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Each issue will include an editorial on a topic that is important for the profession of pharmacy, as well as a review of a new drug that includes a comparison of the new drug with previously marketed drugs that are most similar in activity, and a New Drug Comparison Rating (NDCR) for the new drug. Read on for this month's issue.

December 2017 Issue [Download PDF format]
EDITORIAL:

Blessings and Dreams


Editor's note:

The following is the presentation of the Editor on the occasion of his receiving the Remington Honor Medal at the Annual Meeting of the American Pharmacists Association in San Francisco, March 26, 2017. This presentation was published in the Journal of the American Pharmacists Association (Volume 57: July/August, 2017; 435-438).



2017 Remington Honor Medal recipient Daniel Hussar with APhA President Jean-Venable "Kelly" R. Goode [Photo courtesy of American Pharmacists Association]




I am thrilled and humbled by having been selected as the recipient of the Remington Medal, and I wish to voice my deep appreciation to those who participated in my nomination and selection for this recognition.

I have been blessed in many ways through my faith, my family, and my friends. I am a Christian and greatly value the importance of my faith as a source of encouragement and strength in each of my responsibilities.

I will be devoting much of the time I have this evening to identifying family and friends from whom I have learned so much, and who have contributed in such important ways to the activities for which I have been given credit. My hope in doing this is that it will be reason for each of you to think of the individuals in your lives who have participated in a similar manner in encouraging and supporting you in your personal and professional development and responsibilities.

I have been blessed in many ways by my family. My father and his parents emigrated from Hungary when he was four years old but, within just a few years, both of his parents died at young ages. What my father learned from the difficult childhood he experienced he applied in a manner that made him a wonderful husband and father who was committed to his family.

My mother was an extraordinary woman whose formal education concluded soon after high school. She demonstrated exceptional wisdom, judgment, attention to detail, and love for her family and friends. She lived her final year at our home and I would often ask her to review the editorials I wrote for accuracy in grammar and punctuation. She did that and more – she was interested in the pharmacy issues I was writing about. My parents had very limited financial resources but they were committed to make it possible for their children to attend a Christian school in which the faith and the values they demonstrated for us in our home and our church would be reinforced.

I have a thoughtful and caring sister, Christine, who is a retired nurse and a brother, Ken, who was a fifth grade teacher and is also a humorist and entertainer. When he was a student, my brother did not share the enthusiasm for academics that my sister and I had. However, he was very fond of making an observation that I have often used to encourage my students who were experiencing academic difficulty – "He was in the half of the class that made the top half possible."

In the 31st chapter of the book of Proverbs in the Bible, there is a discussion about a wife of noble character. I am thankful that I have one, and that she has so many fine qualities. Sue and I met as students at the Philadelphia College of Pharmacy and Science (PCPS) and, in August, we will be celebrating our 50th wedding anniversary. Sue has exceptional ability and our Dean who appointed me to the faculty of PCP was fond of reminding me that, if Sue had graduated before I did, she would have been the one appointed to the faculty position in which I have served ever since. Because of her excellent perspective and editing skills, I ask Sue to read every editorial I write before publishing it. If you like my editorials, please tell me and, if you don't like them, please tell Sue. I usually finish preparing an editorial late at night and then give it to Sue. Sue says my editorials are better than Ambien but, like Ambien, they have an amnesia effect and she has no recollection the next morning of anything I wrote.

Sue and I have been blessed with three sons and their wives whom we love as daughters, and they have blessed us with nine grandchildren. They are all here – Our oldest son Eric is married to Terra, and their children are Alex, Wesley, Anna Kathryn, Cora, and Eden. Our son Christopher is married to Carmen, and their children are Pippa, Estee, and Tate. Our son Tim is married to Cristina and their child is Finley. Many years ago, one of our sons gave me a key chain that I still use for my most important keys – to my home and my office. The key chain includes an inscription from the book of III John in the Bible –"No greater joy; my children walk in truth." Sue and I are very thankful that we can make that claim for our sons and "daughters", and our grandchildren.

For many years I have recognized that I have been so very fortunate in having what I would designate as a "Pharmacy Hall of Fame of Friends." As a pharmacy student, my teachers included the late Linwood Tice, my dean, mentor, and friend who subsequently appointed me to his faculty. He was a leader in pharmacy and a recipient of the Remington Medal. Among the many things I learned from him was to have the courage of my convictions and to be bold in communicating my opinions, even when others might not agree. When I was a senior at PCP, Jim Doluisio joined our faculty. I had the honor of being the first graduate student whom Jim recruited. His persuading me to go to graduate school is something for which I will forever be indebted to him, as that decision provided the foundation for the opportunities that have followed over the years. As a dean, pharmacy leader, and Remington Medalist, Jim has continued to be a role model, mentor, and friend.

