Why are pharmacists failing to play their part in the health system?
Drug manufacturing, quality control, storage and distribution are not child's play. So, why or how is it a norm in Bangladesh to undertake such a job without engaging experts like pharmacists?
One of the basic needs of people in the world is to get proper treatment and care for their diseases. Humans face various ailments and, therefore, need suitable treatment from birth. Thus, since the prehistoric era, doctors have had a special status in every society, including those who make medicines for treatments.
There was a time when the same person did the treatment of diseases and the manufacture of medicines. This is true even today in many traditional and old-fashioned medical practices. But with the development and expansion of the health system over time, the treatment of diseases and the manufacture, distribution and overall management of drugs took the form of two distinct branches.
In countries where the health system is on a strong foundation, an independent group of professionals and experts called pharmacists continuously work with doctors to manage these two streams of the health system.
The universities' pharmacy or pharmaceutical science departments are the factories for creating this specialist group of experts called pharmacists. Modern medicine prepares a future doctor as an expert in diagnosing the patient and prescribing medicines accordingly. Still, it is not the job of the doctors to learn or teach the vast and versatile technical knowledge required for manufacturing, quality control, storage and distribution of medicines.
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A doctor must know about medicine, but he learns it only from the perspective of treating the patient. Activities such as manufacturing, quality control, storage or distribution of drugs are not his areas of expertise. In today's world, universities' pharmacy or pharmaceutical science departments are working to produce such experts.
Suppose a doctor diagnosed a patient correctly and prescribed the right medicine, but the quality of the medicine given to the patient from the pharmacy is off the mark. Will it cure the disease?
Consider another aspect – the manufacturer has appropriately made the medicine. However, it was not stored properly in the pharmacy, so the medicine spoiled. If such a medicine is given to the patient, will it work?
When prescribing to the patient, a physician may err on dosages. They may prescribe two drugs that have adverse interactions with each other, or may unnecessarily burden the patient with too many drugs without enough ground — not only financially crushing the patient, but also at the same time prompting them to take so many drugs together that may even lead to liver damage and/or kidney failure.
If the doctor wilfully or unwillingly makes such a mistake, who will catch it? When dispensing the medicine to the patient, it is necessary to explain many things, like when and how to take the medicine – in the morning or evening, before or after a meal, where to keep it, what to do if there are any unwanted side effects, etc.
If these things are not adequately explained to the patient and they fail to handle the medicine correctly, it may either not work properly, or the patient may suffer from various complications after taking the medicine. Do you think it is possible to perform this massive task of giving such important advice to a person who does not possess expert knowledge of medicine?
Drug manufacturing, quality control, storage and distribution are not child's play. So, why or how is it a norm in Bangladesh to undertake such a job without engaging experts like pharmacists?
Ours is a very densely populated country with a vast population. As more people are here, we naturally suffer from more diseases and ailments. And we need to be more cautious in managing drugs than in Europe, America or the Middle East.
We may consider dispensing medicine against a doctor's prescription as a simple task, and we simply cannot understand why such a very simple task requires expert knowledge of medicine. We think it should be enough if you can just read the prescriptions and know the names of medicines.
Children are not aware of the combustion power of fire. So, a child can easily reach into the fire without hesitation. When we do not even understand that medication management is a very sophisticated job, how can we understand the need for a graduate pharmacist in a pharmacy or hospital?
As per the Bangladesh Pharmacy Council website, 13 public and 28 private universities currently offer pharmacy education at the undergraduate level in the country. If an average of 50 graduate pharmacists are produced annually from one of these universities, we produce more than 2000 graduate pharmacists.
While in developed countries, 80-85% of graduate pharmacists perform their professional duties in retail pharmacies, drug stores, or hospitals, in our country, about 90-95% of graduate pharmacists are employed in pharmaceutical companies. Undoubtedly, the pharmaceutical industry has grown tremendously with the participation of graduate pharmacists in the country, but the jobs in this sector have already become somewhat saturated.
So, where will the large number of graduate pharmacists being produced yearly go? As of now, a large part of them migrate to Europe, America or the Middle East. But by involving them in hospitals and retail pharmacies in this country, we could have institutionalised the country's health system.
While we would never accept a barber as a surgeon, we see no problem running a drug store with a technician who has little academic knowledge of drugs. We consider it sufficient to have, at best, a diploma pharmacist in the hospital. In some cases, we consider it redundant even. We feel more comfortable seeing a physician, rather than a pharmacist, at the top of the drug administration in the country.
Dr Mohammad Didare Alam Muhsin is a Professor and Chairman of the Department of Pharmacy at Jahangirnagar University.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
