A year ago, we were beginning to grasp the scope of the debacle at the New England Compounding Center. Like many completely awful situations, this one has caused deaths and ongoing morbidity for surviving patients, and it has produced a lot of collateral damage, including challenges for managers of sterile compounding programs. Clearly, the yearlong discussion about pharmacy compounding has done more than keep pharmacists awake. For those in health-system pharmacy, routine outsourcing of sterile products has been called into question. We have had to revisit that gray area between manufacturing and compounding. We have had to educate legislators and regulators about why centralized operations, when operated properly, are safer than each hospital making all the unique formulations needed for patient care. ■Revisiting the gray area between manufacturing and compounding is necessary to ensuring the focus is on patient health.■Being efficient is not enough; we also need to ask whether our actions are serving the proper purpose. ■Revisiting the gray area between manufacturing and compounding is necessary to ensuring the focus is on patient health.■Being efficient is not enough; we also need to ask whether our actions are serving the proper purpose. For individual pharmacists, the compounding debate has produced soul searching, and that will keep you awake at night. At the recent 50th anniversary of the Illinois Council of Health-System Pharmacists (ICHP), incoming ICHP President Michael A. Fotis said something that really crys- talized our challenges for me: “Pharmacists are such goody goodies. We are so careful to follow every rule and regulation, particularly those rules set out for us by our employers. We also do everything we can to improve efficiency. Of course, it is a good thing to work efficiently and play by the rules. But one imagines that pharmacists and technicians working at some of those compounding pharmacies we have heard so much about were also working very efficiently. “Sometimes efficiency is not enough. We also need to ask if what we are doing serves the proper purpose and if it is worth doing in this way. If all we do is worry about efficiency, well, that’s a good way to end up on “60 Minutes,” exercising our right to invoke the Fifth Amendment. Not the way any of us wants to be seen on network TV.” That’s really something to think about. Everyday, are we blindly following procedures in our institutions without thinking about what we know is right, based on scientific facts, pharmaceutical principles, or ethical beliefs? Are we in a practice environment where the health of the patient is not the primary concern? As Fotis said near the end of his presidential address, “I believe there are too many avoidable errors and much cost inefficiency in our health systems. For the most part, we leave our most vulnerable patients to fend for themselves. Many pharmacists do exceptional work to improve our health system. We need to change the way we work as pharmacists so that all of us can provide this level of care. Our patients need us to do this.” That’s the kind of thinking that will help us all sleep better.