by Malcolm Brown

As a pharmacist, you are both a scientist and an artist. Surprised? I suspect you will be comfortable sporting the “scientist” identity fortified by the formidable wallop of the scientific method. Your backbone metaphorically has “ S C I E N C E ” stencilled within as letters in a stick of Blackpool rock. But artist? You are. Here is why.  

I have dispensed prescriptions that the medical practitioner had annotated "s.a.” ("Secundum Artem"). They were unique; preparing something suitable demanded skill and knowledge of extemporaneous dispensing—and artistic licence. You may retort that extemporaneous dispensing is a museum bygone. However, it remains essential in some hospitals and developing new medicines in the pharmaceutical industry.  

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Moreover, certain tablets, capsules, mixtures, mouthwashes and toothpastes (let alone perfumes) are coloured and offer particular sensory experiences: smells, tastes or textures. Volatile oils, such as peppermint, have been used since antiquity. Your window display, shelf stock and bench top, including the medicines being dispensed, are arranged to look pleasing, aesthetically. All require art.

Do you sell any highly advertised, popular, profitable health products for which the evidence base of efficacy is scanty? Illustrations include certain vitamins, minerals, dietary supplements and botanicals, herbal products, Ayurvedic medicine, traditional Chinese medicine, placebos, aromatherapy or homoeopathic products.  

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Homeopathic medicines have not been available on NHS prescription since 2017, but King Charles appointed a pro-homeopathy doctor as head of the royal medical household. Using the World Health Organization's definition of health (a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity), for believers, those complementary or alternative medicines work. They work because of the art of health practitioners. Placebos also appear effective against certain types of pain. The practitioner must also appear to believe in the remedies.  

This is an extreme example of the pharmacist performing as an actor on a stage. Shakespeare penned “All the world's a stage”, around 1603. The sociologist Erving Goffman (1922–1982) interpreted situations as dramaturgical performances. Your window display, shelf stock and benchtop, including the medicines being dispensed, will be arranged to look pleasing, aesthetically. Community pharmacists identify with their settings and stage props, such as their green cross logo, sales counter, half-hidden dispensary and crucially, the empirical medicines themselves. On that stage of community pharmacy, the pharmacist crucially converts the drug into medicine, during a complex and well-rehearsed performance. Such acting demands more art than science. Drama schools award BAs, not BScs. 

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In the situations where some clinical judgment is required such as a patient presenting claiming infected eyes but without obvious visual symptoms or an anxious patient fearing a serious disease, the pharmacist must use clinical judgement. An example is having sufficient urbanity to know when to stay silent and when to use sufficient vigour for the patient, without undue alarm, to quickly attend casualty. Pharmacists must be sensitive to varying cultures between ethnic groups and birth cohorts. In some ethical situations, the law may be silent yet action is required under the overarching principle of "Do no harm".  

The healer must sometimes perceive and act with subjectivity, the antithesis of the objectivity cherished by natural sciences. Humans are self-aware possessing a “divine fire” or “spark” that no AI is thought to possess, yet. The self-aware pharmacist interacts with the self-aware patient: that intensely human communication with intuition and empathy, fire-to-fire, is valued far more than, say, an automated answering machine message offering a rigid list of options. When talking to people, expertise in the art trumps that in science.  

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The two cultures of science and art as identified by CP Snow (1959), in which each has a different knowledge base and so regards the other as ignorant, remain today. A tweak by the palaeontologist William Gould  (1997) that divided into science and religion or ideology: two "non-overlapping magisteria", adds insight. Science (objective, evidence-based) and religion (subjective, revelation-powered) look down upon, but generally tolerate, each other. An exception is evolution where each believes itself to be the sole possessor of the truth. This perspective may help pharmacists marinated in Western scientific biomedicine to accept involvement with remedies having suboptimal evidence of efficacy.  

Celebrate both your science and art. 

Dr Malcolm E. Brown is a retired community, hospital and industrial pharmacist, and is a sociologist and honorary careers mentor at the University of East Anglia.

His book 'Winning Words' is out now here - watch Malcolm talk about it here.