In general 'community pharmacy' indicates a retail drug store where legally 'qualified pharmacist' dispenses medicines. This activity is controlled under Drugs and Cosmetics Acts 1940 & Rules 1945 and Pharmacy Act 1948. As per Pharmacy Act, 'Pharmacy' is a profession where pharmacist (expert of drugs) does pharmacy practice. This pharmacy profession is controlled under the Pharmacy Act, since the qualification for entering in this profession and course structure of qualified person have been prescribed in this Act. The pharmacists are considered as 'expert of drugs' by virtue of their education and training in their curriculum prescribed under Pharmacy Act. This is similar to other professions where qualified persons are engaged i.e. medical profession where medical graduates, dental profession where dental graduates, legal profession where advocates, charted accountancy where CA etc.
As per 'Drugs and Cosmetics Acts 1940 & Rules 1945' a 'drug licence' is to be obtained to set up retail drug store. The licence is being issued by State Drugs Control Administration in the name of 'qualified person (registered pharmacist)' whose name is being mentioned in drug licence also. The licence is to be displayed in the drug store at a prominent place for visible to patients/customers, since the pharmacist is supposed to supervise all compliance of Drug Rules in drug store besides patient counselling to patient during drug dispensing. As per Section 42 of Pharmacy Act 1948 and Drugs and Cosmetics Rules 1945 (related to sales of medicines), 'only qualified registered pharmacists' are specified. The Section 42 of Pharmacy Act 1948 clearly specifies 'no person other than registered pharmacist can dispense medicines'. It has been implemented from 1st September 1984 throughout our country. But due to ignorance/unawareness, it is not made effective in many places (drug store and hospitals/nursing homes even in military hospitals) which actually deny better pharmacy services to masses and failure of many health schemes of our Union govt.
For handling of medicines and to provide qualified pharmacists to pharmacy profession, pharmacy course was started in our country in the year 1932 at BHU (now IIT). At present, there are about 2000 pharmacy institutions producing more than 75,000 of qualified professionals (D. Pharm & B. Pharm) each year. Actually there is no shortage of pharmacists in our country at all. Time to time AIOCD issues misleading and baseless statements about shortage of pharmacist and to permit unqualified persons to dispense medicines in community pharmacy. Today due to advancement and 75 years of pharmacy education, the pharmacists with higher degree such as M. Pharm, Pharm. D, and Ph. D. are also available. These pharmacy qualified professionals are able to play better health care role in due to their education, provided they get proper position in health care team as per their expertises.
Medicine saves life but on misuse/wrong use it takes life
At the same time the medicines are not like groceries or stationery or paint or hardware items where only name of product reading is required to sell. Though medicines have therapeutic and prophylactic properties but are highly potent with full of toxic & side effects and contraindications for its use with even food or other medicines also. So these medicines are like double edged sword, on its right and judicious use, it saves the life but on misuse/wrong use it may take life of patient. These are associated with high risk or morbidity and mortality if used indiscriminately. Occurrence of drug induced diseases is high and often it leads to hospitalization and thus an unnecessary burden on health care costs and health care facilities. It requires special care while its handling mainly procurement, dispensing and storage besides its administration, dilution and inventory-control too. Accordingly 'warning' has been stated on label of medicines as per provision of Drug Rules. Since maximum medicines deteriorate in bad storage conditions i.e. higher temperature, sunlight and moisture. The expiry date of product is determined by conducting stability study by 'research pharmacist' in R&D lab. Accordingly proper storage conditions are prescribed for medicines on their label. Further sometimes the degraded product of medicines are highly toxic. Simple example is a common and easily available non-prescription pain killer drug 'Aspirin' tablet, on its bad storing, its degraded to chemical 'salicylic acid' which causes gastric-irritation, ulcer and bleeding. Similarly paracetamol tablet - most frequently used as pyragesic and pain killer degrades to 'para-amino phenol' which is highly liver toxic.
Further phonetic resemblance of brand names of medicines are major blunder reason for medication error during dispensing of medicines by slight wrong reading of prescription or pronouncing wrong spelling of name of medicines. Today more than 50,000 different branded products of pharmaceuticals, nutraceuticals, herbal and ayurvedic are available in the market in the brand names which are very slightly different, confusing and some time more or less totally similar, but are having totally different therapeutic category of drugs in combination. Besides this, there are many of them are under category of SALA - 'similar a like & look a like' which may cause fatal or hospitalisation of patient due to wrong dispensing at drug store to them. Simple example is 'DIONIL' - antidibetic drug and 'DIOVOL' - antacid. There are thousand and one examples of such types of branded drug products available in the market. Only a competent pharmacist can differentiate it.
Further nowadays the report of development of 'antibiotic drug resistance' in patient has become a great problem to save life of patients before physicians. It is due to indiscriminate use of antibiotics, since it is easily available without prescription by the salesman at drug store. In general people have the opinion that the person seating at drug store is a qualified person and having knowledge of use of drugs, that's why, they ask medicines for common ailments and take their opinion in health matters also. It is certain that after knowing non-presence of pharmacist in a drug store, the people would not visit that drug store. The pharmacist by sitting at counter provides 'patient counselling' and rational use of drugs to patients. Since the salary offered to 'qualified pharmacists' in drug store by the owner is very meagre. Since the drug licence is in his name and he plays professional role so he deserves a better salary. But due to meagre amount the pharmacists are not attracted to community pharmacy. On seeing the important professional role of qualified pharmacist at drug store and to ensure presence as well as to attract pharmacists to community pharmacy, Kelkar Committee (constituted by Govt of India in 1984) had recommended a token amount of Rs. 0.50 per prescription to pharmacists sitting at counter besides salary. Since Rs. 0.50 was recommended in 1984 so based on present market price a sum of Rs. 5.00 or 1% of prescription cost would be appropriate as prescription fee to pharmacist. The patients will never hesitate to pay token amount for pharmacy services since he spends several thousand by visiting a physicians and for investigations for treatment of diseases.
In view of above it is clearly revealed that a 'community pharmacy' is a 'profession' and not a trade to buy and sell medicines. The presence of 'qualified pharmacists' in drug dispensing is an essential requirement to provide patient counselling, rational use of drugs, drug safety and pharmacy services to patients for better health care in our country.
(Author is Vice President, Indian Pharmaceutical Association &
professor, Dept of Pharmaceutical Sciences,
Birla Institute of Technology, Mesra, Ranchi 835 215)