Pursuant to that resolution, what was known then as the National Drug Trade Conference (NDTC) convened for its first meeting, in Washington, DC, on January 15, 1913. The meeting was held in the Willard Hotel.
The attendance at this first meeting consisted of delegates from five national groups: APhA (founded in 1852), Healthcare Distribution Management Association (founded in 1876 as the Western Wholesale Druggists’ Association), the National Community Pharmacists Association (formerly the National Association of Retail Druggists, founded in 1898), the National Association of Manufacturers of Medicinal Products (founded in 1912), and the American Association of Pharmaceutical Chemists (founded in 1908). Invitations had also been extended to the American Medical Association, American Dental Association and the American Veterinary Association, but they were not represented.
The APhA resolution had specified that the proposed Conference should elect its own permanent officers and should not be conducted under the auspices of any specific group. Accordingly, the following officers were elected:
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President
John C. Wallace (American Pharmaceutical Association)
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First Vice President
Charles A. West (National Wholesale Druggists’ Association)
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Second Vice President
W. C. Anderson (National Association of Retail Druggists)
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Third Vice President
W. C. Abbott (American Association of Pharmaceutical Chemists)
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Secretary
Charles M. Woodruff (National Association of Manufacturers of Medicinal Products)
The minutes of this first meeting were printed in the Journal of the American Pharmaceutical Association (JAPhA), Vol. 2, pp., 234–247 (1913). A second meeting of the Conference was held on April 9, 1913, and is reported in JAPhA, Vol. 2 pp. 628–634 (1913).
Through the years, the Conference itself reflected the growth and movement of the pharmacy profession and the pharmaceutical industry—welcoming new members, bidding others farewell and witnessing the changes and mergers of still others:
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The Proprietary Association (founded in 1881 and known since 1999 as the Consumer Healthcare Products Association) was elected to membership in 1914.
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The American Conference of Pharmaceutical Faculties (founded in 1900 and known since 1925 as the American Association of Colleges of Pharmacy) joined in 1919, resigned in 1988, and rejoined in 1994.
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The National Association of Boards of Pharmacy (founded in 1904) joined in 1919, resigned in 1981, and rejoined in 1993.
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The Federal Wholesale Druggists’ Association (founded in 1916) joined in 1927. (Later, through a merger with the Pharmaceutical Distributors Association which, in 1984, merged with the Healthcare Distribution Management Association, a charter member.)
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The National Association of Chain Drug Stores (founded in 1933) joined in 1947.
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Two charter members, American Association of Pharmaceutical Chemists (name changed in 1921 to American Pharmaceutical Manufacturers Association) and the National Association of Manufacturers of Medicinal Products (name changed to American Drug Manufacturers Association in 1917) merged in 1958 to form what is today the Pharmaceutical Research and Manufacturers of America (PhRMA).
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The American Pharmaceutical Association, a charter member, resigned in 1975 and rejoined in 1984 (with its official reelection in 1985).
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The Cosmetic, Toiletry and Fragrance Association (founded in 1894) joined in 1985, but resigned in 2006.
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The American Society of Health-System Pharmacists (founded in 1942) joined in 1993.
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The National Association of Retail Druggists, also a charter member, changed their name to the National Community Pharmacists Association in 1996.
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The Generic Pharmaceutical Association (founded in 2001) joined in 2009.
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The Biotechnology Industry Association (founded in 1993) joined in 2010.
The name of the Conference itself was part of the change dynamic, from the National Drug Trade Conference to the National Conference of Pharmaceutical Organizations in 1996.
In the first years of the Conference, there was a proposal for including associate members. Consideration was also given to forming a section for groups allied with the pharmaceutical industry and profession, but these proposals were not adopted. Likewise, newly formed inter-profession industry groups were not included because they were already represented in some capacity by being affiliated with one or more of the member groups.
Dr. James H. Beal was Secretary of the APhA in 1912 at the time it adopted the resolution which led to the formation of the Conference. Dr. Beal was one of the outstanding leaders in pharmacy and for many years was identified with the enactment and administration of important laws—state and national—relating to pharmacy and to the distribution of drugs and medicines. After his death, his son, Dr. George D. Beal, supplied a quotation from his father’s diary which gave the reasons for proposing the Conference;
At meetings of the APhA, whenever a representative of any strong group presented a paper or a report, it was certain to be attacked by members of groups representing other interests. I felt that if those groups could be brought together in a place where they might have full and frank discussions, without being bound by other groups to any course of action, we might gradually compose conflicting views and abate jealousies. Knowing the magic in the word “conference,” I proposed such a session. Since there seemed to be nothing dangerous in coming together in the same room, it was discovered that professional questions could be discussed in good temper.
