EDITORIAL
ACADEMIC PHARMACY PRACTICE AND RESEARCH
John A. Bosso
WHY IS RESEARCH IMPORTANT to academic pharmacy prac-
tice? Why is it important that pharmacy practice faculty
perform research? Why should research, in fact, be the ma-
jor focus and effort of at least some of a school's pharmacy
practice faculty? The driving need behind the answer to all
of these questions is the legitimization of pharmacy prac-
tice as an academic discipline. The future well-being of all
of academic pharmacy, particularly pharmacy practice, lies
in scholarship.
To elaborate on this point, a historical perspective of
academic pharmacy and professional curriculum develop-
ment is necessary. Hepler identified and labeled three eras
in pharmaceutical education in this century that he related
to the agricultural, industrial, and informational eras of
American history. These, he labeled the "empirical," "sci-
ence," and "patient care" eras.' The empirical era was based
on pharmacognosy, as it had its roots in the agricultural era.
The development of science in the early 1940s went hand-
in-hand with the pre- and postwar industrialization of the
country. The scientific disciplines of pharmacology and
physical pharmacy were spawned and their development
and maturation contributed greatly to the legitimization of
pharmacy as an academic discipline. It must be acknowl-
edged, however, that this important change heralded the in-
troduction of nonphannacists (anyone who is not actively
engaged in the practice of some aspect of professional
pharmacy) onto the pharmacy faculty, a circumstance that
is still with us today. The patient care or clinical pharmacy
era began in the 1960s, with its focus on an old concept-
the pharmacist as a therapeutic advisor. What we know to-
day as clinical or patient-oriented pharmacy had important
beginnings in San Francisco in the mid 1960s with the ad-
vent of the University of California's six-year Pharm.D.
program. Graduates of this program could actually make
contributions to decisions about drug therapy. This break-
through was greatly furthered at the end of that decade by
the advent of some of the original post-baccalaureate
Phann.D. programs (e.g., University of Kentucky). Such
JOHN A. BOSSO, Phann.D., FCCP, is a Professor, College of Pharmacy, University
of Houston, 1441 Moursund St.. Houston, TX 77030. Reprints: John A. Bosso,
Phann.D.
DICP, The Annals ofPharmacotherapy
programs took an additional two to three years beyond the
five-year bachelor of science in pharmacy curriculum and
turned out a far superior product with even more impres-
sive tools to bring to the patient-care arena. (Although
some of these early post-baccalaureate Phann.D. programs
still exist with all of their original vigor and excellence, our
present lack of credible accreditation standards has led to a
plethora of entry-level and post-baccalaureate programs of
mixed character such that generalizations about the differ-
ing nature and quality of entry-level vs. post-baccalaureate
programs are no longer possible.)
The introduction and popularization of such ideas as
"therapeutic advising," "provision of drug information," and
"patient orientation" led to a number of new areas that need-
ed to be incorporated into the pharmacy curriculum, Who
would teach this new material-especially that which re-
quired actual experiential components in the patient-care
arena? Obviously, it would be these new clinical pharmacy
types who were being turned out of the post-baccalaureate
Phann.D. and the clinically oriented M.S. programs. And,
in fact, large numbers of such individuals were brought onto
pharmacy faculties. It is critical to recognize that, at this
point, the nature of pharmacy faculties had been changed as
a direct result of the science era. Pharmacy was now consid-
ered to be a legitimate academic discipline and its faculty
were judged along traditional academic lines: service, teach-
ing, and research.
Clinical pharmacists were added to faculties in greater
numbers in the early and mid-1970s as clinical pharmacy
(recently renamed "pharmaceutical care") became a highly
desired option and eventually a basic requirement of the
entry-level curriculum. However, the assimilation of these
new faculty into the greater faculty was too often given lit-
tle if any thought. Within a few years, the question of
tenure came up. Some schools were prepared; they had ei-
ther placed these new faculty members into a nontenure
track or made the requirements and rigors of the tenure
system abundantly clear. Other schools took easier ways
out; they wrote separate, less-demanding promotion and
tenure guidelines for these faculty, or they simply applied
their usual criteria and, in effect, instituted a revolving-
door policy for clinical pharmacy faculty.
