In response to the query of Dr. Markinson,
compounding is not a "free for all" in which
arena any practitioner might conjure up a
witches brew of their liking. Compounding
pharmacies with which I am familiar ( I have
used products from 4 different compounding
pharmacies) are all very much supervised by
pharmacists and Pharm.Ds, with the requisite
knowledge to understand what agents may be
combined with what agents, what agents may not
be combined, and so forth. I would venture to
suggest that those responsible have a great deal
more knowledge of potential interactions and
other potential issues than Dr. Markinson.
Individual compounded products do not udergo an
FDA approval process anymore than some of the
products or therapies endorsed by Dr. Markinson
in his lectures. The overall FDA approval
process is through the Pharmaceutical
Compounding Accreditation Board (PCAB), in
additional to which there is the "equivalent" if
you wil,l of board certification with the CQI
(Continuous Quality Improvement) program, an
independent, third party, quality testing
program which ensures potency, purity,
stability, and safety. The CQI program is
voluntary, and I might suggest that should Dr.
Markinson have concerns regarding compounded
prescriptions, that he confine such
prescriptions only to CQI certified pharmacies.
Finally, the suggestion of Dr. Markinson that
compounding is anachronistic is a reflection of
his failure to recognize the resurgence of peer
reviewed literature and advances in delivery
techniques which have resulted in the
widespread, effective, and resurgent utilization
of these products in many specialties dealing
with pain, musculoskeletal pathology, and
neuropathy.
Disclosure: I have lectured for Bellevue
Pharmacy, Total Pain Solutions, both of which
are compounding pharmacies, and as noted
earlier, have additionally utilized products
from at least 2 other compounding pharmaceutical
companies.
Allen Jacobs, DPM, Dt. Louis, MO,
allenthepod@sbcglobal.net
