Worrying gaps in Pharmacy Bill

Professor Tan Sri Dato' Dzulkifli Abdul Razak
My View - The Sun Daily
May 17, 2016

HEALTHCARE safeguards are vital in countries like Malaysia where awareness of healthcare related matters is not fully developed particularly with respect to rights of patients and the use of medication.

This state of affairs has been wanting despite the advent of pharmaceutical care traceable to the mid-1970s as a result of tertiary pharmacy education introduced in the country.

Since then the pharmaceutical care sector has proliferated, producing many qualified professional pharmacists. Sadly, however, the empowerment of consumer rights with regard to medicines or the respect for patients' rights did not see similar advances.

This is reinforced in the proposed Pharmacy Bill.

The bill, which has been at the drafting stage since 1996, aims to tackle lacunae in legislation on issues related to counterfeit, adulterated and unregistered medicinal products.

It is a safeguard that needs to be regularly revisited and tightened as technology and higher cost of drugs increase demand for such illicit items.

The original, albeit "incomplete" Pharmacy Bill, seemed to focus more on enhancing regulatory control at the expense of catalysing pharmacy practice.

This led to the crafting of more "draconian" clauses vis-à-vis that of the Poisons Act of 1952. This came to light recently when the key points of the bill in the final draft were revealed by the Ministry of Health, some two decades later.

Despite the long time it took to distil the best from intensive discussions and workshops held for stakeholders, input from consumers groups and professional pharmacists is still wanting. In contrast, feedback and input from the other health fraternities were said to be largely incorporated into the bill.

Not surprisingly, many participants were taken aback to see such "blatant disregard" with regard to the issuance of prescriptions as well as the concomitant choice as to where to obtain their medicines.

Likewise, consumer rights and empowerment take a back seat in contradiction to the core values like individual responsibility, affordability and community participation as enshrined in the Malaysian Health Vision.

In short, the Pharmacy Bill fails to give adequate consumer protection on matters related to medicines including the right to choice of medication, and the right to know their medicines and prescriptions.

Consumers' request to separate dispensing was "brushed aside" without any serious attempt to address the all-important issue in the context of providing more rigorous safeguards.

As such the globally proven system of doctors-diagnose-and-prescribe while pharmacists-audit-and-dispense continues to be elusive in Malaysia, although the developed nation status is just around the corner.

The universal practice that recognises the roles of doctors and pharmacists as specialised members of the healthcare team must therefore be given serious and immediate attention.

The public may want to know that in general, independent medical clinics only keep about 120 drug items as compared to 2,500 drugs kept in a typical community pharmacy. This means in clinics the choice of drugs is some 20 times less.

More than this, the Pharmacy Bill must not sideline the Malaysia Health System Research (MHSR) warning to transform as reported on Jan 26 in a Facebook posting by the director-general of health.

MHSR advised the health minister that "unless there is serious political will and national commitment to change our healthcare system, we are sitting on a time bomb as the current system will not be sustainable to meet future needs."

The bill risks going against a well-established patient-centred solution, and instead perpetuates the current system of widening health inequalities based on ethnicity and socioeconomic status.

Implicit in such actions are the failure to accord pharmacists their professional expertise in areas where they are better trained in handling medicines to elevate not just safeguards but also the quality of care in general.

This raises yet another question of promoting public awareness on the rights of consumers to empower them in managing their own care safely.

A good example perhaps is the apparent increase in the misuse of psychotropic drugs due to overprescribing by practitioners which should be dealt with by enforcing Regulation (17) of Poisons (Psychotropic Substances) Regulations 1989.

Instead this provision is said to be "abolished" in the Pharmacy Bill with obvious implications to those suffering from mental illnesses including depressed and insomniac patients.

While, some have suggested that the Pharmacy Bill as it stands be withdrawn, it is also suggestive that the bill, when all is said and done, has yet to close the lacunae that it has set to do; casting doubts in the attainment of safer and higher quality of healthcare involving medical products in particular.

This concern must be immediately addressed by all concerned without further placing consumers and patients in a vulnerable state of affairs.