Mar 072011

From The Globe and Mail
Published Friday, Jan. 21, 2011 6:32PM EST

The woman trying on a tendonitis brace rotates her arm, careful not to knock any merchandise in the tight aisle. The tidy pharmacy is a fraction the size of a typical Shoppers Drug Mart – a chain started by one of the shop’s previous owners from the 1950s.

After a long consult, the pharmacist hands her a slip of paper. It’s not a prescription exactly – pharmacists aren’t allowed to do that. It’s a formula for a tailor-made topical anti-inflammatory that will soon get an official re-write from a doctor.

Owner Marvin Malamed is used to seeing his prescription suggestions come back to him in illegible doctor scrawl. His customers usually end up here at Haber’s Pharmacy on Bathurst Street north of St. Clair Avenue by referral from doctors who consider him a pioneer in the resurgent field of compounding pharmaceuticals.

Whereas most pharmacists will quickly wear out shoes from spinning between their counter and the shelves behind to pick out pre-packaged bottles, compounding pharmacists actually concoct medicines on site for customers who are, for one reason or another, slipping through cracks between the big pharma monoliths.

Dr. Howard Winston sends patients down Bathurst Street to Haber’s from the Centre for Health & Sports Medicine, where he is medical director. A typical script has patients pick up an anti-inflammatory cream into which Mr. Malamed has mixed very effective absorption vehicles. Dr. Winston says it targets localized injuries better than any commercial product he’s come across, with fewer side effects – in particular, no gastrointestinal complications.

“There is some magic happening with this formula, and it’s just not available commercially,” says Dr. Winston.

He’s been sending patients to Haber’s since 1992, when Mr. Malamed started dabbling in compounding.

“He was the only game in town for a number of years,” says Dr. Winston.

But that’s no longer the case.

There are at least a dozen Toronto shops that now do more than the elementary compounding done at typical pharmacies. It is a case of modern-day apothecarists rediscovering a “lost art,” according to David Miller, chief executive officer of the International Academy of Compounding Pharmacists.

Up until the Second World War, most medicines were prepared in local pharmacies according to a prescription slip that read like a recipe (Rx is an abbreviation of the Latin word for recipe). During the 1950s – and spurred on by federal legislation in the United States – the pharmaceutical industry began to supply pharmacies with standardized prepared medicines, instead of just ingredients.

This was, by and large, progress, but in the early 1990s, doctors in long-term-care facilities started demanding more options for seniors with differing metabolic rates and sensitivities to certain medicinal or non-active ingredients. Soon after, Internet-informed consumers began expecting customized doses and formulas to treat stubborn ailments that were not common enough to be addressed by pharmaceutical companies, which often need huge economies of scale to justify bringing a patented drug to market.

According to Mr. Miller, by 2008, compounded pharmaceuticals accounted for $19-billion out of a $300-billion industry in the U.S.

The antique tincture bottles on display along the top of one wall in Haber’s evoke compounding’s gilded age from a century ago, but the glass enclosure at the far end has nothing in common with that old-time physicks. Inside, three pharmaceutical technicians in hair nets and surgical masks work at equipment that includes whirring mixers, polished grinders and a scale so sensitive it has a glass enclosure to block air currents.

Though the equipment adds significantly to the expense and complexity of running the business, Mr. Malamed seems to welcome complications.

“It’s not as straightforward as counting pills, putting them in a bottle and slapping a label on it, but it’s exciting to have to think about how to solve a problem. And rewarding when customers come back and tell you they’re feeling better.”

One such customer is Donna Everatt. The 46-year-old MBA and business strategy researcher suffered for 15 years from a mood disorder caused by a hormonal imbalance. Her own investigations convinced her there had to be a better treatment than what was commercially available. As she explains, natural bio-identical hormone therapies have to be precisely tailored to individuals. She decided she needed the flexible doses and formulas offered by a compounding specialist.

“Marvin consulted with me for three or four hours over several weeks, and eventually suggested formulas for the doctor to prescribe,” says Ms. Everatt.

“It might be dramatic to say the treatment saved my life, but my quality of life was suffering greatly. Marvin is my hero. He’s really on the forefront of an important field.”

Special to The Globe and Mail

© 2011 The Globe and Mail