Harvey A.K. Whitney Award Lectures

The Seventh-Generation Pharmacist

Introduction

Receiving the Harvey A.K. Whitney Lecture Award is truly an exceptional honor.  I am profoundly humbled by this award.  I see it as a recognition of the contributions from many outstanding individuals with whom I have had the privilege to work, serving the healthcare needs of our nation. I am deeply grateful to these colleagues, and I dedicate this lecture to them.

To the previous recipients of the Harvey A.K. Whitney Award who nominated me and supported my selection, I thank you for allowing me to join you.

To my mentors, faculty, and friends at the University of Michigan, thank you for preparing me to step forward into my new career, ready to learn and grow.

To my esteemed colleagues and friends in the Indian Health Service: On my first day, you taught me that our focus is on our patients and the communities we serve. You taught me that my pharmacy education and experience were only a starting point, and you challenged me with the encouragement and freedom to take on new roles for pharmacists.  Your unwavering support allowed me to grow and become deeply committed to our mission.

My late parents, Lewis and Gladys Church, have been a constant source of encouragement for me throughout my life.  Their example was a life of service and values that shaped my direction in life.

Most importantly, no one can be successful without the constant love, support, and understanding of their family. My wife, Mary, has been all this and more to me.  She has been by my side as we moved around the country, even when a new locale was not her first choice.  We’ve been blessed by our children, Mark, Ann, and Lori, who joined us along our journey to make it a wonderful adventure of joy, discovery, and purpose.  I am thrilled to share this evening of celebration with you.

I began to prepare for this lecture, my thoughts wandered to who would be in the audience.  I thought about the past Whitney honorees¹, pharmacy leaders from across the profession, colleagues, family, and future professionals.  I don’t think that I am the first to experience a sense of anxiety and uncertainty about addressing such a distinguished group. As I reflected on the legacy of figures like Don Francke, Allen Brands, George Archambault, and many other Whitney honorees, I thought about the depth of their impact on our profession. Their contributions have enriched pharmacy and continue to provide a foundation upon which we build today.  Crafting a lecture worthy of such an audience was daunting and I felt like a rookie baseball player presenting his insights to a gathering of “Hall of Famers”.  After a period of introspection, I relaxed and realized this evening will be a precious opportunity to be with many wonderful friends and colleagues and to share this time with my family.

The Seventh Generation Principle

It is my family heritage that gives my lecture special significance. The title of my presentation—“The Seventh Generation Pharmacist”—is based on a philosophy known as the Seventh Generation Principle^2,3 that is widely shared across many Native American cultures. This principle was first documented well over 500 years ago by the Haudenosaunee-speaking peoples, also known as the Iroquois Confederacy. This philosophy teaches that in the decisions we make today, and in the actions we take today, we should consider their impact seven generations into the future. The principle embodies a deep respect for the past and a strong commitment to the future, recognizing the interconnectedness of all life across generations. It focuses on preserving the Earth and sustaining the well-being of future generations of people and all life on this planet.

We are interconnected across communities and time.

We can visualize seven interconnected generations by imagining a chain that has seven links. Each link in this chain symbolizes a generation, interconnected with the one before and the one following it, creating an unbroken passage of legacy and continuity.  The first link represents our ancestors, whose wisdom and experiences have laid the foundation for our practices today. This link joins with the second, symbolizing the transmission of knowledge, values, and traditions from one generation to the next. Just as links in a chain are interconnected and inseparable, each generation’s experiences and decisions influence the next, creating a continuous flow of impact across time.  With this image in mind, we can envision a chain of seven generations.

The Seventh Generation Pharmacist

For those hearing about the concept of seventh generation thinking for the first time, it may be challenging to comprehend how current decisions or actions can affect individuals in the distant future.  Think about wisdom you may have received from parents, grandparents, or mentors and how your life choices and decisions have been affected by those who came before you.  You, in turn, add your experience and pass it on to those who follow you, and they do likewise.

