Fake medicine

Dispensing is integral to prescribing

ALARM

DR. JAVID IQBAL

While the controversy over spurious drug supply to state health institutions rages, an important aspect of health care is being overlooked. It may be differently categorized; however it is high time to look at the state of our dispensing, as it is integral to prescribing medicine. Pharmacy is the place where the medicine prescribed gets dispensed.  Pharmacology denotes study of drugs--the art of compounding medicine. In the past, there were people who learned the art by experience. They were thus known as compounders. And they mixed it with gaining experience in injecting the drug, if the drug prescribed had to have the administration by Parentral route—intravenous, intramuscular or subcutaneous. An added duty was to work as a dresser. The compounder was thus a person with a multi-faceted job. Those were the days of licensed medical practitioners &/or registered medical practitioners [LMP’s and RMP’s] they would prescribe medicine. Over the years this practice was discontinued as medical science involved in the art of prescribing evolved a bigger form. Apart from prescribing medicine, providing surgical cure became an integral part of medical science. Hence imparting skills assumed a multi-disciplined form. As the annals of prescribing multiplied, so did the art and science of dispensing.
 A pharmacist is supposed to discuss the prescription with the patient, advise him fully on the take of medicine, the timing, the dosage, and the precautions to be taken if any. He is supposed to be fully equipped with the knowledge regarding the medicine prescribed and stands to answer the patient vis-à-vis the beneficial effects, and more important the side effects if any. He may request the prescriber to review the prescription, if he detects drug incompatibility. Drugs have synergetic as well as antagonistic effects, and a trained pharmacist is supposed to know that. That is what makes art of dispensing an integral part of prescribing the drug. And that is what our health care system lacks—the institutional relationship of doctor who prescribes, and the pharmacist who dispenses. The lack of what is an evident feature of medical science in advanced societies could be ascribed to absence of pharmacist with a qualification backed professional standing.         
Pharmacy Act of India allowed one time exception to register pharmacists on experience basis, as the state institutions to train pharmacists were few and far between. The exercise to register people on experience was undertaken in J&K state too. The process on completion was known as the ‘First Register’ as devised by the Pharmacy Act. Ministry of Health, GoI enforced the education regulations in 1991, labeled as ‘Education Regulations 1991’ for diploma course in pharmacy. In the year 2001, J&K government made amendments in State Pharmacy Act and issued notice inviting applications for registration on qualification and experience basis. It is noticeable that such an exercise was taken ten years after enforcement of education regulations. Two, a subsequent registration was not undertaken by any state in India except Jharkhand. The attempted subsequent registration in that state was however stopped by Hon’ble High Court of Jharkhand.
J&K’s subsequent registration might have had a valid explanation. In 2001 there were not enough qualified pharmacists in the state. Kashmir University though did have Bachelors in Pharmacy [B-Pharma] course. The turnout might not have sufficed the need of the state. However at the turn of the century many private players entered the field of paramedical sciences education. Two year Diploma in pharmacy [D-Pharma] course was introduced with State Medical Faculty supervising the academics and acing as the examining body. In addition two year diploma course for Medical Assistants was devised and called Medical Assistant/Pharmacist. Medical Assistant’s course thus entailed what the compounder of yore was supposed to perform—acting as a dispenser, a dresser, as well as getting trained in administering the injectable drug.
J&K State instead of restricting the registration for qualified persons continued to register persons with experience of working in pharmacies creating loads of subsequent registries. There are reports that thousands of such registrations have been carried out from 2001 onwards, in spite of the fact that qualified people were available to take up the delicate responsibility of dispensing. The practice has been going on during the PDP—Congress coalition as well as NC---Congress coalition. Instead of promoting pharmacies without qualified persons, qualified persons could be advanced loans to set-up pharmacies. It is no wonder that admissions to Pharmacy courses have dried up—why should a candidate opt for it, once registration could be obtained without formally qualifying to be pharmacist? The matter definitely calls for probe.
The registered persons without proper qualification might know the beneficial effects of the drug; however medical community is skeptical of whether they know the side effects. Moreover over the counter drug sale is common in the state, devoid as it stands of standard application of drug act. One of the commonest sales is of anti-inflammatory drugs like Ibruffen for joint pains, common in old age. It might relieve the pain, however might cause bleeding in a case with an associated problem of peptic ulcer—ulcer in stomach or duodenum.
The least the state could do is to stop forthwith any registration without formal qualification and devise crash courses in batches for the ones who have had registrations in the past. They are already in business and it would be well nigh impossible to withdraw registrations, it could affect families.
Yaar Zinda, Sohbat Baqi [Reunion is subordinate to survival]
Feedback on: iqbal.javid46@gmail.com        

Lastupdate on : Sat, 13 Apr 2013 21:30:00 Makkah time
Lastupdate on : Sat, 13 Apr 2013 18:30:00 GMT
Lastupdate on : Sun, 14 Apr 2013 00:00:00 IST




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