Dr. Beal had a precedent for his suggested conference. Dr. Hamilton Wright, of New York, had proposed a Federal Anti- Narcotic Law. It contained numerous features objectionable to pharmacists. One in particular was what community pharmacists considered an in ordinate demand for the keeping of records.
A conference committee, meeting with Dr. Wright and Congressman Burton Harrison, found a solution in a provision for triplicate order forms. The proposed federal law was to apply to interstate commerce while intrastate transactions were to be covered by the state. The practicing pharmacist, ordering from the manufacturer or wholesaler, would make out one original and two carbon copies. The original would be retained by the pharmacist in his records; one carbon would be retained by the wholesaler who filled the order; and the other would be filed with the federal official of the district.
The would-be complexities of interstate commerce and of enforcement at the intrastate level were thereby overcome. It was reported that Dr. Wright walked out of the room “in a huff,” but Congressman Harrison said that as a businessman, he understood the objection to requiring multiple reports and records. Dr. James Beal reported:
As Chairman, I went to the office of William Jennings Bryan, then Secretary of State, who gave me a letter to the Chairman of the Committee on Interstate Commerce, stating it was necessary to adopt this measure in order to comply with the obligation the United States had assumed with other nations to control the international traffic of narcotic drugs. When Dr. Wright saw that the measure was likely to become a law in spite of his opposition, he reversed his attitude and declared it was the kind of law he wanted.
The Journal of the American Pharmaceutical Association for 1913 reported the following on the first meeting of the Conference:
Anticipating difficulties due to supposedly conflicting interests, the delegates found to their surprise that the other representatives were quite ready to meet them halfway and to agree upon a basis of settlement fair to all. It was the first time in history that all branches met on a common ground and presented a united front. Why was such a Conference not founded years ago? This is the greatest thing that has been done for American pharmacy.
A less enthusiastic note was sounded at the 1914 Annual Meeting of the Conference, as reported in JAPhA.
Even if results were not as much as imagined, the good it has already accomplished amply justifies the action of the APhA in calling it together.
While discussions in early years at times questioned whether the Conference was serving its purposes, at the APhA 1919 convention, President Charles H. LaWall stated:
The Conference continues to be worthy of our commendation and support. Limited as it is in effectiveness by the fact that its members cannot act for their respective organizations quickly in cases of emergency, it nevertheless is a successful experiment of its kind and is one of the strongest evidences of the need of that real federation for which many of us hope and which all of us will undoubtedly see.
Later the same year (1919), NARD (now NCPA) framed the matter in a different but still supportive light.
We believe that in the Conference we now have the nucleus of an organization which can do everything that the proposed federation of pharmacy had in mind to do, but perhaps in a little different way…
To which JAPhA, in a November 1919 editorial, responded:
If the American Pharmaceutical Association cannot realize its vision of a federated pharmacy, let us have, by all means, the closest possible cooperation between APhA and NARD (now NCPA), but also with the state associations and with the national wholesale and manufacturing organizations, each caring for its own particular interests, in its own way, but each acting in harmony with the other bodies by means of conference committees…
Unanimous Consent Rule
From its inception the Conference has adhered to the “unanimous consent rule.” That is to say: Any motion, resolution or other act which declares policy or commits the Conference, or any member of it, to a stated position or course of action must have the consent of all the members of the Conference. From time to time, one or more members have found the rule irksome and proposed its repeal. In 1918, five years after the Conference was organized, a motion was considered to give delegates the power to act promptly on any Conference motion predicated upon receiving approval by their respective Executive Committees. The APhA approved the motion; NARD opposed it; the others were lukewarm. In 1947, it was proposed that resolutions, instead of being dependent on unanimity, be passed by a two-thirds vote of the delegates in attendance. It was argued that such a procedure would speed action, would result in prompt dispatch of debated issues, would secure greater Conference prestige, and make Conference decisions binding on the members. In 1958 and 1974, discussions were held on changing the rule. But the Conference has held to the rule, and in so doing has remained truly a “conference,” not a caucus and not a legislative or judicial tribunal.
