Past few months saw many struggles on the roads and off the roads by Pharm. D graduates of India. These graduates were shown a Utopian world and taken to Euphoric tower then let down by the people concerned, especially Pharmacy Council of India (PCI). Just like an irresponsible parents, PCI has given birth to this highly acclaimed course and thereafter just washed off its hands. It has not taken any serious efforts to put them in decent job or life. Even at the time of starting the course, this author has forewarned the authorities in his article, entitled 'welcome Pharm. D! where is opportunity?' published in Pharmabiz years back.
Root cause
Selfish, narrow minded doctors at the helm of affairs in the ministry of health are responsible for this problem. Considerable proportions of practicing doctors are also behind the scene. They are not ready to recognize the services of Pharm. D graduates because these Pharm. D graduates are mainly trained to find out the commissions and commissions of doctor's prescriptions and to trace the adverse drug reactions (ADRs) and other problems of the patients while under treatment. Till today, treatment of patients is going on without anybody to monitor in India. Hence, these doctors do not want somebody to find fault with their work and wish to maintain the status of unquestionable emperors of healthcare sector.
Doctor's view
Doctors say the course and subsequently the clinical pharmacy services in Indian hospitals are unnecessary. They claim they themselves can monitor the patients and look after their welfare with the help of resident doctors (house surgeons) and nurses. If it is possible, why then such a big 6 years course was started by developed countries some 50 years back and why it is continuing till today? Are the healthcare authorities and governments of those countries fools and idiots? The irony is the same doctors are ready to work in coordination with clinical pharmacists in those developed countries and even in Indian corporate, private hospitals where Pharm. D graduates are appointed as clinical pharmacists recently. These selfish doctors are not only against the appointment of clinical pharmacists in government hospitals but also successfully prevented even the starting of the course in government medical or pharmacy colleges of India. That proves their motive.
Public ignorance and apathy
By preventing or detecting ADR and other services of clinical pharmacists only the patients are going to benefit but the very same patients or their relatives are ignorant of the services of clinical pharmacists! Even if some educated people are aware of it they simply keep mum or if affected vent their ire against the erring doctors through violence or go to court occasionally. Hence, Pharm. D graduates, like orphans, are fighting alone bottle without any meaningful support from any quarters. Inefficient and corrupt PCI is not able to do anything but can't the well informed, intelligent media do something for the benefit of entire society? If only all the media especially TV channels focused on this, people will start realizing how greedy hospitals and doctors are betraying them. Mighty people can be opposed only with mighty weapon - the pen - that is by educating people concerned. If the people raise their voice selfish elements will go back.
Role of IPC
For decades there were no worthwhile reports from India to WHO. Hence WHO criticized Indian government and wondered how come the second most populous country of the world with more than 1 billion people has no ADR to report! (Credit goes to those clever doctors!) Only thereafter our ministry of health has made some half hearted arrangement to monitor ADR few years back, obviously which was not working satisfactorily. Hence, now this Pharmacovigilance (PV) work is given to Indian Pharmacopoeia Commission (IPC) which is doing somewhat a better job. Appreciably they made the appointment of Pharmacovigilance officers compulsory in all drug manufacturing industries to monitor and report about their products safety after marketing. Similarly Indian Pharmacopoeia Commission should insist appointment of clinical pharmacists in all government hospitals of India. (we can guess why it is not able to do that till date).
Need and ego
Everybody including IPC knows, it is impossible to monitor the inpatients for ADR without a full time a technocrat (clinical pharmacist) nearby in the wards for the purpose. Those who argue physicians themselves can do the job are oversimplifying the work of a clinical pharmacist to just monitoring of patients for ADR. They conveniently forget, apart from monitoring for ADR, clinical pharmacists are looking for irrational prescriptions, drug-drug interaction, drug- food interaction, conducting patients medication history interview, prescription auditing, suggesting alternate drugs to treating doctors, therapeutic drug monitoring, body fluid analysis, interpretation of lab data, patient counselling and more importantly individualization of dose by many pharmacokinetic calculations. Let those doctors answer, who will perform all these works to ensure a better treatment. These duties can be carried out only by a person who is specially educated and trained for the purpose. When such a specialists are available, why these doctors wants to avoid them? It is not due to ignorance but due to arrogance and ego of doctors. They know pretty well that clinical pharmacy services are just supportive to them for better treatment of their patients and helps them to avoid future litigation, heavy monetary compensation etc. Even then why they are against this arrangement? They have so much faith in our people's ignorance and inaction!! Ultimately their unhelpful attitude prevents Indian patients from getting an expert's service and put them fully under the mercy of treating doctors.
What is the way out?
Our Pharm. D graduates and students should take the matter to top consumer court of India, if possible, through patients affected. Also we should educate consumer associations, general public and patients through sustained campaign via all media. We should also take the matter to the World Health Organization headquarters and inform them how Indian hospitals are deprived of services of clinical pharmacists. World Health Organization may come to our help, as they did earlier by criticizing Indian government for not monitoring and sending ADR report for decades. Similarly any patient affected severely by ADR or irrational treatment can file a case in High court, demanding heavy compensation from government for lack of monitoring of treatment by clinical pharmacists in India. But remember all these are just struggles towards the goal, may or may not lead to success, only the awareness and support of people will ensure Pharm. D graduates their rightful place in the Indian health care team.
(Author is ex. president, Indian Pharmacy Graduates Association, Madurai, Tamil Nadu)