The public in the state of Maharashtra are misled by public outcry of retail chemists and druggist trade organizations (C&DTO) who are demanding to amend the drug laws to their convenience and are showcasing their demand is justified as law of the land is a draconian and does not serve any purpose of public utility. The issue is of whether the registered pharmacist should be present all the time of dispensing the prescription drugs to the patients and attendants of patients. Before we agree and express our support to the CD&TO let us ponder over, what is the issue of dispute, so that we can take an unbiased stand regarding the issue.
It is evident that all the prescription drugs carry a unique inherent risk of causing an injury to the organs and system. Some drugs are known to effect the functioning of liver, kidney, lungs, brain, heart and stomach. Others are known to interfere with blood pressure, diabetes and respiratory rhythm as well. All modern medicines are not at all safe as usually perceived. Some of the ill effects of the drugs are difficult to identify and pinpoint. Some drugs are known to induce effects on children’s yet to be born. For example a drug, by name Diethyl stillbosterol was advocated for mothers to avoid habitual abortions and miscarriages in 1960. It took 14 years to realize that DES was the cause for uterine cancer among schoolgirls and the boys had no functional testis. This led to the world wise action against common belief regarding the drug effects. Further it led to a birth to a new science called Epidemiology.
Epidemiology
The Epidemiology is the science and technology monitoring the effects of drugs, diseases and its impact on health environment. It is extensively applied to understand and manage challenges of public health. Hence, reanalyzing the potential risk most of the governments across the world made the pharmacist be the custodian of prescription drugs and shall dispense the medicine to the patients on receipt of a registered medical practitioner. This arrangement will restrict the common man on experimenting with prescription medicine in the name of self-medication. As it is unscientific and dangerous to play with medicine, in the larger interest of public health to ensure safety this has been in practice since the modern medicines were put to use. The pharmacist having a academic background and expertise in medicine is the right person to be consulted while using the medicine. In countries like USA, United Kingdom and Australia the pharmacist are the vital link between the doctors patients and nurses. They facilitate the patients by counselling them in matters of disease, drugs and life style modifications. The patients like the community pharmacist, as they are easy to access and interact. All these developments has happened out side India and in our country we remained to update and change. The other factors also prevented from updating, for example the silence of Government over the changes happening across the globe
Unfortunately the health care in India has remained doctor centric and product centric. This wrong practice for several decades has led to an atmosphere of hegemony of doctors, industry and of late retail drug sellers. The issue of establishing a transparent health care has become mirage .The government and regulators are made to yield to unjustified demand of doctors, industry and even retail drug sellers.
The doctors, especially the private practitioners are warned by their own council to exercise strict restraint while dealing with the industry representatives. They should not accept free gifts, conference registrations and any materials by which doctors are made to prescribe the brand medicine. The IMA although advocates unfortunately, their members are not ready accept. Similarly industry also tries to push their products in the market and leave no stone unturned to get their sales targets. Retail drug sellers are also ganged up and wants to sell medicines to public and earn margins of profits. They have lost the professional flavour and are on the streets demanding easy laws.
Failing health care service
All this could have been accepted provided there are no serious consequences of such practice. For example, when doctors accept gifts from company representative, the company accepts immediate returns in the form of prescriptions. Similarly industry also has to compete with their peers for the share of market. Hence, the industry is happy if the market grows. On the same grounds the retail drug sellers are happy if they have an increase in turnover. Unfortunately the patient has to suffer and in a long run the nation has to pay heavy price as result of careless treatments and unnecessary consumption of drugs. This has become a public menace and soon or later there can be public protest and huge rally against failing health care service.
Govt should curb, curtail unethical practice
The government should awake and start taking measures to curb and curtail unethical practice and demand of doctors, industry and retail pharmacist. It is not just the presences of pharmacists, but should he should be encouraged to practice pharmacy. From next year by April 2014, regular Pharm D start coming out after through training of six years from nearly 120 pharmacy college. The practice of pharmacy involves engagement of pharmacist in public health in community and clinical pharmacy for inpatients. The guidance by a qualified competent pharmacist will defiantly bring change in health care. The Pharm D holders should be encouraged to practice pharmacy in clinics and community.
The pharmacists with Pharm D are competent enough to cater the needs of the doctors, nurses and public.
(The author is with Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka 576 104)