Conference Discussions and Accomplishments
From 1913 to the Great Depression of the ‘30s, some of the subjects considered at Conference meetings were (1) modifying Treasury decisions to conform to the Harrison Anti-Narcotic Act, (2) drafting a bill to reform the patent system, (3) registration of drug names, and (4) “the granting of limited rights to sell certain drugs suitable to the best interests of the drug trade.” Other subjects considered were: sale of drugs by registered pharmacists only, substitution, caustic acid and poison label requirements, listing of potent and toxic drugs, study of habit-forming drugs, mailing of medicinal “poisons,” reporting complaints of alleged malfeasance on the part of food and drug inspectors, and the setting up of an Army Pharmacy Corps.
On the subject of requirements to render proprietary remedies safe for public consumption, the Conference adopted a resolution entitled “Incurable Diseases” which read:
Proprietary products are not to be advertised or recommended as a cure for those diseases which are generally recognized as incurable by the simple administration of drugs.
While the Conference had concerned itself with narcotics in the days of the Harrison Anti-Narcotic Act and with medicinal alcohol difficulties in the Prohibition Era, the New Deal brought new areas of concern. The demand for informative labeling, formula disclosure and regulation of advertising resulted in the introduction in the United States Senate of a bill to revise into the Pure Food and Drugs Act of 1906.
The bill was introduced by Senator Royal S. Copeland of New York on June 6, 1933, and was referred to the Senate Committee on Commerce of which Senator Copeland was the Chairman.
The bill was officially designated as S.1944, but in common parlance it was called variously the “Copeland Bill,” the “Tugwell Bill,” or the “Tugwell-Copeland Bill.” Dr. Rexford Guy Tugwell was Assistant Secretary of Agriculture, and the proposal and the design for the new legislation was attributed to him.
NDTC took an active part in the hearings on S.1944, setting up a committee with Dr. James Beal as chairman. The committee was instructed to oppose S.1944 as introduced and to advocate instead that new legislation be accomplished by amending the 1906 Act or redrafting S.1944.
The services of that committee should not be forgotten. It prepared a bill to amend the 1906 Act. Dr. Beal appeared before the Senate panel on the first day of the hearings, made a comprehensive statement on behalf of the Conference and submitted the bill for inclusion in the record. It appears, beginning on page 114 of the hearings on S.1944 in the 73rd Congress, Second Session.
The hearings began on December 7, 1933—the day which eight years later was to be “Pearl Harbor Day” and 26 years later the beginning of the Kefauver drug hearings. The presentation by Dr. Beal on behalf of NDTC aided greatly in finding for the entire drug field a course through the confusion which ensued upon the introduction of S.1944. The bill which was finally enacted in 1938 reflected the study, the discussion and the concessions of many interested parties, including NCPO. Following enactment of the 1938 Act, the Conference made a significant contribution in the preparation of a model State Food, Drug, and Cosmetic Act to achieve uniformity between the federal law with and among the states. This bill was prepared by a committee, chaired by Dr. Robert P. Fischelis, who at that time was Secretary of the APhA. Other members of the committee were Charles Wesley Dunn, American Pharmaceutical Manufacturers Association, and James F. Hoge, Consumer Healthcare Products Association (then The Proprietary Association). Through many meetings and many drafts, its success was ultimately attested to by the general acceptance which the bill met in state legislatures, beginning with Indiana in 1949.
One of the most distinguished definitive accomplishments of NDTC was the creation of the American Foundation for Pharmaceutical Education. During the dark days of the Great Depression, the necessity of supporting the nation’s colleges of pharmacy was recognized by the Conference. For five years, a Committee on Endowment headed by Dean Ernest Little (Rutgers University) studied the problem and emphasized the need for industry contributions. Out of these reports came the plan that eventually led in 1942 to the incorporation of the Foundation.
In 1956, the Conference participated in observance of the Fiftieth Anniversary of the Food and Drugs Act of 1906, commonly known as the Wiley Act. The year 1959 brought the beginning of the Kefauver hearings, which were of absorbing interest to all divisions of the drug trade and profession. They led to the 1962 Amendments to the Federal Food, Drug, and Cosmetic Act which accomplished substantial revisions in the law, especially in regard to prescription drugs, “new drug” controls and efficacy requirements.
