Foreword to the First Edition

Evidence of the maturity of a profession is not unlike that characterizing the maturity of an individual; a child's utterances and behavior typically reveal an unrealized potential for attainment, eventually, of those attributes characteristic of an appropriately confident, independently competent, socially responsible, sensitive, and productive member of society.

Within a period of perhaps 15 or 20 years, we have witnessed a profound maturation within the profession of pharmacy. The utterances of the profession, as projected in its literature, have evolved from mostly self-centered and self-serving issues of trade protection to a composite of expressed professional interests that prominently include responsible explorations of scientific/technological questions and ethical issues that promote the best interests of the clientele served by the profession. With the publication of Pharmacotherapy: A Pathophysiologic Approach, pharmacy's utterances bespeak a matured practitioner who is able to call upon unique knowledge and skills so as to function as an appropriately confident, independently competent pharmacotherapeutics expert.

In 1987, the Board of Pharmaceutical Specialties (BPS), in denying the petition filed by the American College of Clinical Phar-macy (ACCP) to recognize "clinical pharmacy" as a specialty, conceded nonetheless that the petitioning party had documented in its petition a specialist who does in fact exist within the practice of pharmacy and whose expertise clearly can be extricated from the performance characteristics of those in general practice. A refiled petition from ACCP requests recognition of "pharmacotherapy" as a Specialty Area of Pharmacy Practice. While the BPS had issued no decision when this book went to press, it is difficult to comprehend the basis for a rejection of the second petition.

Within this book one will find the scientific foundation for the essential knowledge required of one who may aspire to specialty practice as a pharmacotherapist. As is the case with any such publication, its usefulness to the practitioner or the future practitioner is limited to providing such a foundation. To be socially and professionally responsible in practice, the pharmacotherapist's foundation must be continually supplemented and complemented by the flow of information appearing in the primary literature. Of course this is not unique to the general or specialty practice of pharmacy; it is essential to the fulfillment of obligations to clients in any occupation operating under the code of professional ethics.

Because of the growing complexity of pharmacotherapeutic agents, their dosing regimens, and techniques for delivery, pharmacy is obligated to produce, recognize, and remunerate specialty practitioners who can fulfill the profession's responsibilities to society for service expertise where the competence required in a particular case exceeds that of the general practitioner. It simply is a component of our covenant with society and is as important as any other facet of that relationship existing between a profession and those it serves.

The recognition by BPS of pharmacotherapy as an area of specialty practice in pharmacy will serve as an important statement by the profession that we have matured sufficiently to be competent and willing to take unprecedented responsibilities in the collaborative, pharmacotherapeutic management of patient-specific problems. It commits pharmacy to an intention that will not be uniformly or rapidly accepted within the established health care community. Nonetheless, this formal action places us on the road to an avowed goal, and acceptance will be gained as the pharmacotherapists proliferate and establish their importance in the provision of optimal, costeffective drug therapy.

Suspecting that other professions in other times must have faced similar quests for recognition of their unique knowledge and skills I once searched the literature for an example that might parallel pharmacy's modern-day aspirations. Writing in the Philadelphia Medical Journal, May 27, 1899, D. H. Galloway, MD, reflected on the need for specialty training and practice in a field of medicine lacking such expertise at that time. In an article entitled "The Anesthetizer as a Speciality," Galloway commented:

It has been my experience that, given the opportunity for one-on-one, collaborative practice with physicians and other health professionals, pharmacy practitioners who have been educated and trained to perform at the level of pharmacotherapeutics specialists almost invariably have convinced the former that "the importance of their work will not be lessened, but enhanced, by the increased safety and dispatch with which" individualized problems of drug therapy could be managed in collaboration with clinical pharmacy practitioners.

It is fortuitous—the coinciding of the release of Pharmacotherapy: A Pathophysiologic Approach with ACCP's petitioning of BPS for recognition of the pharmacotherapy specialist. The utterances of a maturing profession as revealed in the contents of this book, and the intraprofessional recognition and acceptance of a higher level of responsibility in the safe, effective, and economical use of drugs and drug products, bode well for the future of the profession and for the improvement of patient care with drugs.