Expanding the scope of practice: 2020 Distinguished Alumnus James E. Knoben

Maybe it was their vast knowledge about drugs and human health. Or maybe it was their sharply organized pharmacy and their professionalism in ministering to patients in need. But whatever it was, a young James E. Knoben, PharmD ’71, MPH, could see himself thriving among his mother’s colleagues at a community pharmacy in San Diego.

Knoben’s intuition was right, and he would go on to spend his 45-year career excelling in the fields of pharmacy and public health. Knoben, the 2020 UCSF Pharmacy Alumni Association Distinguished Alumnus of the Year, says “getting into UCSF was one of the best things in my life­—it laid a critical professional foundation needed to meet many new challenges.”

Knoben has worked at the United States National Center for Health Services Research, Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the National Library of Medicine. He served with distinction in the U.S. Public Health Service Commissioned Corps (USPHS) and retired with the rank of Captain in 2005 after 33 years of active service. And he won three U.S. Surgeon General’s Exemplary Service Medals and the PHS Career Achievement Award in Pharmacy for improving access to drug information, introducing a new breed of doctors of pharmacy (PharmDs) to policy making, and supporting the U.S. Public Health Service.

Knoben is the founding author of the Handbook of Clinical Drug Data, which was a critical part of a pharmacist’s reference for decades. Throughout all his jobs, Knoben has tirelessly forged new paths for advanced pharmacy clinical practice, expanding the scope of practice for all pharmacists.

A start in pharmacy

Growing up in Ocean Beach and Point Loma, California, Knoben stayed nearby after high school and took general classes at San Diego State College. He was pondering his future when his mother took a position as a clerk in a local pharmacy and he soon found himself drawn to the work, especially the professional skills required.

After graduating, he applied to only one place—the UCSF School of Pharmacy, which was the only public pharmacy school in California at the time.

Knoben arrived in San Francisco at the height of the hippie movement. The School was only blocks from its epicenter: the crossroads of Haight and Ashbury.

Under teachers like Warren (Bud) Kumler, PhD, (“quite an interesting character,” according to Knoben) and Thomas Tozer, PhD, he found he had a knack for pharmacy, and his love of organization came into play.

Knoben noticed that his fellow students were carrying pocket notebooks to jot down “clinical pearls,” critical features of drugs that were not yet organized in published literature.

Recognizing a need, he worked with School colleagues Phil Anderson, Art Watanabe, and Bill Troutman as co-editors, as well as a host of clinical pharmacist contributors, to consolidate clinical information on drug compounds in a compact format. The resulting book, the Handbook of Clinical Drug Data, eventually turned into a 30-year passion that led to 10 consecutive editions used by multiple generations of clinical pharmacists throughout the nation.

Knoben also found time to serve as president of the Associated Students of the School of Pharmacy.

A detour leads to a path in public health

In Knoben’s final year of pharmacy school, he entered a 2-year internship/residency program. But the Vietnam War, raging on the other side of the globe, interrupted his residency when he was drafted into the U.S. military.

“I think it loomed over everybody because at that time it was a lottery system,” Knoben said of the Selective Service, which determined which young men would serve during wartime. “So you really didn't know whether you'd be subject to the draft or not. But once you knew, that kind of set your future.”

While the military hadn’t been part of Knoben’s original plans for a pharmacy career, the experience ended up putting him in an exciting space for a pharmacist. It led him to work under the late Donald C. Brodie, a UCSF School of Pharmacy associate dean who, at the time, was on sabbatical at the National Center for Health Services Research serving as chief of a new drug studies and pharmacy-related program.

Brodie was widely considered the originating theoretician of the clinical pharmacy movement, which significantly expanded the role of pharmacists in inpatient hospital settings. Knoben joined Brodie’s efforts to advance that enhanced role as well as the professional education necessary to prepare clinical pharmacists.

The job also alerted Knoben to the work of the Public Health Service, the federal organization that includes critical parts of America’s official health response, including the NIH, the CDC, the Indian Health Service, and the FDA, among others.

Committed to further broadening his contributions to the Public Health Service, in 1975, Knoben attended Yale University’s School of Medicine and earned a Master of Public Health (MPH) degree.

A long and varied career

After graduating from Yale, Knoben returned to the USPHS Commissioned Corps, which is one of eight uniformed services in the U.S. government. Initially serving as the pharmacy advisor to the Bureau of Quality Assurance, he formulated policy for the National Professional Standards Review Council. Wanting to move west, he transferred to the PHS office in San Francisco, where he was appointed pharmacy consultant for the southwest region of the U.S., responsible for the direction and oversight of pharmacy and medical practice matters.

During this time, he served as the drug utilization review expert to Congress’s Office of Technology Assessment and special government consultant to the FDA’s Drug Use Trends program. He used his proximity to his alma mater to immerse himself in the work of the UCSF Pharmacy Alumni Association, serving as its president from 1981-82.

Knoben was then recruited by the FDA to serve in the Center for Drug Evaluation and Research as chief of the Drug Information Analysis Branch. He was quickly promoted to director of the Division of Drug Information Resources, a position he held for 12 years. As the first pharmacist to occupy the position, he introduced new and enhanced drug information resources, incorporated informatics technologies, and hired pharmacists to serve in novel practice roles dealing with the review and dissemination of clinical, regulatory, and research information.

Knoben went on to serve his remaining federal career as special assistant to the associate director of specialized information services at the National Library of Medicine, an institute of the NIH. While there, he also served as drug information consultant, helping to improve the Library’s drug information resources and create new databases that are accessed by millions of users worldwide each year.

An advocate and a pioneer

“What stands out is the fact that he was a pioneer in many of these positions, demonstrated a pharmacist’s capability in a variety of roles, and advanced pharmacy clinical practice,” wrote Wilma K. Wong, PharmD '73, about Knoben.

Knoben's unconventional career path also indirectly led him to his wife, Alice, a fellow pharmacist he met while working at the FDA.

Semi-retired, he still serves part-time as a consultant at NIH, and in 2016 became a Fellow of the American Pharmacists Association. He wrote two editions of the U.S. Public Health Service Officer’s Guide: Leadership, Protocol, and Service Standards with his wife, and co-edited Public Health Emergency Preparedness and Response with former Surgeon General Richard H. Carmona. From 2008 to 2010, he also served as president of the PHS Commissioned Officers Foundation for the Advancement of Public Health. Knoben is currently working on a history of the U.S. Public Health Service.

Knoben is proud of his work on behalf of patient care and advancement of the pharmacy profession. “I see the acceptance of doctors of pharmacy in many areas,” Knoben said. “I see it mainly in the federal government, all kinds of agencies around the federal government hired pharmacists for things that they may not have in the past. The range of careers available to you as a pharmacist are varied and fascinating.”

Because of the COVID-19 pandemic, Knoben will receive his award in person next year during Alumni Weekend 2021, April 16-17. This year's Alumni Weekend will continue online the week of June 8-12.