• /991 October, Volume 25 • lJ29
 The bottom line is that schools ended up with large
numbers of new faculty lumped in a discipline commonly
referred to today as pharmacy practice. What academic
"citizenship" do these faculty members hold? To answer
that question, we first must examine the criteria for a legiti-
mate academic discipline. In the physical and biologic sci-
ences, it seems that legitimacy is afforded by a unique or
focused body of knowledge that is generated, by-and-
large, by the members of the discipline. This definition
suggests a program of scientific inquiry that requires phys-
ical resources and has the accepted, common academic re-
sult (i.e., publication in the peer-reviewed literature). The
physical resources to which I refer include money, time,
and space. Let's pause for a minute and focus on one of
these elements-money. I stated before that the body of
knowledge of an academic discipline is generated to a
large extent by its own members. Externally generated re-
search dollars fuel this enterprise. This is a reality of 2Oth-
century higher education in the US. Thus, it should not be
surprising that the contemporary powerbase in academic
health sciences is built on externally generated research
dollars.
One should then ask whether academic pharmacy prac-
tice fits my definition of a true academic discipline. I would
have to say "Not very often." Why not? Once again we
must dust off our history books and examine the evolution
of pharmacy practice in academia. Who was hired, what
was the job description, and what resources were supplied
to these people to carry out their charge? The who, as I've
stated, were mostly post-baccalaureate Pharm.D.s-the ad-
vanced clinical practitioners who had the knowledge and
skills now thought to be important for all pharmacists. The
job description was to be a role model practitioner/educa-
tor for patient-oriented pharmacy practice in patient-care
settings. They also were required to teach some associated
didactic material such as pathophysiology, clinical phar-
macology, and clinical pharmacy (collectively referred to
today as pharmacotherapeutics). The job responsibilities I
have just described imply a 30- to 6O-hour work week and
often need to be provided 52 weeks a year. What resources
were supplied to these new faculty? Generally, an office, a
white coat, and maybe a beeper.
Given this scenario, is it a surprise that pharmacy prac-
tice has no unique, focused, self-generated body of knowl-
edge? Is it a surprise that pharmacy practice has no easily
identified program of scientific inquiry? Is it a surprise that
there is not a consistent, across-the-board record of publi-
cation by pharmacy practice faculty in the peer-reviewed
literature? I think not.
There are several reasons for this state of affairs. These
new faculty did not have the education and training to per-
form the traditional tasks of the academician. They were
not given the time to perform or carry out a research pro-
gram of any substance, nor were they given the physical
resources to perform this task (e.g., money, lab space).
But some of these faculty have succeeded in this arena.
They have succeeded admirably and on all fronts. It was
pointed out in the pharmacotherapy petition to the Board
of Pharmaceutical Specialties in 1989 that the number of
pharmacotherapeutic research articles authored by phar-
macists increased an amazing 343 percent between 1978
and 1982. Some members of our discipline obviously are
performing credible research and succeeding in the tradi-
1130 • Dltl]', The Annals ofPharmacotherapy • 1991 October, Volume 25
tional academic evaluation system. These individuals have
learned how to do research. They have obtained the physi-
cal resources to create and maintain an active, well-funded
research program. Unfortunately, they are the exception
rather than the rule in too many schools of pharmacy. One
or 2 individuals cannot create or mold the character of an
entire pharmacy practice department. One or 2 of these in-
dividuals in a department of 15 or more members cannot
create the needed academic powerbase.
