Saturday, December 5, 2020
Editorial

Dispensing drug

Pharmacy is an integral part of health care system and pharmacists are regarded as “experts of medicine”. However when it comes to our state a big question comes to the fore: Are our pharmacists really experts of medicine? In fact, we seem to have overlooked an important aspect of health care – the state of our dispensing medicine, 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 who 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 this 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 here. Today majority of people practicing pharmacy profession in our state, either in health care systems or retail pharmacy, neither have degree in pharmacy nor diploma in pharmacy. The big question is how such persons get registered as it indicates a clear violation of rules. It is quite logical that persons practicing pharmacy without studying the subjects/curriculum of pharmacy could end up harming a patient. As there goes a saying “Poison in safe hands becomes medicine and medicine in wrong hands becomes poison”. Because of unqualified persons practicing pharmacy, our people have paid the price like development of antimicrobial resistance due to irrational dispensing of antibiotics; rise in counterfeit medicines; toxicity due to dispensing of medicines having narrow therapeutic index which is at times life threatening and illegal sale of drugs having abuse potential. Here another question is: where are our qualified pharmacists? It is a matter of concern and onus lies on the state for not developing institutions of pharmacy and for not promoting pharmacy education. Another important aspect is most students opts out of studying pharmacy courses – and why should a candidate opt for it, once registration can be obtained without formally qualifying to be pharmacist? 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.

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