Samuel Breiner

Imagine a 1920s era store lined with glass-fronted, mahogany breakfronts filled with ceramic jars ornately labeled in Latin.

Out front, customers enjoy root beer floats at a marble counter. In the rear workroom, some prescriptions are still made using mortar, pestle, and scale, although the Industrial Revolution of the late 1880s had introduced enteric-coated pills, gelatin capsules, and tablets, making prefabricated medications more available.

Lederle, Johnson & Johnson, Mulford’s, Parke-Davis, Smith-Kline, and Wyeth products line the shelves.

 Fast sellers include Sloan’s Liniment, St. Joseph’s Worm Syrup, and white pine and tar syrup for coughs.

If this store is in a rural area, the pharmacist is likely to be a medicinal drug retailer—often called an apothecary or druggist&mdash;and also a primary care provider. With few physicians available, people seek health care

In 1920, Johnson & Johnson created the slogan “Your Druggist is More Than a Merchant. Try the Drug Store First.” It emphasized druggists’ scientific background and ability to help improve community health.

Druggists 100 years ago were similar in many ways to today’s pharmacists. Similarities included a need for advanced education and the preponderance of pharmacy practitioners working in community settings. Today’s primary care physician shortage is also similar,

 as is the presence of a devastating global pandemic.

 The 1918 influenza pandemic was ending, though it must have seemed like an endless curse. The United States in the 1920s had increased regulation of recreational drugs, just as today there is increased regulations for opioids. Prohibition had outlawed alcohol in January 1920 and would continue until 1933.

 Marijuana was used as an alternative to alcohol and for a variety of complaints, and it remained legal until 1937.

Pharmacists were educated professionals. By 1920, 54 pharmacy schools were operating, many at major universities. Pharmacy students at accredited schools had to complete a 3-year program. The profession, having standardized drug preparation, was approaching the 100th anniversary of the National Formulary (NF) and its 10th decennial review. The Journal of the American Medical Society published a letter in 1920 from a concerned and seemingly grumpy physician, Dr. W.A. Bastedo, discussing the NF.

His narrative called the NF “a book of convenience for the pharmacist” and lamented his colleagues’ propensity to prescribe “old-fashioned galenicals” or medicine prepared by extracting 1 or more active plant constituents. Bastedo urged physicians to eschew the NF and instead use the American Medical Association’s pocket-sized Useful Drugs. Yet he demanded increased participation in the NF revision from medical schools and physicians’ professional associations.

Review of Bastedo’s comments also shed light on common or emerging drugs. He asked the NF to add glandular drugs (eg, epinephrin [sic], corpus luteum, ovarian extract, etc), and include the percent of pure alkaloid in each alkaloidal salt, noting specifically that “morphin [sic], sulphate contains only three-fourths its weight of morphine.” Bastedo referred to drugs dosed in minims (1/60 of a fluiddram) and suggested some new drugs, such as acetaminophen, be added. He also asked for the NF to restore whisky and brandy to its list, writing, “With our new Prohibition laws, these medicinal liquids will be as precious as potent tinctures and will need standards if they never

The NF listed comparatively few drugs. Apothecaries did not label prescription vials dispensed to patients with the name of the drug. That requirement only became widespread in the 1960s.

Medicalization—generally considered a movement to convince people that conditions that did not necessarily need treatment now required treatment&mdash;could be found in the 1920s, also. Listerine first became available in 1879 as a surgical antiseptic. It became an OTC mouthwash in 1914, and shortly thereafter, its manufacturer popularized an obscure medical condition called halitosis. The company profited $8 million over the next 7 years.

 A Listerine advertisement suggests that counterfeit products were a problem then, too. A 1920 ad warns, “Listerine, the safe antiseptic, is never sold in bulk….You can avoid fraudulent imitations by insisting on obtaining Listerine in

Final insights come from 3 ragged, water-stained, and worn binders of prescriptions the authors found in the University of Connecticut School of Pharmacy’s basement. The absence of prescriptions for antibiotics is startling; there were none until sulfa made its debut in the late 1920s. Insulin was not available until 1922. The most common prescriptions in the book were codeine, iron, morphine, nitroglycerin, quinine, and tonics.

The 1920 druggist and the 2020 pharmacist, were they to meet, would have much to discuss. No doubt, the 1920 practitioner would find today’s number of medications and current scope of practice fascinating. The 2020 pharmacist would have to commend the 1920 druggist’s ability to do much with very little and applaud the druggist’s close connection to the community.

, is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

Cowen DL, Helfand WH. Eisenstein R, eds. 

Liebenau JM. Scientific ambitions: the pharmaceutical industry, 1900-1920. 

1920s drugstore. North Carolina Museum of History. Accessed September 2, 2020. https://www.ncmuseumofhistory.org/exhibits/1920s-drugstore.