Other highlights of the 1950s included NDTC’s work on uniform state bills such as a state barbiturates act, animal remedies act and state narcotic act. The NDTC Committee on Uniform State Legislation continued its work to keep the uniform state bills current into the 1960s.
During the 1960s, the Conference visited and revisited certain subjects: Medicare and government social service programs and their impact on record keeping; state regulation of interstate business and the need for uniform legislation; and drug abuse problems. Among other topics discussed were patent polices, personnel needs and the Universal Drug Code.
In the ‘70s, conferees considered product coding on several occasions. National health insurance was an issue in the U.S. Congress and was discussed at the Conference. Other kinds of third-party payment were discussed, including the impact of HMOs (health maintenance organizations) and MAC (maximum allowable cost) efforts. NDTC members considered the impact of government on the pharmaceutical field in other diverse areas such as labeling, recalls, the Food and Drug Administration’s over-the-counter Drug Review, and the 1970 Poison Prevention Packaging Act. On the latter, the Conference approved a model state poison prevention packaging act in 1972.
After the 1982 tampering tragedies, NDTC focused on the issue of tamper-evident packaging - also calling for legislation to make tampering a federal offense and reaffirming its support for stronger federal penalties concerning controlled substance crimes.
During the mid-1980s, the Conference looked at issues such as healthcare regulation, the pros and cons of a third class of drugs and data sharing. A common feature of Annual Meetings, the “Roundtable,” took on even greater significance as volunteer leaders began presenting their associations’ views.
In the latter half of the 1980s, the Conference focused its attention on the need for product liability reform by states and the Congress, animal testing, the need for Congress to fully fund FDA as it performs its important regulatory functions, and the continuing need for a uniform national system of regulation for pharmaceutical and cosmetic products.
In 1988, more than 300 Members of Congress, government officials, pharmacy leaders and industry executives gathered in Washington to celebrate the 75th anniversary of the founding of the Conference. Highlighting the dinner was a 30-minute multimedia presentation of the history of the Conference, the national associations it represented, and the important role of pharmacy and pharmaceutical-related industries in America’s future.
The shifting landscape of healthcare and healthcare reform were focuses of the early 1990s. In 1996 the Conference expressed its support for national uniformity in drug and cosmetic regulation in the context of FDA reform legislation.
At the turn of the 21st century, the transformation of health policies related to drug enforcement administration became the focus of the Conference.
Likewise, contemporary issues in particular, related to the Medicare Prescription Drug Benefit, Part D, workforce trends, and emergency drug preparedness, all became and continue to be major foci of the Conference. To this end, in June 2002, NCPO members collectively wrote the white paper titled, “A 21st Century System of Terrorism Defense.” In light of the unfortunate anthrax attacks that followed September 11, 2001, this paper detailed the importance of the U.S. pharmaceutical supply system as the cornerstone in the safe, accurate and efficient delivery of large quantities of medicines and supplies to patients in times of national emergency.
In its most recent years, the Conference has taken on the modern issues of disruptive innovation, and ways in which the profession can transform pharmacy practice from a dispensing model to a patient care model, where new business models for ongoing pharmacist-delivered patient care services can be introduced, developed, sustained and evaluated. As well as other key issues regarding the opportunities and challenges in demonstrating the value of prescription medicines in an era of cost containment; supply chain security from manufacturer to disposal; and reducing prescription drug abuse have all been Conference foci.
But more important than resolutions or the specific accomplishments of the Conference are the cooperative efforts among members fostered by the very presence of the Conference. This is no less true today than when Dr. Beal called for the Conference over 100 years ago, where groups could come together for full and frank discussions without being bound to a Conference-mandate course of action.
The Enigma
The constituency of the Conference is representative of all sides of pharmacy. It is inclusive of the profession and trade, of manufacturing and distribution, and of teaching, dispensing and caregiving. It, therefore, must reckon with subjects of disparate professional and trade interests. These have included academic concerns, economics of production and distribution, laws and practices pertaining to fair trade, cooperative advertising, commercial practices and numerous other subjects.
Over the life of the Conference, some of these subjects have generated heat and acrimony. A characterization of one of the meetings might be applied to some of the others. The 1935 Annual Meeting was characterized by its having been said of the minutes of the Meeting that one might be more impressed by what was unsaid at the Meeting than by what was openly stated.
