We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Therapeutic Substitution: Usurpation of the Physician's Prerogative

Ronald L. Williams
JAMA. 1987;257(20):2759. doi:10.1001/jama.1987.03390200099020.
Text Size: A A A
Published online


To the Editor.—  It is unfortunate that Dr Ballin's recent editorial on therapeutic substitution1 implies that organized pharmacy is launching some kind of concerted campaign to usurp the prerogatives of medical practitioners.No organization in American pharmacy, and certainly not the American Pharmaceutical Association, advocates indiscriminate therapeutic substitution by pharmacists. All of the examples cited by Dr Ballin in which pharmacists are taking a more active role in drug therapy share as a feature dialogue and joint decision making by physicians and pharmacists. In both Washington and California, pharmacists act under strict protocols jointly developed by the two professions, and in Florida pharmacists are permitted to dispense only a few drugs in five categories, all of which were selected by a committee on which both pharmacists and physicians are represented.As Dr Ballin observes, pharmacists are much better trained than they were a few years ago, and as a


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.