Gurowitz M. Your druggist is more than a merchant. Kilmer House. September 29, 2008. Accessed September 13, 2000. https://www.kilmerhouse.com/2008/09/yourdruggist-is-more-than-a-merchant.

Association of American Medical Colleges. New report confirms growing shortage of primary care physicians. Primary Care Collective. July 10, 2020. Accessed September 2, 2020. https://www.pcpcc.org/2020/07/10/new-report-confirms-growing-shortage-primary-care-physicians.

Taubenberger JK, Morens DM. The 1918 influenza pandemic and its legacy. 

. 2019;a038695. doi:10.1101/cshperspect.a038695.

Hall W. What are the policy lessons of National Alcohol Prohibition in the United States, 1920-1933? 

. 2010;105(7):1164-1173. doi:10.1111/j.1360-0443.2010.02926.x.

Musto DF. The Marihuana Tax Act of 1937. 

. 1972;26(2):101-108. doi:10.1001/archpsyc.1972.01750200005002.

Bastedo WA. The national formulary, useful drugs, and the coming revision of the pharmacopeia. 

. 1920;74(12):818-819. doi:10.1001/jama.1920.02620120044027.

Iroegbulem VC. Disease mongering: how sickness sells. Augustana Digital Commons. March 16, 2020. Accessed September 3, 2020. https://digitalcommons.augustana.edu/cgi/viewcontent.cgi?article=1020&context=ethicscontest.

Medicine ads of the 1920s. Vintage Ad Browser. Accessed September 3, 2020. http://www.vintageadbrowser.com/medicine-ads-1920s.

Articles

In 1920, Johnson & Johnson created the slogan “Your Druggist is More Than a Merchant. Try the Drug Store First.” 

100 Years Later, Pharmacy Retains Its Past

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death by disease in the United States.

COPD is one of the most prevalent chronic diseases associated with lifelong economic burden without a cure. As the disease progresses, patients can experience exacerbations leading to a decreased quality of life, and increased costs.

Individualizing COPD therapy is key in every patient’s progression, and pharmacists play a vital role. Individualized care can lead to better adherence, decreased exacerbations, and ultimately decreased costs for patients.

evaluated an unclear benefit of nebulized arformoterol (ARF) over handheld inhaled corticosteroid and long-acting beta agonist (ICS-LABA).

The team of researchers discovered that beneficiaries who switched to nebulized ARF following a respiratory event (COPD-related hospitalization or emergency department (ED) visit) experienced 1.5 fewer exacerbations at the 180-day follow-up.

An earlier study published in the journal 

 attempted to study uncontrolled COPD symptoms with ARF with budesonide. These researchers also found significant reductions in ED visits, and hospitalizations, due to a decrease in exacerbations.

Nebulized ARF may cause concern due to the cost of durable medical equipment (DME). Research proves despite the initial cost for the ARF DME, the total health costs compared to control are similar due to decreased use of pharmacies, inpatient, and outpatient care.

Decreased adherence to inhaled therapy increases unplanned admissions. Researchers explored causes behind this as it is multifactorial.

One reason is that some patients have difficulty using the inhalation devices properly.

 Pharmacists need to emphasize and reiterate the importance of individualized therapy; that is, patients need to be matched to the best device for them.

In the study completed by the COPD Foundation, the researchers indicated that many factors that could have contributed to patients’ exacerbations and hospitalizations—things like cognitive impairment, dexterity, and patient preference&mdash;escaped their observation. This was a potential limitation.

Ensuring patients receive individualized therapy with devices that they are able to use promotes adequate medication dose delivery—ultimately decreasing exacerbations, hospitalizations, ED visits, and costs.

 is a 2021 Pharmacy Candidate at the University of Connecticut in Storrs.

American Lung Association. How Serious is COPD. 

https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-is-copd.html

Maryam Navaie, Bartolome R. Celli, Zhun Xu, PhD, et.al. Exacerbations, Health Resource Utilization, and Costs Among Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease Treated with Nebulized Arformoterol Following a Respiratory Event. 

https://journal.copdfoundation.org/jcopdf/id/1244/Exacerbations-Health-Resource-Utilization-and-Costs-Among-Medicare-Beneficiaries-with-Chronic-Obstructive-Pulmonary-Disease-Treated-with-Nebulized-Arformoterol-Following-a-Respiratory-Event

Lydia Winnicka, MD, Jamie Molina, MD, Crystal Duran, MD, Charumathi Raghu Subramanian, MD. Improved COPD Control With Combination LABA/CS Using Small Volume Nebulized Delivery. 

https://journal.chestnet.org/article/S0012-3692(16)57223-7/fulltext

As COPD progresses, patients can experience exacerbations leading to a decreased quality of life and increased costs.
 