Seventh Generation Pharmacists, in their professional lives today, will strive to ensure that their decisions and actions have favorable prospects for the future of patient care, the future of healthcare delivery, and the future of their profession.

Our pharmacy community and family

It is likely that each of us can identify many people by name who have influenced our careers or with whom we share a common service bond.  This is our pharmacy community and family.  As I list a few examples, you will quickly see that we are all part of one interconnected family.

Consider where we received our education and training.  There are many who share some association with the University of Michigan where I studied pharmacy and completed my residency.  You may also have graduated from there, completed a residency, served on the faculty or staff, or had some other connection.  We are a type of family.  The same type of relationship exists for everyone with their respective schools and institutions.

Consider the institutions or health systems we have served.  Perhaps you, like me, served in the Public Health Service (PHS), which encompasses the Food and Drug Administration, National Institutes of Health, the Indian Health Service (IHS) and other related agencies.  Some of us have been together since the day we were commissioned, while others have spent a formative portion of a career there.  You may have served in the PHS through student programs, clinical rotations while in school, or through other training sessions. You may have served in one of the military services or the Veterans Administration.  We have a special bond through the federal pharmacy community.

We share many of the same mentors or people who have influenced us. When reviewing the list of past Whitney honorees, I can see many whose careers and wisdom have influenced me.  George Phillips was the Director of Pharmacy and my residency preceptor at Michigan.  Allen Brands was the IHS Chief Pharmacist when I began my PHS career.  There are many more recent mentors, educators, researchers, and others who have contributed to our careers.  We share the wisdom of many of the same pharmacy leaders.

While these are just a few examples, it is clear that we are part of the same family.  Additionally, our family extends over multiple generations like the links in a chain.  We are not just connected with one another; we are inextricably interconnected.

We honor the past

We are connected to our history.  The profession of pharmacy has evolved significantly over time, incorporating new knowledge, new drug discoveries, and traditional healing practices with modern medical science.

Throughout our history, patient-centered care has been an essential aspect of pharmacy practice. Ancient apothecaries prepared remedies tailored to the patient’s well-being, using treatments based on individual needs and local ingredients. This rudimentary patient-focused approach formed the foundation for the many developments leading to modern pharmacy practice.

Integrating the past and present to prepare for the future

While pharmacists have steadily taken on new management and leadership roles in all areas of healthcare, the changes in our profession that I have witnessed over my lifetime are truly amazing.

For example, when I completed my pharmacy degree in 1970, it would have been inconceivable to imagine that the vast majority of medications in common use today were not available then. This includes entire classes and categories of medications.

The focus has shifted from the process of dispensing medications to focus on the patient, ensuring the appropriateness and optimal use of drug therapy.  I am fortunate to have been able to participate in the Indian Health Service’s early efforts to establish such programs⁴. In the 1960s, IHS pharmacists began managing patients’ medication therapy by using physical assessment and ordering lab tests, mainly in outpatient settings. They also began counseling patients to promote understanding and ensure proper medication use. These practices evolved and gained widespread acceptance. After the Omnibus Budget Reconciliation Act of 1990 (OBRA 90) mandated medication counseling, materials from IHS were incorporated into pharmacy school curricula nationwide to train pharmacists in patient consultations.

The use of new technology has profoundly transformed pharmacy practice. The advent of computer-based systems has streamlined drug dispensing processes, ensuring greater accuracy and efficiency. Advanced diagnostic tools and electronic health records have replaced manual paper records to improve support for patient care. Telepharmacy has expanded access to services, especially in remote areas. Management systems have been transformed, while artificial intelligence (AI) and machine learning have enhanced drug discovery and predictive analytics.

There are major implications for the Seventh Generation Pharmacist in the evolution of healthcare technology. We must ensure that this technology is used to support human connection rather than replace it. We must underscore the importance of empathy and contextual understanding in patient-centered care. Human judgment is necessary to consider the unique needs, values, and cultural backgrounds of each patient and to avoid the pitfalls of purely algorithmic decision-making in patient care.

