Y’know, I just saw the email for the next OPA conference—evolution is its theme. The disappointing part is that the logo they came up with meant the first time I looked I thought it said revolution. But, I was wrong—just plain old evolution (am I showing bias yet?).What’s the difference? We learned in school that evolution was the slow changes over millions of years that should improve our odds of sticking around longer. If, on the other hand, they did not improve your chances of survival (like, say, fluorescent pink camouflage), then this evolutionary change meant the end of your species.Revolution, however, has an extra letter. The ironic part of this word is the two main meanings. One refers to the revolution that changes a government or a way of life, usually in rapid and radical ways (think industrial revolution). In contrast, the other definition means going around in a circle, where one revolution puts you back to where you started.That said, let’s focus on the former meaning and its relevance to the state of pharmacy. The process of revolution, like evolution, is also a constant (just read a little history). Ever since Cain smote Abel, our world has been created largely by revolution.That begs the question—does the practice of pharmacy need an evolution or a revolution? The problem with evolution is that it takes too damn long. I will be dead and gone before evolution makes any real difference, as will those who are in positions of influence who are comfortable with the way things are right now. (Guess which option they prefer.)On the other hand, a revolution in pharmacy leads to uncertainty. Will the new way be better than the old way? I was in Paris recently (and also watched Les Misérables in London), and the French used to have lots of revolutions. During at least one of them the established powers lost their heads (literally) with the change that came. So, clearly, those in power who are comfortable with the allocation of power do not want a revolution.Do pharmacists need evolution or revolution? That has also been the question since Galen was both a philosopher and a pharmacist. And as his philosophies got mostly burned in a fire, he abandoned us to the eternal question.Think of evolution. Besides being slow, it is a very passive process where you wait and hope that any changes work out. That’s kind of like how the vast majority of pharmacists have been for centuries. It also follows the environment, as opposed to creating an environment.It is interesting that after the industrial revolution our profession took a product- rather than patient-focused path, and thus the problems of a lot of years. And, finally, evolutions are introspective—it only matters to you, because it is about your survival. No one else cares.Now think of revolution. It shakes people up; rattles them; makes them uncomfortable. It is also very active in that people are forcing a desired outcome rather than waiting for something to happen. And the change is quick.What’s more, revolution has always been about the many who have disagreed with the few who owned the process, a life at the expense and disenfranchisement of that many and the disquiet leading to force change for the better. A successful revolution was about reallocating power closer to where it should be.What do you think? And, more importantly, what is each individual pharmacist prepared to do? To do little or nothing is to choose evolution. To make a difference is a revolution.Ken Burns is a pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
