Long before pharmaceutical companies claimed stake in the multibillion-industry of drugs, pharmacists compounded custom medications for all sorts of ailments. By the 1960s, the science of compounding was on its way to oblivion, as corporations took over the medication business.
   But today, a small number of pharmacies are returning to their roots, saying their goal is to fill the gap left by drug manufacturers. Estimates show about one percent of prescriptions today are compounded, and more pharmacies look to offer at least some form of customized medications.
   Craig Kvam, R.Ph., owned a “traditional” pharmacy in downtown Poulsbo since 1977, but a couple of years ago he built a special lab and went 100 percent “compounded” — essentially starting his business and clientele from zero. He even changed the name eventually, from Poulsbo Drug Store to Poulsbo Compounding Pharmacy, so it better reflects his specialty.

Craig Kvam, R.Ph. Owner of Poulsbo Compounding Pharmacy

   What started as one or two compounded prescriptions a day in 1988 has grown to become Kvam’s niche. “It was so rewarding that I decided to focus on it. It became my salvation,” he said.
   On a usual day, Kvam can be found in his pharmacy lab that is stocked neatly with bottles, pipettes, syringes, suspensions and other trappings that slightly hint to the old days of medicine. The large windows overlook the picturesque downtown Poulsbo — but Kvam doesn’t get much time to view the scenery. Even though he fills fewer prescriptions per day compared to his old pharmacy, which was located just down the street, the pace is still brisk.
   It wasn’t at first: When Kvam did away with traditional prescriptions and stopped accepting insurance plans, he had to hire a full-time marketer. But it seems the market was already there: not only for patients looking for bio-identical hormones or having problems swallowing medications, but also for veterinarians who have few choices for pets. Now, he even mails some prescriptions to Eastern Washington, Seattle, and other areas.
   Kvam has about 6,000 formulas for custom medications, and can compound anything from capsule and tablets to injections and “gummy treats” for kids or fish-flavored “treats” for dogs. Some medications require a sterile environment, and the building has a special sterile room and other equipment for that purpose.
   “All pharmacists are licensed to do compounding, but not everyone spends the energy and money to do it,” Kvam said. Kvam himself made a substantial investment when he decided to take the plunge — including further education, buying specialized equipment and designing a bigger lab, in a building that formerly housed a restaurant. He continues to attend seminars and participates in other networking and educational events.
   The growing compounding industry has come under fire nationwide due to lack of regulations and consistent reinforcement, and various groups have been lobbying Congress to restrict certain practices, citing some instances when patients were hurt due to improper compounding or use of raw materials. However, the industry argues those cases are no different than in any other medical areas; but most importantly, compounding pharmacies can help those people who can’t be helped by manufacturers.
   “We can help someone where no one else can. If we can solve a problem that commercial products can’t, that’s what we’re here for,” Kvam said.
   The help is especially urgent for patients who have difficulty swallowing medications, kids for whom dispensing is nearly impossible due to the drugs’ taste, people with allergies to preservatives and other ingredients, or those who simply don’t respond to commercial prescriptions. For veterinarians, compounding is a life saver — there are very limited choices when it comes to medicine for pets, especially exotic ones.
   Another popular group is hormone users, since many of the compounded medications are trans-dermal, administered through the skin and absorbed directly into the blood stream.
   And what’s more important, Kvam said, is that customized medications include the patient in the loop.
   “Patient — pharmacist — doctor is the framework to find the best therapy… The more time I spend listening, the better I can work with the doctor and the patient,” Kvam said. That sometimes even includes one-hour consultations and other services Kvam offers in addition to filling prescriptions.
   Kvam doesn’t look much like an old-fashion doc mixing up concoctions in a corner — even if he uses a pestle and mortar in his well-ventilated lab. But as he creates special recipes for patients, somehow there is a feeling of what good medicine used to be like ions ago, away from the mad rush of the world of super-everything and from the bureaucratic rule of the HMOs.
   To add a little to the feeling of old-fashion, Kvam’s pharmacy is a family business. Wife Sally, a nurse, has become more involved with the office side of things recently — a sign that business is picking up.
   “I used to do everything and as I got busier I delegated more to Sally,” Kvam said. These days, their goal is to “make sure we do a good job” and that the patients’ challenges are solved.