For historical interest, the question then at issue was that of endorsing the Kelly Bill, introduced in Congress following the demise of the NRA (National Recovery Act). The retail drug code had previously provided price floors, but these were now eliminated. Following a morning of debate, a conclusion was reached in the afternoon. The bill was not endorsed, but the principles underlying price stabilization were. Differences in professional and trade opinion were involved in such legislative proposals as the Durham- Humphrey and factory inspections amendments to the Federal Food, Drug, and Cosmetic Act. Consequently, they became subjects for protracted debate and discussion. But no subject revealed such differences of opinion and evoked such intense debate as the so-called “restrictive sales” argument. For example, older meeting minutes reflect much time and consideration on a proposed uniform pharmacy bill. The members found themselves in agreement on many of the provisions of such a bill but a Conference position was never attainable because of the “restrictive sales” issue. That issue, recurring at every Annual Meeting for several years, stymied the Conference by its consumption of time. The Conference wisely realized that its usefulness might be seriously impaired if this issue dominated each and every meeting.
The subjects of “substitution,” “duplication” and “imitation” have been debated at many Conference meetings. While the minutes do not reveal general agreement on these subjects, nor do they always reveal definable progress toward a solution of problems, they do attest to the interest of the members and to their constructive aims and efforts.
In the minutes of an Annual Meeting of the Conference in the late ‘30s, there was this meaningful note with reference to a resolution of these subjects: “All favored the resolution in principle, but few gave it their unqualified approval.”
In the 1950s, increasing clamor for legislation probably accelerated the formation of the Health Information Foundation. Some questioned whether it and the National Pharmaceutical Council, which was organized in November 1953 and originally directed against substitution and imitation, represented a failure of the Conference to meet the subjects which brought these organizations into being.
These matters put strongly in focus such persistent questions as: “Is it the office of NCPO to meld trade and professional opinion? Can petty differences and personal animosities be overcome by the forum approach? Isn’t Conference discussion valuable to the field even when unanimity of opinion is unattainable?”
So it has been from time to time over the years that questions have arisen as to the place and service of the Conference. Therein has been the enigma. For, despite the differences and surviving all the questions, the Conference has gone on for more than 99 years, deriving vitality from the purpose of its founding.
As proposed by Dr. James Beal, the Conference was to “compose conflicting views and abate jealousies.” The record may not show a full measure of accomplishment, but it does show a sustaining dedication to purpose and a sense of direction. And this it does in contemporary context of practical concern and experience.
Conclusion
Such are the historical origins of the Conference and a glimpse at some of its activities and achievements.
Like all records, this one relates but a part of the story. The centrality of pharmaceutical agents and their use toward the quality of healthcare provided to patients will remain a major issue of the 21st century. Present days of change and challenge will, of course, bring new problems and demands to an industry and a profession related to such vital interests as the health of a nation and its people.
A meeting of minds may be more difficult than ever to achieve, but it is more important than ever. The Conference may serve the new day by providing opportunity for all segments of pharmacy to meet, to talk and to listen in a common endeavor to unify and educate.
Change has become the constant for all of the domains represented in the NCPO. The rapidity and consequential nature of these changes requires open communication, coalition building and forceful advocacy in a variety of sectors. Hopefully, the NCPO can continue to build on its tradition and serve eloquently as a platform for important dialogue.
Adapted from a presentation entitled “Behind the NDTC Curtain,” made at the Conference’s Annual Meeting in Washington, DC, on December 3, 1954, by Ray C. Schlotterer, Secretary. Revised in 1971 by James F. Hoge, Counsel for the Consumer Healthcare Products Association, George B. Griffenhagen of the American Pharmaceutical Association, and Charles W. Bliven of the American Association of Colleges of Pharmacy. Updated in 1976 by Mr. Griffenhagen, Arthur E. Schwarting, PhD, of the American Association of Colleges of Pharmacy, and James D. Cope of the Consumer Healthcare Products Association. Updated in 1983 by Mary F. Simons of the Consumer Healthcare Products Association. Updated in 1989 and revised in 1996 by Mr. Cope. Updated and revised in 2005 by Dr. Henri Manasse, American Society of Health-System Pharmacists. Updated in 2013 by Dr. Paul Abramowitz, American Society of Health-System Pharmacists.
