2039: Pharmacy after the fall

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There were signs of what was to come even before the collapse. With hindsight we can see the path we were treading, the conditions, circumstances and events that gave us glimpses of the coming disaster. Sharp rises in the cost of medicines, shortages of fundamental drugs, and a pervasive belief that a prescription was the standard outcome of a medical consultation.

Then came major stressors. Brexit and acrimonious trade wars between various economic blocs were bad enough, but it was a series of weather and geo-related natural disasters in the early 2020s that sent the biggest shockwaves through the world’s remaining fragile manufacturing capacity. Globally the supply of pharmaceuticals teetered, and then in 2025, totally disintegrated.

The world was plunged into a new reality and it is easy to imagine that the pharmacy professions would have simply been rendered obsolete. When medicine supplies slowed from a torrent to a trickle, what need was there for a pharmacy? 

The truth of course, was pharmacy professionals didn’t ‘just supply’. Yes, some entrepreneurial pharmacists found ways of providing raw materials from backyard herb gardens, resurrected small-scale manufacturing and plugged some of the gaps. The impact of this was very welcome, and bespoke compounding expertise in high street locations became overtly valued. The far greater impact however, was that the pharmacist’s expertise was needed to gain every last drop of benefit from the remaining trickle in medicines supply.

‘Extreme clinical pharmacy’ was the only way to eke the most benefit out of the remaining resource. Pharmacists became the arbiters of who received a precious supply of medicines and who did not. A diagnosis no longer automatically generated a standard prescription, according to some protocol or other. Pharmacists would take the diagnosis, work closely with patients and come up with treatment plans embodying the greatest likelihood of success within limited resources. Deprescribing became an essential tool of practice.

Pharmacist-led follow-up was, and still is, of paramount importance. The consequence was that centralised shared record-keeping became the norm, to guarantee the provision of clear care plans easily available to healthcare professionals and patients alike. Pharmacists from the UK in particular, but also from North America and Australasia, were already recognised as world leading from a clinical standpoint and so their expertise was highly sought from around the globe. ‘Script Chambers’ sprang up to manage demand, becoming centres of expert medicines practice and acting as prescription-clearing houses before onward transmission and dispensing from fully automated distribution hubs.

A new lucrative trade emerged that centred on training the world’s pharmacists in medicines optimisation. This coveted expertise contributed hugely to the UK’s economy, and even now in 2039 is a significant replacement for the loss of the financial services sector two decades ago.

Nowadays wherever there is a medicine, there is a pharmacist. A full partner of healthcare, trusted by patients, valued by society and very much the aspirational career. Pharmacy is a profession whose symbol is no longer a big green cross, but a big green tick. What could have been a calamity, has become a salve.

Mark Borthwick

Mark Borthwick, consultant pharmacist in critical care, Oxford University Hospitals NHS Foundation Trust.

Mark’s piece is the winner of our 2018 writing competition ‘Future Pharmacist’. He will receive an Amazon Fire tablet for his entry. Read more entries here.

Readers' comments (3)

  • ... and the world came to realise in 2039 that human-kind was not, scientifically-speaking, Homo sapiens but a hybrid swarm best described as Homo x sapiens. Individual members of this hybrid swarm could be categorised as the truly wise (var. sapiens) and the not so wise (var. pseudosapiens). The essential difference between these two variants is the will or otherwise to learn. Amongst those with a will to learn are the individuals who are able and willing to fund research and/or undertake research and, crucially, to learn from the advances in knowledge and understanding recorded by others. They are characterised by a capacity for "delayed gratification" (1). The rest are characterised by a lack of eagerness to learn and by a need for instant gratification, often with no "manual over-ride button". It came to be recognised by the healthcare professions that these individuals generally did not respond to healthy-living advice, and indeed actively spurned any such advice proferred by well-meaning and knowledgeable healthcare practitioners who had diligently engaged in continuing professional development. By 2039, all that human-kind needed to know about healthy lifestyle had been thoroughly researched and documented, and taken on board by Homo x sapiens var. sapiens. There was little need for medication in these individuals. Their continuing good health followed from the simple foods and drinks they ate and drank in moderation (and especially during pregnancy), from their active lifestyles, and from the care they took to look after their skin and gut microbiomes. The truth of the maxims “you are what you eat” (2), “an apple a day keeps the doctor away” (3), and “eat less and move about more” (4) had been accepted by these individuals. Any ill-health they suffered could be put down to sheer bad luck. As for Homo x sapiens var. pseudosapiens, illness was tacitly accepted as a fact of life, and medicines as part of a normal diet. But the supply of medicines had dwindled to the point where there was insufficient to treat all of these patients symptomatically (so-called "polypharmacy"), as was the norm in the earlier years of the 21st Century. Instead of acceding to the expectations of these patients for symptomatic treatment that would enable them to live longer (thus giving politicians something to brag about whilst at the same time causing patients to suffer a long, lingering, and often painful self-inflicted illness before their eventual and inevitable demise), their illnesses were allowed to follow a natural, more rapid, and therefore more humane course as was the norm in the final quarter of the 20th Century. Researchers are still seeking to determine whether there is phenotypic plasticity in those who are provisionally categorised as Homo x sapiens var. pseudosapiens, this being the most obvious potential route towards the cost-effective use of scarce medicines ... but should those scarce resources be reserved for Homo sapiens var. sapiens or Homo sapiens var. pseudosapiens?


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  • Great piece! Well done Mark!

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  • This is excellent work. I definitely agree with the future pharmacist roles as highlighted especially with the current changes in the UK and worldwide. I also belief pharmacists have get potential in the future of health care but they should take the initiatives to drive the changes they want to see in future.

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