharmacists.  There was no choice really.  As pharmacies became more involved in the design and evaluation of new treatments, only they had the scientific knowhow to optimise their usage.  Just then, a bleeping noise interrupted the proceedings and a screen started blinking.  “What’s that?” Joe looked startled.  “Oh, it’s only NHS Healthpoint Birmingham West 34”. We’ve got a little trial going on with our latest diabetes telepharmacy App.  When the patient’s phone detects a bit too much blood sugar in their texting thumbs, we get a signal and they get a 3D-media message about the hypoglycaemic smart doses we have waiting for them”.

 

“But what about pharmacy medicines?”, Joe asked sadly, “Does no one want a cough bottle anymore?”, but he was cut short as Mab swiped his hand across a seamless soft screen which had popped into existence soundlessly to reveal a patient talking to what appeared to be a pharmacist about her medicines.  Only, for some reason, the pharmacist on the screen was copying the exact movements of Mab.  Joe realised what was happening. The pharmacist on the screen couldn’t really be Dumbledore.  Joe looked at Mab and Mab winked.  “Just a little bit of self indulgence when it comes to my remote controlled holo version I’m afraid…….Yes, Mrs Swann, nice to see you……..yes it’s a medicine made just for you…..yes indeed, it only works with your genetic fingerprint so I’m afraid it wont cure your dog’s cough.” 

 

Jo watched as one of the pharmaceutical engineers, who according to Mab was a former materials expert from Astraglax, tapped in a data code corresponding to Mrs Swann’s diagnosis.  “Histopathology biomarker set- received and downloaded.  Pharmacogenomics- dataset dowloaded. Progress to dispensing and cross-referenced for clinical trials pharmacist referral for consent.  Log reference to dispensary devices pharmacy technician Aurora/Dave.”

 

The scientist gave a single vigorous nod.  The machines started to whirr and a template for a personalised nanobot-directed lung implant loaded with the Pulmonary Irritant Receptor Complex Uncoupling Protein (PIRC-UP) agonist that would cure Mrs Swann’s cough was transmitted to NHS Healthpoint Birmingham 345.  Then, as if by magic, an identical vending machine to the one Joe had seen here on the Moon spat a dispensed medicine from its funnel.  Even from 250,000 miles away, Joe could see the digitally enhanced cautionary and advisory label flashing as the headmaster of The Hogwarts School of Witchcraft and Wizardry explained how to use the medicine; before directing the patient to the Healthpoint pharmacist-led long term medication outcomes planning clinic, whose real life pharmacist could be glimpsed at the screen’s periphery.

 

“Well, that’s Mrs Swann’s cough bottle seen to”, said Mab as he swiped away the soft screen with a flourish.

 

Joe noticed that on the opposite wall was a small holographic plaque showing an accurate three dimensional representation of Mab, with the words “The responsible pharmacist is Mab Starr.  His registration number is 9786754433456374.”  Joe chuckled “Well at least they got rid of that awful ungrammatical ‘their’ ”.

           

So, it seemed that in this version of the future at least, pharmacy had become a research-led, innovative profession and had prospered.  “When the money ran out and we could no longer drill for more pieces of papers, we started to mine here instead,” Mab tapped his forehead, “and look what riches we found.”

 

One thing was bothering Joe though “But how do we get the time to do this? What about targets from non-pharmacist store managers?”

 

Well, that was 3 things, but Mab considered the frown that had suddenly blown across Joe’s face like a storm cloud and guided him to the window. Joe caught his breath as he saw for the first time the beautiful panoramic vista of the blue Earth below them. “Look down there, Joe, what do you see?”  Joe followed Mab’s line of vision and his eyes fell on a large grey behemoth of titanic proportions, the only man-made structure visible from space- a single warehouse with the words “Tedzsburysons” written on top.  “That is our unified global food hypersaler for online delivery of individualised meals according to nutritional and health status.  Joe, we don’t worry about store managers in our time. There are no stores. Only Tedzburyson Locals and they are all research ready pharmacies.”  Mab laughed heartily as Joe’s perception of the world started to spin out of control, as he lost all sense of the past, present and future.

 

When the world eventually came to a holt Joe found himself once again in Expharm 9562 and was relieved to note that what had seemed to be a staircase into the abyss in the oily, black darkness was actually only 5 small steps.  Apart from a dent to his pride, he seemed to be quite unharmed, although oddly, he could still hear Mab’s jovial laughter.  He made a mental note to drop by the hospital and get checked out for possible concussion. As his senses cleared he realised with dread that the laughter came not from Mab but from the shop floor, and that it was at his expense.  “What, Joyce love?  Your chemist has fallen down t’ stairs?  ‘E only has to get box off t’ shelf!”  Joyce appeared at the door “Are you goin’ to be long?  Regular pharmacist don’t usually ‘ave break”. 

           

Joe eased himself off the stone floor and walked dejectedly back into the dispensary.  “Name and address” he said as he held up the bag.  “I’ve been comin’ ‘ere 20 year!” said the man impatiently as he skulked out of the pharmacy.  Just then, something, shining bright like a diamond, caught his eye from the wastepaper basket...

 

 

 

 

 

Filed Under: Pharmacy Research