At a relatively early time in my responsibilities as a faculty member, I was privileged to be appointed by Linwood Tice as Chairman of our Department of Pharmacy and, when he retired as Dean four years later, he recommended to our President John Bergen that I succeed him as Dean (without a search – you could do that then). I "survived" my experience as an academic administrator as a result of the excellent abilities and strong motivation of our faculty that included John Gans, Victor Rossi, Joe Fink, Pete Vlasses, George Downs, the late Maven Myers, and other future stars of our profession. They could make any Chairman or Dean look good and, if I can take credit for anything, it was recognizing their abilities and potential, supporting them to the fullest extent that I could, and then getting out of their way. They have been much more than faculty colleagues – they have been career-long friends from whom I have learned so much. I have come to recognize and value the foundations that have characterized these friendships and working relationships – personal integrity, trust, mutual respect, and advocacy for our profession and our pharmacy students.

The Philadelphia College of Pharmacy at the University of the Sciences has provided me with numerous experiences that have been so fulfilling that I have remained there for my entire professional career. I am very grateful to our administrations (plural since I have outlasted many of them) and our Boards of Trustees for the confidence they have placed in me and the opportunities they have provided for professional growth. There have been situations in which someone did not like an editorial I had written and complained to our President, but not to me. But our President responded in the best way - that he supported academic freedom. It helped that those who were criticizing me weren't able to identify anything I had written as being inaccurate – they just didn't like to be criticized.

My faculty colleagues have contributed greatly to my continuing education through their ideas, accomplishments, and friendship, and I appreciate that a number of them are here this evening. But they have something that I don't – their youth! As much as I value and appreciate being honored this evening, my advice to my colleagues and to you is to "Value your youth!"

And then, there are my students! I can't do anything about my chronological age, but my students keep me young at heart. I can only hope that they have learned as much from me as I have learned from them. They are a continuing source of encouragement, inspiration, and optimism for the future of our profession. I greatly value these relationships, and the friendships with so many alumni that have continued over many years since their graduation. With respect to my responsibilities as a faculty member, I hope that it can be said my students received my highest priority. I wish to thank my students who are here this evening.

My friend and Remington Medalist John Gans was the individual who was kind enough to nominate me for the Remington Medal and recruit individuals to participate in support of my nomination. Those individuals include, in alphabetical order, James Appleby, Bruce Canaday, Robin Corelli, Jim Doluisio, Pat Epple, Joe Fink, Julie Gerhart-Rothholz, Doug Hoey, Karen Hudmon, Lisa Lawson, Gene Lutz, Marvin Samson, Jennifer Sands, and Pete Vlasses. How fortunate I am to have had these individuals supporting my nomination. I am greatly appreciative to each of them. They are such eloquent and persuasive writers that they could make an impostor sound great.

On this occasion at which you are so kind in recognizing me, I can't also help but think of things that I have wanted to see accomplished, but for which my efforts have not been strong enough or persuasive enough. I have stopped counting but I might hold the record for having the most items of new business rejected by the APhA House of Delegates, although there have been a few that have been approved. There have been some disappointments and frustrations, and my impatience increases as I age. But one of my sources of encouragement might be considered an unlikely one. I am an avid Philadelphia Flyers ice hockey fan. In a typical game there are dozens of shots on goal. However, in spite of fast and intensive effort, the vast majority of those shots never get into the goal. But when one does, it can make a huge difference.

In looking back, I would not trade the experiences and opportunities I have been privileged to have. Even in the difficult experiences, there were valuable lessons to be learned. I would, however, identify several regrets:
  • I should have been bolder sooner! Bolder in sharing my faith, bolder in my advocacy for our profession, and bolder in challenging my students and colleagues in identifying the values and activities that are most important in enabling them to attain their full potential.

  • With respect to my teaching, I have not come close to providing the opportunity for my students to experience something that I value so greatly – the joy of learning! I do not fault the students. I accept responsibility for not doing enough to expand their horizons by learning beyond what will be covered on an exam or what is addressed by objectives that are too specific and limiting.

  • I would have become actively involved in politics. It's dirty, but that's where so many important decisions are made.
But this is not the time for looking back – we must look ahead!

