Therapeutic Substitution: Usurpation of the Physician's Prerogative

Ronald L. Williams
JAMA. 1987;257(20):2759. doi:10.1001/jama.1987.03390200099020.
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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


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