All India Organization of Chemists and Druggists (AIOCD) observed one day bundh on 14th Oct, 2015 opposing permission to start online pharmacies in India. In the last few decades info explosion has exploded many things via internet, pharma retail cannot be an exemption. Nowadays anyone can order anything online and it will be delivered at their home. Such is the scientific development we face. Naturally its extension is online pharmacy through which you can get your medicine too, at your home after ordering online. But is it the same getting consumer electronics or textiles or groceries and drugs online? Let us evaluate.
Difference between drugs and commodities
Drugs are potential chemicals, if not used properly can harm the users. Hence, consumption of drugs requires physical examination, prescription, supervision, correction or stoppage prior to or during its use. Obviously all other commodities require none of the above while ordering or using. That makes the big difference between them. Misuse or abuse of drugs may kill the consumer and/or harm the society he lives in. Can we say the same for commodities? Then how come the idea of online pharmacy gained ground?
Reasons for concept of e-pharmacy
Though drugs are under the control of government departments from its manufacture, import and export to distribution in all the countries, the degree of enforcement of acts and rules is a big question mark which varies drastically between the countries. It is some what better in developed countries to very bad in least developed countries. Thus there is shortage, uneven distribution, non- availability, huge difference in price and difficulty in getting prescription, etc, which all lead to the concept of online pharmacy. There are growing numbers of destitute, disabled and aged peoples in all countries, who have nobody to help or look after. For such people online pharmacy is god sent to get their medicine requirement. That apart, there is one more advantage of big discount on price, online pharmacies are offering, which are tempting even the people who can visit pharmacy to get their medicine. Thus convenience and commerce has pushed the concept of e-pharmacy to the front row.
Pharmacist's service
When this author started listing the advantages of purchasing drugs from the hands of a pharmacist, a net addict, IT employee neighbour immediately countered, “Where is the pharmacist in the shop? Who gives counselling or advice or answer questions in the pharmacy as you said? In which world are you living?” He said it is one and the same to purchase from the pharmacy or online where too you are not getting [or not expecting?] services of a qualified pharmacist. It exposes the big hole in the drugs regulation in our country. Unless we ensure the presence of pharmacist [better a graduate pharmacist] and offer services like, counselling, advice, guidance, clearing doubts, maintaining patient medication profile etc by him, general public are not going to support opposition to online pharmacy. Majority of Indian patients have, till to day, not enjoyed or benefited by the services of qualified pharmacists in medical shops, hence they think they have nothing to loose. What the AIOCD is going to do about it? Many of its members have even opposed compulsory wearing of white apron by their pharmacists earlier. Thus identifying pharmacist itself a problem in our Indian pharmacies, leave alone questioning him. Hence, corrections have to start from within. Nevertheless we have the duty of educating the people about dangers of online pharmacy.
America and online pharmacies
Even USA with well developed FDA is struggling to control the online pharmacies. US FDA website warn in its ‘I want to know my online pharmacy’ page that there are thousands of fraudulent pharmacies on the internet. It says “According to the National Association of Pharmacy, only 3% of more than 10,000 online pharmacies reviewed comply with US Pharmacy laws. This means if you search for online pharmacy most of the results are likely to be fraudulent pharmacies. Further more, these websites can be so convincing that any one can be the victim to online pharmacy scams.” This apart there is an appeal in that website to health care professionals to encourage patients to shop only at pharmacies licensed by their state board of pharmacy, rather than buying online. It also points out that patients are more informed when in direct contact with doctors and pharmacists.
Dangers of e-pharmacies and warnings
Jane E Henney, commissioner of Food and Drugs, US FDA, in a speech to healthcare providers sometime back has listed the dangers and problems of e-pharmacies. He said permitting e-pharmacy will lead to Direct to Consumer advertisements in media that will promote self medication among the people. We know the dangers of self medication: misuse, abuse, drugs addiction, drugs resistance, permanent damage to body systems, death, suicide or even the murder… the list is endless. Jane has also pinpointed another danger of jurisdiction over the e-pharmacies. How to control e-pharmacy operating from another country is a big problem, he warns. There is a chance for counterfeit, substandard and spurious drugs easily flowing into the country. Well, even after so much warnings if e-pharmacies are permitted in India, what to do?
Advice to patients
US FDA gives the following advice to the patients: It says patients should not purchase from e-pharmacies,
1] If they offer to prescribe [and supply] for the first time a prescription drug without a physical examination
2] If they sell drugs not approved by FDA [Drugs Control Department]
3] If they do not offer the opportunity to question of a Registered Pharmacist
4] If it require the consumer to link to another website to purchase the drug and
5] If they do not provide [US] phone number and address to contact for questions.
We should spread this warnings and advices among our people, especially among net addicts, by pamphlets and posters displayed in all pharmacies. AIOCD should lead and do the needful.
Apart from the above very important point to be noted is India is not yet ready to absorb the luxury of e-pharmacy. If online pharmacies are available in developed countries means: Almost entire population of those counties is well educated for many generations, so that they cannot be cheated easily; Majority of them are under Govt or private insurance cover; Poverty, corruption, social indifference etc, are under control there; Consumer vigilance is at its peak in those countries [compensation for damage goes to millions of dollars!]; They have well developed and well equipped Drugs Control Department throughout the country to check and punish the culprits; Healthcare sector is strictly regulated and well developed with phone or online consultation, video conferencing facilities etc [All useful to control damage or in emergency] above all; Medication profile of almost all patients and even their family members are digitalised and maintained by pharmacies and hospitals in those countries. They are available for verification at anytime by any healthcare provider on request.
Hence, India should achieve all the above first and then permit e-pharmacy. Pass SSLC first before seeking enrolment in MSc! India should not behave like a foolish cat that branded its body with hot rod to look like a tiger!!
(Author is ex. President of Indian Pharmacy Graduates Association, Madurai)