Anchored at the corner of Fifth Avenue and McKee Place in Oakland, Hieber’s Pharmacy sports a glass block window that reads, “We Create Medicine For Your Family.” Inside, white cabinets hold powdered chemicals and a rainbow assortment of empty capsules waiting to be filled.
Hieber's is a compounding pharmacy.
Technicians are trained and licensed to make medicines from pure, raw chemicals, like all pharmacies used to do. Now, they’re one of only a few left in the area.
“People seem to think all drugs are the same, and all drugs are not the same,” said owner and pharmacist Joe Bettinger.
He points to a workstation where technician Mark Bower is carefully measuring.
“These are powder hoods," Bettinger said, as Bower steadily poured a small amount of water. "They suck in the air so you don’t breathe the stuff in.”
Bettinger and his staff mix medicines in the front room, while sterile prescriptions are blended in a sealed off room in the back of the store. Hieber’s can customize a heart medication for a newborn or provide a common medication in an uncommon form.
“I can make medicine maybe 49 different ways,” Bettinger said. “I can make it in a nasal spray. I can make it in a Popsicle. I can make it in chocolate. I can make it in a lollipop. I can make it in a topical cream that you can rub on your arm. So it makes the medicine fit the patient.”
Brothers Albert and Ben Hieber first opened their drug store in the Strip District. Though it’s moved a few times, it’s been in continuous operation since 1860. Early on, there was a distinction between the doctors who prescribed medicine and the experts who mixed them. But pharmacists are trained to advise patients, and Bettinger said he wants both physicians and patients to think of him as a resource.
“It really, really, really bothers me that people don’t use pharmacists,” he said.
He might see patients more frequently than they see their doctors, so a lot of his practice is people watching, he said. Or, as he puts it, asking “stupid” questions.
“So much happens with small talk. In fact, I don’t even think there is such a thing as small talk because I think everything’s big talk. ... I always ask, ‘Is it working for you?’”
Historically, personalized medicine existed at the end of the process in pharmacies like Hieber’s. But with advances in technology — being able to analyze someone’s metabolism or genetics — it’s now possible to customize care from the very beginning. It’s a process, said Dr. Phil Empey, assistant professor of pharmacy and therapeutics and researcher at the University of Pittsburgh’s Institute for Personalized Medicine.
“We give medication when someone’s sick, and sometimes it works beautifully like we expect, and other times we have to find a better drug or a different drug,” Empey said.
Empey investigates how drug response varies from person to person. Other researchers are compiling feedback from patients about how medicine works for them. Using an algorithm, doctors can then better predict what might be most effective.
“We really rely upon patients to provide that data back to us to understand (how) to make the best decisions. It’s a partnership,” he said.
To Bettinger, that’s how medicine should work: an open and ongoing conversation between a patient and his care providers through every step of the health care process.
“My belief is that we all need to be touched. And I think it helps us get better and with our patients," he said. "Connecting with them is important, and that’s all part of the healing process. It’s not just the tablets or the capsules; I think it’s the whole thing.”
New tools and new technologies are in play, but personalizing medicine is an old idea.
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