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Say ‘no’ to inducement
  - Comment -
By: Professor Tan Sri Dato’ Dzulkifli Abd Razak
Source: New Sunday Times - May 25, 2014
   

SOME four decades ago, I made an important decision in my life — joined the first pharmacy degree programme pioneered by Universiti Sains Malaysia (USM) in the early 1970s.

It meant forgoing a year of study in the science programme to be in the more promising pharmacy course. Why not? We were among the pioneering batch at a time when the word “pharmacy” was alien to many.

Some thought it had something to do with “palmistry”; others thought it was a new breed of farmers called “pharmers”.

The vocation as a “pharmacist” was also not in vogue. The Public Services Department knew pharmacists as ahli kimia ubat, otherwise called “chemists”, operating small outlets (there were no major pharmacy chains then), literally selling medicines to the public.

The outlets also stocked non-pharmaceuticals such as toiletries, healthcare products and even cards and toys. This, perhaps, is understandable given the many misconceptions about pharmacy.

In addition, many clinics had their own dispensaries dishing out medicines prescribed by the doctors. Most of the dispensers, as they were called, were not pharmacists but rather school-leavers with rudimentary training in basic pharmacy.

There was an absence of “dispensing rights” that were important to fully develop the profession of a pharmacist as part of a bona fide member of the healthcare team.

The clarion call was (and still is) to legally instate the pharmacist’s “rights” to dispense as much as the “rights” to prescribe belong to the medical profession — with a very small gray area in between. This is the benchmark ethical practice worldwide in delivering a superior healthcare system.

Fast-forward to the 21st century, the situation is basically unchanged.

Although the practice has advanced significantly, in terms of qualified pharmacists in both the public and private sectors, the separation between the right to dispense and prescribe remains elusive.

Yet the number of pharmacy degree programmes has increased many folds; the number of pharmacy students graduating jumped by leaps and bounds.

The discipline attracts some of the best brains in the country! When I was helming USM, it was not unusual for top students to opt for the pharmacy course, making it not only one of the most popular choices but also among the most competitive.

It is, therefore, very sad to see that the professional pharmacy practice is held back in this day and age when talents are highly sought after and well-recognised.

There seems to be another barrier: the availability of a comprehensive financial system — making the enterprise even more elusive.

Meanwhile, other unsavoury practices such as the alleged “unethical practices of drug and supplement companies” exist.

This is highlighted by the campaign slogan: “Say No to Inducement to Medical Prescribers” led by the Malaysian fraternity of community pharmacists last year. Among the plan of action proposed is putting a stop to “the illegitimate source of original goods” involving what is called “runner-trade” from the original points of supply.

Another is curtailing the “upper tiers of bonuses and samples” based on large quantity of sales, but rather extending “the same price and bonus scheme to all independent community pharmacies”.

Yet another is “prohibiting all guises of price inducement or inducement to purchase” in the media — print, Internet, audio, visual or audio-visual.

In general, such practices are said to have caused differences in prices between clinics and pharmacies to a tune of more than 200 per cent more profit (in addition to the normal selling margin) for the latter.

Argubly this goes beyond the so-called “differential pricing”, bordering on corrupt practice.

Forty years on, what seems to be a “promising” vocation has not professionally delivered on its promise.

Instead, it remains vague withwhat seems to be a paralysis of action to ensure a transformation in the country’s pharmaceutical care system on a par with the rest of the world under the 1Malaysia banner of “people first, performance now”.

A statement by the World Health Organisation (WHO) categorically regards medicines as no ordinary commodities of commerce unlike most other commodities. Accordingly to WHO, medicines are “are not chosen directly by the buyer (the patient), the buyer is not always the responsible payer”.

Therefore, unless the system is ethical, professionally accountable with rigorous deterrents to inducement, people will unknowingly remain vulnerable.



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