Dispensing medicine: Address the central issue
By : DR MILTON LUM, Petaling JayaNST, 1st April 2008
I REFER to the reports on the issue of dispensing medicine ("Doctors to be disallowed from dispensing medicine" - NST, March 29 and "A need for 24-hour pharmacies" - NST, March 31) and the misrepresentations in the statements attributed to John Chang, past president of the Malaysian Pharmaceutical Society (MPS).
Among his claims were:
- With serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge rather than from a doctor who had none.
- Doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more.
- The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist.
Pharmacology is not synonymous with pharmacy, although the two are sometimes confused in everyday usage.
Pharmacology, which is the study of the interaction between drugs and humans to produce a change in function, is part of a medical undergraduate's training and continues throughout the medical course.
Pharmacology encompasses drug composition and properties, drug interactions, toxicology, therapy, and medical applications of drugs.
On the other hand, pharmacy is the study of medicinal substances and drugs, their origin, nature, properties, formulation, production and effects, and their use in humans and animals. Depending on the university, pharmacology may or may not be part of the pharmacy course.
There is also confusion between prescribing and dispensing.
Depending on the illness, a doctor prescribes treatment, which may or may not include drugs, subsequent to making a diagnosis, after taking a history, doing a physical examination and/or carrying out diagnostic investigations.
A prescription is a written instruction authorising a patient to be issued with drugs and/or other treatment.
Dispensing refers to the preparation and supply of drugs prescribed by doctors.
Because of the nature of their training, doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe.
The only healthcare providers who see and treat adverse drug reactions are doctors. Nurses also see adverse drug reactions and they assist doctors in treating them. However, pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals, where they may see and assist doctors.
Drug interactions can be minimised when there is knowledge of the patient's medical, surgical, drug and family history. Such information is usually provided by patients to their doctors. This information is usually unavailable to pharmacists or, if available, insufficiently detailed.
Drugs are prescribed and dispensed by doctors. Some are branded drugs while others are generics. Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown, unlike the branded drugs.
Many doctors are already prescribing and dispensing generic drugs.
When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.
Patients seen in private clinics have a choice of having their prescriptions dispensed by the clinic or by a pharmacy. Doctors who dispense incur costs for providing the service, i.e. carrying cost for the drugs and staff salaries.
The claim that doctors prescribe and dispense expensive medicines because of profit and hold patients to ransom is inflammatory.
Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible.
The proposed pilot study by the Health Ministry should answer a fundamental question: Who decides where patients should get their drugs from; doctors or pharmacists? Or is it the patient's right to make his own choice? The MPS president's advocacy that patients be deprived of his right of choice in the dispensing of his drugs, needs an answer from the people who are affected, the patients.
- With serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge rather than from a doctor who had none.
- Doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more.
- The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist.
Pharmacology, which is the study of the interaction between drugs and humans to produce a change in function, is part of a medical undergraduate's training and continues throughout the medical course.
Pharmacology encompasses drug composition and properties, drug interactions, toxicology, therapy, and medical applications of drugs.
On the other hand, pharmacy is the study of medicinal substances and drugs, their origin, nature, properties, formulation, production and effects, and their use in humans and animals. Depending on the university, pharmacology may or may not be part of the pharmacy course.
There is also confusion between prescribing and dispensing.
Depending on the illness, a doctor prescribes treatment, which may or may not include drugs, subsequent to making a diagnosis, after taking a history, doing a physical examination and/or carrying out diagnostic investigations.
A prescription is a written instruction authorising a patient to be issued with drugs and/or other treatment.
Dispensing refers to the preparation and supply of drugs prescribed by doctors.
Because of the nature of their training, doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe.
The only healthcare providers who see and treat adverse drug reactions are doctors. Nurses also see adverse drug reactions and they assist doctors in treating them. However, pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals, where they may see and assist doctors.
Drug interactions can be minimised when there is knowledge of the patient's medical, surgical, drug and family history. Such information is usually provided by patients to their doctors. This information is usually unavailable to pharmacists or, if available, insufficiently detailed.
Drugs are prescribed and dispensed by doctors. Some are branded drugs while others are generics. Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown, unlike the branded drugs.
Many doctors are already prescribing and dispensing generic drugs.
When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.
Patients seen in private clinics have a choice of having their prescriptions dispensed by the clinic or by a pharmacy. Doctors who dispense incur costs for providing the service, i.e. carrying cost for the drugs and staff salaries.
The claim that doctors prescribe and dispense expensive medicines because of profit and hold patients to ransom is inflammatory.
Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible.
The proposed pilot study by the Health Ministry should answer a fundamental question: Who decides where patients should get their drugs from; doctors or pharmacists? Or is it the patient's right to make his own choice? The MPS president's advocacy that patients be deprived of his right of choice in the dispensing of his drugs, needs an answer from the people who are affected, the patients.
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