When Jennifer Burch stepped onto her career path, she went into the family business—a common choice. Her father, Bill Burch, was a pharmacist and his pharmacy was a place where Jennifer hung out as a child, making hot fudge sundaes at the pharmacy’s traditional soda fountain. Perhaps less common, however, is her discovery of just how right the choice was for her.

“I may have chosen this career path because it’s the world I grew up in,” she says, “but along the way I found that the evolving role of compounding pharmacy matched my own interests and skills, and that the work of the compounding center—a setting where you knew and spent time with patients—was where I belonged.

“Compounding pharmacists play a special role in medicine,” she explains. “We prepare custom medications for individual patient needs. So, you could say that we are the counterpoint to ‘one-size-fits-all’ medicine.

“Most patients benefit from the extraordinary array of medicines available to them,” she acknowledges. “But not all. For them, we’re able to remove dyes, preservatives, or other irritants or to reformulate medications into liquids, creams, or other forms. Using transdermal preparations we can bypass sensitive GI tracts; special dosages permit gradual increase or decrease of medications; and varied flavors make meds tolerable for children and pets.

“In other words, our job is to make the adjustments necessary to enable patients to use the medications they need. And, frankly, it’s the creative, fun part of pharmacy.”

Changing Role of the Compounding Pharmacy

“We’re practicing in an information age,” notes Dr. Burch, “an age that is changing understanding about health and about the practice of medicine, and it’s certainly changing the role that pharmacists play—especially compounding pharmacies.

“For one thing, medicine is moving—gradually, but steadily—down the path toward personalized medicine. And it seems to me that compounding is at the heart of that evolution.

“Despite the extraordinary range and variety of standardized commercial medications it’s still challenging to match patients and pills,” she says. “Not everyone needs the same dose; people metabolize things differently; and diets, ailments, genes, and age are among many factors that alter how we respond to medications. So, while it’s likely that drugs of the future will be targeted much, much more specifically. Compounding allows us to address many of those individual needs right now.”

Hormone Replacement Therapy

“If I’ve learned one lesson in my career,” says Dr. Burch, “it’s that being a lifelong learner is part of being a good pharmacist. You’ve got to keep learning.”

That’s because, she says, the work of a compounding pharmacist has changed significantly—focusing increasingly on areas that demand continuing education as well as patient education. Among these is the field of hormone replacement therapy. 

“Better understanding of the role hormones play in balancing our health, has led to an appreciation of the benefits of adjusting hormone balances medically,” she explains. “And this is definitely work for compounding. Not only do medications need to address imbalances for each individual, but hormone replacement therapy has to be flexible, adjusting over time and in response to the patient’s experience.”

Comprehensive hormone testing and monitoring is a critically important part of this process, says Dr. Burch, because it allows for accurate hormone adjustments. “The hormone testing protocol at Central Compounding Center is comprehensive,” she says, “including measuring levels of all hormones. After the initial test, an abbreviated test three months later may be needed for some hormones; and an annual recheck is recommended.

“Accurate testing is especially important,” she adds, “because symptoms of may be misleading; the same symptoms could signal low levels of one hormone or high levels of another. So, we don’t make assumptions, we test.”

Following testing, Dr. Burch works closely with physicians, making recommendations about how to balance hormones, as well as providing specialized treatments.

CBD and Supplements

The educational role for compounding pharmacies has grown enormously in the years since I’ve been practicing,” says Dr. Burch. That’s due in part to the range and variety of non-prescription therapies available—including  OTC medications, supplements, and the many ‘cures’ offered by ‘Dr. Google.’ And patients themselves are more involved than ever in seeking non-prescription remedies for their ailments.

“Helping patients navigate this overload of information and exposing myths and misinformation has become an increasingly important role at Central Compounding,” says Dr. Burch.

“Supplements—such as vitamins—are another topic about which I discovered I needed more information,” she recalls. “First, because patients came in asking about them, and second because they didn’t teach about them in pharmacy school. So there’s a tremendous need to help people by steering them towards quality products, helping them understand dosages, and explaining interactions with medications. Quality is the primary consideration in choosing what we stock at the pharmacy.”

Another subject Dr. Burch has needed to master, is the use of cannabidiol (CBD) products. “Since approval for over-the-counter sale in North Carolina,” she says, “CBD has been widely used as an alternative, non-pharmaceutical treatment for conditions including pain management, sleep regulation, and a range of mood disorders. “However, its effectiveness depends on guidance and education,” emphasizes Dr. Burch, “and we have learned the importance of careful, individualized dosing, and of the quality of the product. The hemp plant is much like a sponge. So, you don’t want to use CBD from hemp planted in toxic soil. We carefully vet all products to ensure they have the appropriate level of CBD and are not contaminated with pesticides, herbicides, or heavy metals.”