Pharmacists and Reference Librarians

I’ve been thinking about pharmacists lately. They’ve been in the news lately, since Plan B (another drug in the line of “morning after” pills) was recently approved for use by women in Canada without a prescription. No prescription required, but the drug will be held behind the pharmacist’s counter, and women will need to ask for it. There’s been some controversy around the role of the pharmacist in that transaction. Why put a barrier in the way of women trying to control their own fertility? Who is this person who stands in place of a doctor, who guards the more dangerous drugs, even though we have a legal right to them?

Why exactly does one need a degree in pharmacy in order to guard drugs?

Pharmacists, it seems to me, are in very much the same position as reference librarians. Technological innovation and the commercial exploits of big business have altered their respective roles so severely that the intense, arduous education required of both fields seems to have been rendered nearly useless.

The medieval and early modern apothecary did not just to dispense the drugs prescribed by a doctor, he made them. Apothecaries harvested medicinal plants, dried and treated them, and prepared the concoctions as directed according to the instructions passed down from master to apprentice. The apothecary knew two languages; the Latin terms for medicinal plants, cited in the ancient texts of Hippocrates and Galen and in the prescriptions from physicians, but also the vernacular names, the local names for herbs and flowers that were often different from region to region. The local physician would pride himself on not knowing anything about the vernacular terms; that was lowly labour-related knowledge, not fit for the elite, university-trained physician. Erasmus tells a story about asking a table full of learned physicians to identify one of the greens in their salads; they all passed it around, and claimed it was some foreign vegetable they couldn’t name. A passing maid told them it was parsley.

So apothecaries were the interpreters, the ones who could understand what the doctor’s theoretical prescriptions meant in the real world. They matched theory with an actual physical plant or mineral. That interpretive role made them a threat to the medical establishment, who often felt that the apothecary could easily take advantage of the physician’s ignorance and feed the wrong medicine to a sick patron, making it look like the physician’s fault. They worried that those apprenticed apothecaries might start guessing about humours and their interaction and doling out medications on their own.

At one time, the pharmacist was a powerful person with a crucial role in local life.

Even in Norman Rockwell pictures, the pharmacist is mixing up cough syrups and pain medications tailored precisely to each patient. The profession clearly required a lot of training, and the community who appreciates his work certainly wouldn’t want him to be poorly-trained or under-paid.

Today Big Pharma makes the drugs. Pharmacists, highly trained all, are reduced to basic retail work. The act of actually counting out the drugs and pouring them into a plastic bottle isn’t even performed by a pharmacist these days.

There was a time (not long ago) when your local reference librarian was the only search engine you would have access to. If you needed information, you would go straight to her. She would go through the involved and complicated search procedure for you and make sure you leave with what you need. She was the interpreter, the map-maker into this world of information. With the internet, with Google, that work has been outsourced and made free for all. The reference librarian’s role, like it or not, has been vastly reduced (or, at least the stats show dwindling user questions asked per annum). Librarians have had to face the possibility that they are being phased out by an algorithm. Librarians are currently facing the challenge of accepting the new technologies that have largely made their skills obsolete and choosing a viable path into the future, one where the library will still have a crucial place in public life. Librarians need to find ways to make themselves relevant to their communities.

But the pharmacist is in a worse position; pharmacy as a real community service is possibly just a bit further along the road to annihilation than librarianship is. Here we have these well-trained, intelligent, knowledgeable professionals standing behind rows of antihistamines, overseeing paperwork and restocking Viagra bottles, and anxiously awaiting any question from customers milling around the drugstore. Is this the future of the reference librarian?

Perhaps all is not lost. At least reference librarians can (and have) become experts at finding information in whatever medium is best, fastest, and most robust. At least librarians can tackle big concepts like information literacy and computer core competencies, getting meta about what it means to need and get information. Academic librarians can become experts on database management, archiving digital documents, instructional technologies and undergraduate outreach. Public librarians can focus on services like toddler and teen programs, turning their facility into real community space rather than book storage, and refocusing on becoming excellent reader’s advisors. (A good reader’s advisor is, after all, worth her weight in ipods.) Fortunately there is space here to rescue and reinvent the profession.

It would be interesting to see the same kind of movement among pharmacists.