Compounding pharmacies and the art of medicine
Whereas the trend is one-size-fits-all products, compounded medicine brings the individual back into the picture.

Within all the science available to the modern doctor, there still lies an art which is integral to the practice of medicine: understanding the individuality of the sick person. This was well chronicled by the Roman educator Aulus Cornelius Celsus in De Medicina, written 2,000 years ago. Celsus teaches that the doctor applies common knowledge while searching for unique characteristics in the patient that may be at odds with usual practice. “Even in the same patient,” he writes, “the particular aspects of a disease are variable, and those who have been treated for a time in vain by the ordinary remedies have often been restored by contrary ones. ”
Attention to individuality, then and now, makes all the difference in quality care. It’s in assisting with this practice that a compounding pharmacy has a vital role to play.

A LOOK INSIDE THE SHOP
Unlike most retail pharmacies, you won’t find rows of prescription medicines, over-the-counter remedies or baby food. Compounding pharmacies focus on what pharmacists do best, using their skills and education to prepare customised products for those who need them. These pharmacists also prefer them to commercially available, “one-size-fits-all” products.
It’s easy to forget but, in the past, “compounding” was “pharmacy”. Throughout history, it was common for pharmacists to prepare medicines in individualised dosages for patients, as prescribed by medical practitioners. In the early 1900s, however, the pharmaceutical industry began manufacturing a myriad of different medicines and dosage forms, and the need for com- pounding diminished.
Since the early 1990s, much has began to change, first with the pharmaceutical companies discontinuing certain lines of medicine and, secondly, the realisation that individuals are different and that their medicines should be tailored to meet specific needs.

WHEN IS IT NECESSARY?
In these common situations, a doctor would choose to prescribe a compounded medicine:
•    When the desired strength is not commercially available. Compounding assures that all patients get the precise dose they need
•    When a certain method of use or application isn’t commercially available. Compounding allows the best delivery option for each patient, whether oral, injection, suppository or through the skin in the form of a cream. Also, compounding provides medicine not currently manufactured, or in dosage forms not available at present
•    When the route of delivery needs to be changed. Compounding pharmacists can change a hard-to-swallow pill into a flavoured sublingual lozenge, or an injection into a transdermal cream
•    When certain flavours need to be improved or eliminated. This ensures that the patient uses the medicine as prescribed, particularly fussy children, by substituting custom-made flavours for those the child (or adult) likes more
•    When certain potential allergens need to be eliminated. People who suffer from asthma or allergies benefit from prescriptions that are compounded preservative-free or dye-free
•    When sugar intolerance is an issue. Compounded syrups with non-caloric sweeteners help diabetics control blood sugar levels
•    When certain commercial medicines have been discontinued. Occasionally, manufacturers stop the production of effective medications that are simply no longer profitable. If this happens, compounding pharmacists can often reproduce the formula.

AREAS OF FOCUS
Compounding pharmacies usually have a particular focus and might not always cover all the points above. An obvious area where they play a vital role is in compounding bioidentical hormones. No two people, when tested, have the same hormone profile, so compounding pharmacies give doctors the flexibility to prescribe according to each patient’s requirements.
Compounders also formulate the hormone in a dosage form that has the best safety record. For instance, research supports the use of estrogen in a cream or gel, as oral ingested estrogen can be broken down in the liver to form harmful metabolites.
Hormones can also be compounded using specialised manufacturing processes that improve their absorption. Examples of this include pluronic lecithin organogels (PLO) that were developed by compounding pharmacist Marty Jones. These gels allow medication to travel through the different layers of the skin and enter the bloodstream more consistently and effectively.  
Another example is how compounders have overcome the poor oral absorption of the hormone progesterone. They created a technique whereby progesterone is treated to make smaller particles, which are better absorbed. Oral progesterone has been shown to be more beneficial in treating sleep disturbances due to hormone imbalances.
Through these interventions, compounding pharmacies have increased the options available to medical practitioners, allowing them to practice the art of medicine more effectively.