The Seventh Generation Pharmacist increasingly will be challenged by broad trends in society.  For example:

• How should our profession confront the financial imperatives in healthcare that emphasize profitability, often to the detriment of our professional, ethical, environmental, and social responsibilities⁵?
• How should we deal with the rapid advancement of technology that presents challenges in integrating innovative tools and systems to enhance patient care while navigating concerns such as data privacy, cybersecurity, and the ethical implications of artificial intelligence in healthcare?
• What should our role be in promoting environmental stewardship, to ensure that our actions today do not compromise the health and well-being of future generations?
• What role should our profession play in addressing dramatic ideological shifts of elected officials regarding public health, research, scientific evidence, education, and health equity to ensure that our actions (or inactions) do not compromise the well-being of current and future generations?

Attempting to envision the landscape of pharmacy practice in seven generations is perplexing.  Will pharmacists become obsolete, replaced by AI-driven personalized medicine systems? Or will they become even more vital, guiding us through an unprecedented landscape of therapies that we cannot begin to imagine today? No one is sufficiently clairvoyant to answer these questions with confidence. However, we can continue to develop future leaders of our profession who have skills that will help pharmacy evolve to be well aligned with the needs people have for expertise in responsible use of medicines—pharmacy leaders imbued with the Seventh Generation Principle.

Looking into the future, the essence of patient-centered care should continue to be our guiding star. Our primary focus, whether in policy or practice, should remain on the well-being of the patient, the well-being of the communities in which people live and work.

Who is the Patient?

Let’s examine the nature of patients and the related core values or guiding principles we need to prepare for the long journey to the seventh generation. Our patients are not a monolithic entity but rather a diverse collection of individuals with unique needs, cultures, and backgrounds.  Patients vary in age, gender, ethnicity, and socioeconomic status as they bring their own perspectives, cultural contexts, and life experiences to healthcare encounters. They may be dealing with a complex range of health conditions, from acute issues to chronic illnesses or preventive-care needs.

Moreover, individual patients have their own distinct expectations and goals regarding their health and treatment. Some may prioritize immediate symptom relief, while others may focus on long-term health management. Patients also have varying levels of understanding about their health status. Frequently, patients enter the healthcare system when they are highly vulnerable, feeling powerless, seeking hope, and unable to participate actively in their health journey.

Our ongoing challenge is to recognize this diversity and uniqueness and tailor our care to address it. When you think of a patient, envision a face, recall a name, and remember a person who has inspired you to provide care. It is recognition of the patient’s humanity that motivates healthcare providers to offer their best, ensuring that each interaction is infused with compassion and respect.  Whether we are frontline providers, program managers, or policy makers, this personal connection is what brings our commitment to life. A Seventh Generation Pharmacist will see patients as people with names and faces, will honor their individuality, and will honor the profound impact of our service on their lives.

Foundational Values

Five values can form a solid foundation for both our personal and professional lives. Together, they shape our character, influence our choices, and ultimately determine the kind of impact we have on the world and the legacy we leave for future generations. These values are relevant whether we serve in direct patient care, management, leadership, or any area of service.

