A much revered wise-saying in Akan goes like this; “Dua kontonkyitonkyi na ɛma yɛhunu dwumfoɔ”. An English rendition of which will be, “a crooked piece of wood reveals the skillful carver”. This adage gives us a test for artful craftsmanship, pointing to the fact that it takes so much learned or innate skill to make meaning out of a seemingly useless situation. In the context of professional practices it illumines us to understand that skill is what sets apart the professional from a lay person.
In our modern world, many thanks to information
communication technology(IT), both pharmacists and the lay public now have an
almost free access to a large breadth of information on drugs, specifically,
and healthcare in general. But much as breadth in perspective is seen
effortlessly, so much skill and labour are required to discover depth. The
capacity to process and make meaning of the same information presented to both
the pharmacist and the lay person is what sets the one apart from the other.
And this skill is most relevant in situations when there are obvious
contradictions or unfilled gaps with the pieces of information presented. It is
requisite for a pharmacist, a sine qua non, in order for him or her to excel in
the chosen profession, to possess the skill to expertly sift the available
pieces of information on drugs and take an informed position. There will be no
difference if a pharmacist also absorbs any information presented hook, line
and sinker just as the lay person. In the events when there are unfilled gaps
with the available information, a recourse to an educated guess will be
necessary. A pharmacist who proceeds along this line of thought is guided by
the merits of scientific criticism
in his or her practice.
A recent report tells of a pharmacist who declined to
dispense diazepam to a client, having been requested of the latter for that
drug by name to relieve an episode of insomnia, and recommended the intake of
chamomile tea instead. Was scientific criticism involved in the decision-making
process here? That depends on what this pharmacist would give for a reason. It is
a scientific argument if the pharmacist’s reason is that diazepam is a
controlled substance, a prescription-only drug (POM), and therefore the client
required a valid prescription to access it (The Legal Argument). It is a
scientific argument if the pharmacist is just being mindful that the habit of
taking a drug to induce sleep could lead that client to a state of drug
dependency or addiction (The Addiction Argument). It is again a scientific
argument if the pharmacist’s recommendation was a matter of preference for
natural therapies and a personal disposition to promote any therapy of natural
origin above synthetic drugs (The Orientation Argument).
In this case, however, an argument made within pharmacology
(The Pharmacology Argument) will not stand the test of scientific criticism. Why,
because whereas a large body of knowledge has been documented in literature in
favour of diazepam, currently there is an information gap as far as the herb chamomile is concerned. The pharmacist
most likely knows, or at least can easily access, so much information on the
pharmacology of diazepam, including its chemical identity, mechanism of action,
duration of activity, known and predictable drug interactions, risk of
tolerance and its addiction potential, safe dosing regimens, and much more. This
wealth of information on diazepam has, rather unexpectedly, bred a common
phobia against it within the healthcare community. On the other hand, the literature
is currently not as much rich with these pieces of information towards
chamomile. It is fine if this dearth of information on the pharmacology and
toxicology of chamomile is appreciated and not misinterpreted to mean a better
safety profile of this herb compared to diazepam. To wit, our pharmacist will
not be right in this instance if his or her recommendation to that client was
on the basis of an idea that chamomile tea is a safer option.
To elaborate on the pharmacology argument, how else could
chamomile effect sedative properties if it does not contain active principles
(secondary metabolites) which also interfere with the activities of one or more
neurotransmitters in the CNS? Assuming even that the active principle(s) in
chamomile does not exert action on the GABA-ergic neuronal pathways diazepam is
known to be involved with, it is very reasonable to say that that active
compound and diazepam are both molecular entities and for that matter the
classical laws of drug-receptor interaction hold all the same. The only
difference here being that whereas the active principle(s) in chamomile is
naturally derived, and perhaps not yet isolated, diazepam is a purely synthetic
drug. It is only when we were to have a detailed pharmacological profile of
chamomile can we scientifically compare this natural therapy with diazepam
along the lines of pharmacology.
It makes so much difference how we defend our positions and
choices in the practice of pharmacy. If doing a scientific criticism means
taking a position opposed to the orthodox viewpoint on the matter do it for being
the noblest course of action. This holds true so long as some pieces of
evidence, either documented or experiential, can be adduced in defence of the
position espoused.
