For years, pharmacists have been ranked as one of the most trusted professionals in this country. From 1989 through 1998, pharmacists consistently held the number one spot in the annual Gallup poll on Honesty and Ethics in Professions. This trust has been shaken since August 2001 when Robert Courtney was arrested and charged with the criminal dilution of chemotherapy medications.

Fortunately, dishonest pharmacists like Robert Courtney are extremely rare. His actions, which were unthinkable prior to his arrest, should not, however, undermine our confidence in the drug delivery system in this country.

The United States sets the world standard for safety of manufactured pharmaceutical products. The Federal Food and Drug Administration issues stringent regulations governing every aspect of drug development and man-ufacturing. No prescription drug product can be sold by a pharmaceutical manufacturer without prior FDA approval.

Moreover, every aspect of the manufacture, testing, packaging, sealing and labeling of prescription drugs is governed by federal regulations, and manufacturers are subject to unannounced FDA inspections at any time. Other nations in the world routinely look to the United States for guidance on the safe use and distribution of drug products.

As safe as the manufacturing system is, the ultimate delivery of prescription drugs to patients depends on the integrity and competence of health care professionals, including doctors and pharmacists. Prescription drugs are not available except as ordered by a physician. It is the physician’s responsibility to examine and evaluate the patient and prescribe medications as necessary to treat the individual. These medications are generally dispensed by pharmacists.

Pharmacists are drug experts. They have specialized knowledge regarding the selection, dosage, and mixing of drugs, as well as adverse events and drug interactions. To become a pharmacist today requires a minimum of six years of focused schooling, hundreds of hours of supervised internship, and a passing score on both national and state licensure exams.

Pharmacy students take specialized courses on ethics and professional responsibility. The pharmacist’s oath affirms the obligation to serve humankind and to relieve human suffering.

State organizations are responsible for licensing and supervising health care professionals. In Missouri and Kansas, a pharmacist’s license must be renewed every two years. Once licensed, a pharmacist must complete thirty hours of continuing education courses prior to each renewal. Additionally, the state board of pharmacy performs regular inspections of every pharmacy to ensure that the pharmacy and pharmacists meet required standards of practice.

This system, with its multiple layers of responsibility, works very well. The vast majority of drugs dispensed in this country are safe, properly prescribed, and dispensed as directed by the physician. Prior to Robert Courtney’s arrest, no similar scheme to dilute chemotherapy drugs for profit had ever been uncovered.

Unfortunately, it is virtually impossible for any system to provide complete protection against unknown and intentional covert acts of a diabolical criminal. Nevertheless, in the post-Courtney era, experts are considering ways to improve the system and provide additional safeguards.

For example, Senator Kit Bond has asked that the FDA assume a larger role in regulating pharmacies that mix drugs. The Missouri Board of Pharmacy plans to institute a random testing program to deter and detect improper preparation of drugs by pharmacists. Other proposals would require at least two pharmacists to sign off on every mixture prepared in a pharmacy.

Patients, too, can play important roles. Patients should ask questions not only of their physicians and nurses, but also their pharmacists. Medications are safe and effective, when used appropriately. Choose a pharmacist that you trust and follow-up with your own health questions.

Marie Woodbury is the Managing Partner of Shook, Hardy & Bacon’s Pharmaceutical and Medical Device Litigation Division. She may be reached at 816.474.6550.