• Respect – Showing genuine respect for patients entails honoring their unique perspectives, beliefs, and values. Regardless of our service role, it involves creating an environment that provides care with dignity throughout their healthcare journey. Empathy and compassion grow from respect, enabling us to understand and connect with the diverse experiences and emotions of others. This builds trust and fosters a supportive environment where patients feel valued and cared for and ensures that patient values guide our healthcare institutions and services.
• Humility – We honor our patients’ well-being by acknowledging the limits of our own knowledge as we collaborate with team members to obtain the necessary information. Humility encourages individuals and organizational leaders to recognize the diverse expertise within the healthcare community and the value of each team member’s contribution. Organizations exhibit humility when their leaders recognize that improvement is always possible.  Demonstrating humility shows patients that we value their feelings and beliefs when we actively listen to their concerns as they share their unique knowledge. It guides us to place forward thinking service ahead of personal rewards.
• Courage – We can exhibit courage by addressing complex healthcare issues with confidence and principle. Courage may involve tackling systemic issues detrimental to patients’ interests or advocating for underserved or marginalized patients who face barriers to accessing services. It might require addressing broader public health issues across communities. It will always require maintaining ethical principles while envisioning a healthier future for all.
• Honesty –Patients require honest, accurate, and understandable information to make informed health decisions. Addressing misinformation about medications and health-related topics honestly and accurately is essential for contributing to a better-informed public. Leading and mentoring with honesty models behavior that benefits future generations as well as the present. Emphasizing honesty in daily practice builds trust with patients and establishes a reputation for integrity, ensuring safe and reliable patient-centered care for future generations.
• Wisdom – Wisdom is a value that we strive to achieve, that transcends mere knowledge acquisition. It involves critically analyzing new information, adding our experience, and applying ethical principles to make evidence-based decisions that are in the best interest of patients. As we move forward, it is our responsibility to build upon the legacy of our predecessors and contribute to a future where pharmacy practice is guided by intentionally blending science, compassion, and sustainability.

Conclusion and Call to Action

We are the beneficiaries of a rich heritage as we acknowledge and honor the legacy and wisdom of our predecessors.  Each of us has an opportunity and a responsibility to add our own thoughts, ideas, and actions.  These will become the contributions and wisdom we add to guide pharmacists in navigating their future challenges.

In conclusion, we can be guided by four actions:

1. Recognize that serving patients is the heart of our profession. Throughout the history of pharmacy, our focus on the patient has been the cornerstone of our profession that binds the past, the present, and the future.  It provides a focus and purpose for the way we make use of the new capabilities of the future.
2. Build a solid foundation grounded in values. Every person of any generation needs a solid moral foundation to be successful in terms of the Seventh Generation Principle.  Our values serve as a compass, signaling to those who follow us to apply future knowledge, technology, and innovation in ways that transcend personal self-interest.
3. Harmonize human judgment with technological innovation. We must embrace and use technology to support and improve human connections rather than replacing it. Future technology, such as AI-driven diagnostics and advanced patient care algorithms, will provide new capabilities that are not possible today. However, not every patient fits perfectly into an algorithm. Human judgment is essential for interpreting data, understanding context, and making decisions that are ethical, compassionate, and tailored to the patient’s values.
4. Maintain personal balance in our life.  Maintaining balance between one’s professional, personal, emotional, and spiritual life is crucial for overall well-being and success. This balance prevents burnout and stress, promotes happiness, and ultimately leads to a more fulfilling and sustainable life.  Our service to others is synergized by our personal health.

The essence of the Seventh Generation Principle in pharmacy goes beyond the present. It leads us to always consider how today’s decisions and actions will affect our profession seven generations into the future. It urges us to adopt a mindset that prioritizes the well-being of our interconnected future generations.

I hope everyone here this evening will share my aspiration to live a life that is consistent with this principle. To my fellow pharmacists gathered here, let’s strive to ensure that our actions today pave the way for a bright future for our profession and the well-being of our patients. Together, let’s commit to being worthy of being recognized as Seventh Generation Pharmacists.

References

1. American Society of Health-System Pharmacists. Harvey A.K. Whitney Award Lectures. Accessed March 1, 2025. harveywhitney.org/lectures
2. Lyons, Oren. “Looking Toward the Seventh Generation.” American Indian Studies Program, University of Arizona. Tucson, Arizona. April 17, 2008. Presentation.
3. James Vukelich Kaagegaabaw, The Seven Generations and The Seven Grandfather Teachings, James Vukelich, 2023, pp. 11-12.
4. Church, R. (2019). Reflections on Clinical Pharmacy: Clinical Pharmacy in the Indian Health Service. In Elenbaas, R., Worthen, D., and Webb, C. (Eds.), Clinical Pharmacy in the United States: Transformation of a Profession (2nd ed., pp.138-139).
5. Berwick DM. Salve Lucrum: The Existential Threat of Greed in US Health Care. 2023;329(8):629–630. doi:10.1001/jama.2023.0846