Why do we need an academic powerbase? It is because
the people with the academic powerbase have the most in-
fluence on the professional curriculum. It is the department
with an academic powerbase that can successfully com-
pete for the college's resources and create and maintain
faculty positions with a supportive environment for the
growth and success of clinical scientists who then further
contribute to the discipline's legitimacy and strength. Let's
examine each of these points. First, departments with an
academic powerbase have the most influence on the cur-
riculum. At many schools, the basic science faculty wield
this influence. By my definition, nonpharmacy practition-
ers dictate the professional curriculum. Please do not read
this as a criticism of the basic science faculty. I am simply
leading up to this question: Can we really expect nonphar-
macists to have the needed insight to identify what is need-
ed in contemporary curricula when they have no basis in
contemporary pharmacy practice? Obviously not. The sec-
ond point related to the creation and maintenance of a sup-
portive climate for pharmacy practice involves the clinical
scientist faculty member. The clinical scientist needs pro-
tected time, start-up money (as does the new pharmaceu-
tics or pharmacology faculty member), and laboratory
space. He also needs a reasonable teaching load and, even
more importantly, limited clinical service obligations. We
cannot expect a productive research program without this
environment, nor can we expect the creation of an academ-
ic powerbase without a cadre of such individuals.
If provided with this environment, pharmacy practice
faculty should be evaluated along traditional academic
lines. That means that we do not create and apply special
retention, promotion, and tenure guidelines for the tenure-
track pharmacy practice faculty. They should be evaluated
with the same yardsticks used for their basic science coun-
terparts. The maturation and legitimization of the disci-
pline will not be served by anything less.
What constitutes legitimate research? This question
should be approached cautiously. It is probably wise to refer
to the area as "scholarship" or "scholarly activity" rather
than "research," because "research" has a rather narrow def-
inition and scope in the minds of many academicians. In any
case, the answer ought to be that which is scientifically
sound and adds to the body of knowledge regarding the
clinical use of drugs in humans. Such work should be in-
vestigator initiated, although the source of the funding for
such scholarly pursuits is largely inconsequential.
At this point it should be clear why at least a critical
number of clinical pharmacy or pharmacy practice faculty
should fit into the traditional academician's mold and have
solid research programs-to further the legitimization of
our discipline. However, this position leaves an obvious,
related issue unaddressed: If we give this job description to
six or so pharmacy practice faculty in the average pharma-
cy practice department, who will teach? First, let me point

out that I did not state that such faculty would not teach. In
fact, they should have reasonable teaching obligations.
However, they will not succeed in the role I have described
if they must teach major courses singlehandedly every
semester and be "on service" most of the year providing
supervision for clinical clerks. So, who will do the rest of
the teaching?
We obviously need some clinical faculty whose primary
responsibilities are simply service and teaching. For such
faculty, scholarship should be encouraged but not required.
Such individuals are just as vital to the mission of the de-
partment as the clinical scientists and should have similar
job security and award systems. But even departments that
have good complements of these two types of faculty are
either now having or in the future will have trouble meet-
ing the experiential requirements of the contemporary
pharmacy curriculum.
How can this proposed model be accomplished? Just as
pharmacy practitioners serve as faculty for extemship ex-
periences in hospitals and community pharmacies, we
must call upon nonacademically based clinical pharmacy
practitioners to serve as preceptors for clinical pharmacy
clerkships. Fortunately, the number of advanced level prac-
titioners in nonacademic positions has increased dramati-
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DICP, The Annals ofPharmacotherapy •
Editorial
cally over the last two decades and represents a consider-
able pool of potential role model educators. Academic
pharmacy must tum more and more to these individuals
and their institutions to carry out its mission. At the same
time, it should be realized that the notion of "volunteer"
faculty may soon come to an end as the time and effort in-
volved with the training of a clinical clerk becomes more
evident to nonacademically aligned practitioners. Thus,
colleges and schools of pharmacy should be prepared to
start paying for such teaching services.
Broad adoption of such a model for academic pharmacy
practice should allow the diverse needs of academic phar-
macy to be met. A critical mass of pharmacy practice fac-
ulty will be afforded environments for success as well-
rounded academicians. A unique body of knowledge will
emerge within pharmacy practice. Academic legitimacy
will be achieved. Most important, a contemporary pharma-
cy curriculum will be designed and delivered, largely by
pharmacist practitioners. ~
Reference
I. HEPLER CD. The third wave in pharmaceutical education: the clinical
movement. Am! Pharm Educ 1987;51:369-85.
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1991 October, Volume 25 • 1131