Pharmaceutical policy and the pharmacy profession* Æ Janine M. Traulsen and Anna Birna Almarsdo ´ttir ; Introduction In this, the fifth article in the series, we look at the relationship between pharmaceutical policy and the pharmacy profession. The scope of this article does not allow a thorough review of policy and legislation governing pharmaceuticals that includes the entire pharmacy sector. Therefore, we will focus on phar- macy practice and pharmacists working in health care services. We will discuss what we see as one of the most important issues in pharmaceutical policy today: how policymakers view pharmacy and pharmacists. We will look at the ideology of managerialism and the division of labour, two factors influencing both policy and the profession. Finally, we will look at the pro- fession’s attempts to influence policy. How policymakers view pharmacy The policies influencing pharmaceuticals and the pharmacy profession are global, international, national and local. The politics of pharmaceuticals is complex and dominated by three policy inputs: public health policy, health care policy and industrial policy. Thus policy makers face overlapping and at times compet- ing regulatory tasks. First and foremost is to guarantee safe, high quality and efficacious medicines to the consumer through public health policy. Next is to balance health care budgets and control health and drug costs, which is the realm of health care policy. Third, given the economic contribution of the sector, is to promote a regulatory environment conducive to business through industrial policy 1 . These policy in- puts – two concerned with health and one with commercial interests – have a tremendous effect on the present and the future of the pharmacy profession. The main professional roles of the pharmacy pro- fession do not fit neatly into either health or industrial policy. The areas of practice of the pharmacist differ- entiate between activities concerned with patient care and public health and those concerned with drug development, supply and dispensing. We see one of the major challenges for the phar- macy profession as educating policy makers about the width and breadth of the contribution of the profes- sion not only to industrial and economic growth but also to public health. In the following, we argue that the effect policy has on the pharmacy profession can be directly related to how policymakers view pharmacy and pharmacists in the policymaking process. The goal of all policymakers is to ensure the overall health, welfare and wellbeing of society. However, when looking at studies that analyse policy in this area 2,3 , we find that policymakers operate with two conflicting views of pharmacy and pharmacists. In the first view, the pharmacy sector is seen as a commercial enterprise contributing to the economic good of the community. In this view, policymakers see pharmacies as commercial enterprises and phar- macists as business (wo)men. In the second view, the pharmacy sector is seen as contributing to health services and pharmacists as contributing to overall public health. Here policymakers view pharmacies as local health care centres – the first contact the public has with the health care system – and pharmacists as the most easily accessible health care professionals. In order to understand which of these views dominate in a particular policy debate, it is important to look at the two views in the context of the policy: for example, is the goal to increase patient safety or to save on drug expenditure? These two views can be found in the historically anchored conflict the profession has been struggling with since its conception: business interests versus professional interests. Despite hundreds of years of regulation, there is no universally accepted perspec- tive on how policymakers view and regard pharmacy (and pharmacists). When policymakers view COMMENTARY 359 Pharm World Sci (2005) 27: 359–363 ª Springer 2005 J.M. Traulsen (correspondence, e-mail: jam@dfuni.dk): Department of Social Pharmacy, The Danish University of Pharmaceutical Sciences, Universitetsparken 2, 2100 Copenhagen Ø, Denmark A.B. Almarsdo ´ ttir: School of Health and Education, Reykjavı ´k University, and Faculty of Pharmacy, University of Iceland, Hagi, Hofsvallagata 53, 107 Reykjavı ´k, Iceland Key words Pharmaceutical policy Pharmacist Pharmacy Pharmacy profession Professionalism Abstract In this article, the authors look at the relationship between pharmaceutical policy and the pharmacy profession with focus on pharmacy practice and pharmacists in the health care sec- tor. Pharmaceutical policy encompasses three major policy in- puts: public health policy, health care policy and industrial policy. In order to analyse and understand pharmaceutical policy, it is important to know how policymakers view phar- macy and pharmacists. The authors look at the issues that arise when policy regulates pharmacy as a business, and what this means for the profession. The perspective of pharmacy as a health care profession, as well as what it means when we view pharmaceutical policy in the context of the health sector labour market, is discussed. The authors also discuss how factors external to the profession are affecting its purpose and realm of practice, including the current trend in managerialism, and how the division of labour with other health professionals such as physicians and phar- macy assistants is affecting the pharmacy profession’s position in the labour market. Next the authors look at ways in which the pharmacy profes- sion has affected policy. Pharmacists have been instrumental in developing new and expanding roles for the profession, sometimes inspired by external events, but often as a result of their own prerogative. The pharmacy profession is encouraged to take a leading role in forming and contributing to policy, in this way making visible its contribution to society in general and public health in par- ticular. If not, the profession will forever be reacting to policy and will remain at the mercy of policymakers and other strong actors in society. Accepted September 2005 *This article is the fifth in a series of articles on this topic that will appear in Pharmacy World & Science during 2005.