PHARMACIST. — The pharmacist, a natural collaborator of the physician (v.), shares with him—though in a subordinate role—the nobility and importance of their mission. The pharmacist’s profession is therefore laden with many responsibilities, especially today, since the pharmacist’s principal activity is no longer, as in the past, the preparation of medicines in a modest laboratory, but rather the role of a living dispenser of a flood of specialties and patented products that the pharmaceutical industry places on the market.
The pharmacist is thus faced with two moral questions: Is it permissible to substitute specialties with other products of equal efficacy manufactured by the pharmacist himself? And how should the pharmacist regulate advertising?
Regarding the first question, justice forbids the fundamental imitation of a product and its introduction into commerce under the patented name. Such counterfeiting is also punishable under the law (cf. Cod. pen., arts. 473). Substituting specialties with products of equal or perhaps greater therapeutic efficacy may be considered illicit, at least when the customer does not present a medical prescription and is not informed of the substitution. Such substitution is, in fact, justified and commendable when, for example, the high cost of the specialty would prevent the customer from purchasing it, and when the therapeutic value of the specialized product is proven to be negligible or nonexistent. It is not uncommon for imprudent advertising, exploiting the public’s psychological dispositions, to present medicines of little or no therapeutic value as infallible remedies (cf. G. Lami, *Questioni d’osteologiche in tema di specialità medicinali*, in *Studium*, 44 [1948], pp. 25 ff.). The pharmacist should therefore examine the composition of patented and specialized medicines to verify their actual contents.
Even when a prescription is presented, substitution cannot be declared illicit outright if it is evident that the physician was concerned not with the name of the remedy but with its efficacy.
A medicine is a chemically defined substance capable of inducing a functional change through a chemical or physicochemical modification of the cellular protoplasm (not through a physical modification). The purpose of pharmacology is best appreciated when compared with that of physiological chemistry. Chemically defined substances are used in physiology to study functional modifications, and in this sense, as Cl. Bernard coined in 1856, medicines and poisons are, in the hands of the experimental physiologist, “true reagents of life.” For pharmacology, however, functional modifications are not the goal of investigation but the means: the study of functional variations serves to assess the chemical and physicochemical changes that produced those functional variations. In this sense, Sabbatani felicitously compared functional variations to the color changes of indicators in chemistry.
It is true that the drug, as known by its chemical and physicochemical properties, does not always remain unchanged when it comes into contact with blood or tissues; thus, it is also the task of pharmacology to study how the drug is modified within the organism. The aim of pharmacology as a biological science would be to arrive, through the study of the activity of substances of known chemical constitution, at an understanding of the structure and dynamics of protoplasm—that is, to penetrate the mechanism of life. Meanwhile, more modestly, pharmacology serves to provide a scientific basis (freeing therapy from empiricism) for chemical therapy (distinct from physical therapy) as opposed to other forms of therapy.
From a conceptual standpoint, it may be observed that the definition given of pharmacology holds only if the independence of chemistry from physics is acknowledged. If chemistry were reducible to physics, the definition would need to be modified. But considering that it is the scale of observation that creates (or delimits) the phenomenon, and that pharmacology, like chemistry, is a macroscopic science, the raison d’être of pharmacology is the same as that of chemistry.
It is clear that pharmacology relies on experimentation on living beings or surviving parts. Pharmacological experiments are therefore conducted on plants (microorganisms are plants upon which disinfectants and some chemotherapeutic agents are tested), protozoa, and animals of every type, class, and species. Each species serves to bring the drug into contact with living cells; but whereas the living cell comes into contact with the drug through the entire surface of the body, in the case of animals (to limit ourselves to them), there are natural or artificial routes of drug administration.
Isolated cells of metazoans, such as red blood cells, and surviving organs (e.g., the heart, frog’s eye) are in turn excellent reagents for biological research on drugs, which can act on relatively small substrates in proportionally small doses. The nature and dosage of the drug used must be taken into consideration (biological research and dosage of drugs). A fundamental concept in pharmacology is that of *dose*: it is the dose that makes the poison; any substance can, depending on the quantity, be a nutrient, a medicine, or a poison. Sodium chloride, for example, normally participates in metabolism; its absence in food is felt, necessitating its intake, and a lethal dose is also known. But since the concept of dose ultimately refers to a ratio between the living weight on which the drug acts and the weight of the drug itself, one must not be misled by the fact that extremely small weights of a drug act on proportionally small living weights. It is easy then to speak of minimal doses, and it is possible that homeopathy seeks quick support in these experimental results. But if one keeps in mind the ratio between the weight of the active drug and the weight of the living matter on which it acts, the so-called minimal doses prove to be minimal only in relation to the small quantity of living matter (e.g., the mass of a red blood cell) and have nothing in common with the doses (concentrations) of homeopathy.
Pharmacology is distinguished into general pharmacology, special pharmacology, and therapeutic pharmacology. General pharmacology deals with what is common to drugs, regardless of their elective action. Special pharmacology examines absorption, the modifications they undergo in the organism, distribution, elimination, and the conditions and factors that alter their action. Special pharmacology deals with the action of drugs according to their chemical classification. Therapeutic pharmacology is a preparatory, critical, and interpretive task concerning the therapeutic applications of drugs (Meneghetti).
Among the recent advances in pharmacology, those achieved by chemotherapy since Ehrlich up to the discovery and application of “antibiotic” substances such as penicillin and streptomycin should be noted.
Bun: For its history: S. Dale, *Pharmadoxika, seu manuductio ad materiam medicam*, London 1693, and Berne 1696. For the concept of p. as a reagent, C. Bernard, *Leçons sur les effets des substances toxiques et médicamentées*, Paris 1857; new ed. 1883. For solid concepts of general p., E. Meneghetti, *Emmeni di f. e farmacoterapia*, Padua 1934 and subsequent editions. Among the classical works of descriptive p.: G. Gaglio, *Trattato di f. terapia*, Milan 1926. On the horizons of chemotherapy, A. Fleming, *Chimioterapia*, French trans., Paris 1947. The most extensive work is the *Handbuch der experimentellen Pharmakologie*, begun under the direction of Heffter and continued by Heubner and Schüller, Berlin 1926 ff., with the *Ergänzungen* (updates until 1939). For the history of the relations between pharmacy, medicine, botany and p., A. Benedicenti, *Malati, medici e farmacisti*, Milan 1924. For the pharmacotherapy of domestic animals, E. Frohacker, *Lehrbuch der Antimimetiktheorie für Tierärzte*, Stuttgart 1921. For the toxic and lethal doses of drugs on common laboratory animals, compiled in tables, F. Flury and Zernik, *Zusammenstellung der toxischen und letalen Dosen für die gebräuchlichsten Gifte und Versuchstiere*, in *Handbuch der biologischen Arbeitsmethoden*, 4th sect., part 7. Luigi Seremin