The pharmacist is known as expert in drugs and is engaged from bench to bed drug development. Pharmacist traditionally acted as custodians of medicines, playing pivotal role of protecting the community from ill effects of drugs. All the synthetic drugs, natural are rich in active principles which have a potential to cause harm if used irrationally. There is a need to carry out a risk benefit analysis before a medicine is prescribed to a patient. In a model of health care delivery, doctors are supposed to diagnose and prescribe, nurse to give nursing care and administer drugs and pharmacist to dispense the drugs as per the prescription of the doctors. Unfortunately, In India due to commercial interest, the medicines are promoted as health promoting commodities. The emphasis is on consumption of drugs, to make it happen the laws and regulations are misinterpreted and governments also are involved in promoting conflicting legislation detrimental to the health care delivery.
The government of India, in its gazette notification under Pharmacy Act, has laid down the pharmacy practice guidelines 2008, which allows the registered pharmacist to deliver pharmaceutical care by practicing of pharmacy. The pharmacy practice guidelines never mentions about prescription by pharmacists. Unfortunately some state governments are announcing that pharmacists can write prescriptions, if they have three months experience with an MBBS practicing doctor. It is really a blow to the health care delivery, because how the pharmacist is able to identify the risks involved while using drugs, the pharmacists do not study extensively the basic life sciences, applied medical sciences and community health sciences which makes a doctors to lead the therapeutic team. Especially in event of emergency the pharmacist shall run for a cover as he is incompetent to handle medical emergency. Hence, changing the role does not benefit the patients who are actually the sponsors of medical treatments.
The changing roles is not only for pharmacists and doctors also practicing pharmacy by becoming dispensing doctors, having medical shops attached to pharmacy. In fact, long ago, doctors are allowed to dispense medicines to their own patients on a small scale under the provision of the law, to help the patients in non-availability of pharmacist or pharmacy. Many private practitioners are engaged in selling medicines to the patients directly by purchasing the medicines from wholesalers and manufacturers. Dispensing doctors are playing havoc with public health and are easy means for the pharmaceutical industry to push the prescription drugs in the market. The doctors, if indulge in selling the medicines, instead of treating the patients, he prescribes only those medicines, which he is interested to sell. Again an unethical liaison with pharmaceutical industry leading to widespread abuse and irrational prescribing of prescription drugs leading to great risks to public health.
The pharmacist are supposed to be a caregiver than a trader of prescription drugs. In developed countries where transparency, accountability are normal things, the health care provider are having lot of respect for the concern and care shown by them. In our country, there is no value for the pharmacy practice or care. Here the sole income for a retail shop is from the amount of drugs sold to the public. Usually a 20-30 per cent margins. To maximize the profit, the retail shop always think of selling more medicines and seldom thinks of welfare of his customer due to serious conflict of interest. Hence, majority of the chemists and druggist are interested in selling the prescription drugs with or without prescription. The generic medicines are not sold for the reason it brings less profit than the branded medicines. Although government interested to promote the affordable quality generic medicines, the brand medicines gets an edge over sale although the brand medicines are expensive than generic medicines 200 -300 times.
In such scenario, if you give the powers of prescription to pharmacist, it could lead to chaos in health care delivery and lead to increase in many fold prescription drug induced injuries to the people who received the prescriptions and dispensing from the same pharmacy trader.
Nowhere in the civilized world, are the pharmacist confronted with doctors for prescription rights. It is high time for all of us to oppose the laws allowing the pharmacist becoming the doctor or doctor dispensing the drugs.
All the available medicines are capable of causing potential harm if used indiscriminately and need to be used after consideration of risk against benefits, the golden rule for using medicine is at stake if pharmacist starts prescribing legally. Now also most of the prescription drugs are available in every part of the country for self-medication and people are asking prescription drugs from medical shops which is quite a norm in retail pharmacy. Inadequate watch and ward of sale of prescription drugs is rampant practice across the country. The pharmacy practice regulations 2008, never empowers the pharmacist to prescribe the medicines, but empowers the pharmacist to safeguard the patients from drug accidents arising due to unscientific and irrational use of medicines.
We should not forget each medicine is a technical product carrying its own classified information for using it, The doctors can never be experts in technological details of the medicines hence the need for collaborative care is the only way in which the modern medicine can be relevant to public health needs, otherwise there can be more harm than help by the modern medicines.
(Author is with Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka 576104)