Those who come to a Remington dinner have a right to expect that they will hear some profound observations. But, actually, none of the individuals who supported my nomination mentioned the word "profound," although there was another "pro" word that appeared – I think it was "provocative." I would like to focus now on what might best be described as "dreams." It starts with me and with us as individuals. I dream that I and…

  • every pharmacist has pride and passion for our profession, and a missionary-like zeal to be an advocate for our profession and our patients;

  • every pharmacist avoids substance abuse, and is an active participant in programs to prevent others from engaging in such activity. Can our colleges of pharmacy have drug-free campuses? Can our profession provide the best possible example for other professions and our society? If we can't, can we expect anyone else to?

  • every practicing pharmacist uses her/his knowledge and skills to assure the best therapeutic outcomes for their patients, and to prevent drug-related problems;

  • every pharmacist recognizes that, as a citizen of our profession, there is a duty to be a member of our professional associations. They are essential! APhA has provided opportunities that have been of great value in my own professional development, including speaking at meetings, publishing papers, service as a delegate, and recognition by peers.

    Many know that I am a strong advocate for independent community pharmacists. They are the pharmacists who are best known to the public and who have earned the respect and recognition from which all of us in less visible responsibilities in the profession greatly benefit. In my opinion, the future accomplishments and success of the profession of pharmacy are inextricably linked to the extent to which the personal communication and service of the type provided by independent pharmacists can not only survive, but thrive. The National Community Pharmacists Association and the American College of Apothecaries, in addition to the APhA, are strong advocates for independent community pharmacy.
As individual pharmacists working together, my dreams continue that…
  • The profession of pharmacy will have a national organizational structure that will have the membership, resources, and strength of a united profession. In my opinion, this is essential if we are to achieve the synergies and accomplishments that will fulfill our potential.

  • The profession of pharmacy will establish our own prescription drug benefit administration program that provides incentives for achieving positive therapeutic outcomes for patients and equitable compensation for pharmacists, and does not include restricted networks or financial incentives that prevent or discourage continued use of the local pharmacy with which there is a long-term professional relationship and friendship with a personal pharmacist. The current system fragments pharmacist care and increases risk in the use of medications. We can provide a better, safer, and more efficient program!

    But can our profession afford such a program? There is a declaration that we have heard often in the last year that can be adapted for our purpose. "Mexico will pay for the wall." Our version will be, "Pharmaceutical companies will pay for this program," and I would quickly add that it will be in their best interests to do so. After all, it is the drugs they have developed for which we as pharmacists will increase effectiveness and safety, increase societal recognition of the value of medications, and increase the companies' return on their investments.

  • The profession of pharmacy will adopt a community, or a small state such as Delaware, and/or a disease such as asthma, in which to establish a medication delivery, education, use, and monitoring system that will serve as a model for what can be accomplished and expanded to a much larger scale.

    The March 6 issue of The Wall Street Journal included an article titled, "Many Asthma Patients Use Their Inhalers Incorrectly, Research Shows" (Sumathi Reddy). It is noted that "patients make at least one mistake as much as 70% to 90% of the time. The result: only about 7% to 40% of drug is delivered to the lungs.

    " What if the profession of pharmacy established a program and network of pharmacists who were available to provide counseling and monitoring that would assure the appropriate use of an inhaled medication for every patient with asthma in a designated community for whom such a product is prescribed? The companies which market these inhalation products should recognize the value of this program for patients and themselves in supporting this program.
Approximately one month ago Sue and I attended a conference in southern California that was conducted by the World Vision Christian humanitarian organization. The theme of the conference was "clean water," something we would rarely think about but the lack of which puts hundreds of millions of people around the world at risk of infection, malnutrition, and death. World Vision has just announced the start of a more than one billion dollar campaign that will have as its goal the provision of clean water to every community in the world by the year 2030. One organization can't accomplish this huge goal alone, but it will bring together and catalyze the efforts of many individuals, churches and other religious organizations, corporations, foundations, and governments. The passion and commitment that we observed at that conference leads us to believe that goal will be accomplished!

I believe that our dreams and vision for pharmacy can come true. I say "our" dreams because, although I recognize that many will consider the dreams I voiced to be naïve, impossible, unrealistic, crazy, or all of the above, I can't imagine that anyone here can be satisfied that we are currently doing enough to assure the appropriate, effective, and safe use of medications. So do we move forward with baby steps, or with bold and grand dreams? I would suggest that there is no status quo – if we do not move forward, we are losing ground! I recognize that dreams can be somewhat hazy, but that our vision must have clarity. If there is any question about the clarity of my vision, I would note that in the last 3 months I have had 3 cataract surgeries. The third surgery was to correct the second one. I can legitimately claim that my vision is clear.

Our dreams and vision must be greater than our resources! If they can provide outcomes for which benefit and value are recognized, and I believe that they will, the resources will come!

Daniel A. Hussar

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