The issue behind Senate Bill 1900

A few years ago, "An Act Regulating the Education and Licensure of Physicians and Their Practice of Medicine in the Philippines and for Other Purposes," otherwise known as Senate Bill 1900, caused a stir among pharmacists when an attempt to redefine the physician's roles was being "cooked" in the Senate.

If the bill passed the Senate, physicians will be allowed "to diagnose, treat, operate or prescribe and dispense any remedy for any human disease, injury, deformity, physical or mental condition."(1)

To air its position, the Philippine Society of Hospital Pharmacists issued an official statement for "A Call to Modify Senate Bill 1900." (2) The Drugstores Association of the Philippines also wrote the senate outlining its comments on the said bill. (3)

I suspect that maybe the reason why the word "dispense" found its way into Senate Bill 1900 is because of our failure to do properly what we are licensed to do.

For example, Dr. A.G. Romualdez, Jr. claimed that “here in the Philippines, until the advent of the Pharmacy Law…, most private Filipino patients obtained their medicines from the doctors who prescribed them. In most of the country, dispensing physicians were historically a big help in the distribution chain of drugs and they ensured that services were reasonably priced. Unfortunately, the practice has largely disappeared mainly because, under the Pharmacy Law, doctors were allowed to dispense only those medicines that they directly administered either by injection or inhalation or direct application to specific organs.” (4)

Now, this should be a wake up call to all of us...

________________________________

References:
1. http://www.inq7.net/globalnation/col_pik/2003/jul31.htm
2. http://www.pshp.org.ph/article.aspx?ID=5
3. http://www.dsap.org.ph/index1.php?fid=senate
4. Romualdez, A.G. Jr., MD. "Anti-poor conspiracies." Malaya 18 Aug. 2004.

Not a license to kill

"Lack of drugstore pharmacists kills patients." This is the title of an article written by David Dizon in 2002.*

It noted that "[p]harmacists play a crucial role in the process of dispensing safe and effective medicine to consumers" and that "they give valuable information that could mean life or death for patients."

Unfortunately, "some pharmacists actually 'rent out' their licenses and/or diplomas to drugstore owners while maintaining other jobs."

I don't know if we have improved already but I always tell my interns that their license is not a license to kill but a license to heal.

_____________________________

* http://uw2.abs-cbnnews.com/images/news/microsites/onddot/DavidDizon08132002.htm

Quote of the day

"I am a survivor of a concentration camp. My eyes saw what no person should witness. Gas chambers built by learned engineers. Children poisoned by educated physicians. Infants killed by trained nurses. Women and babies shot and killed by high school and college graduates. So I'm suspicious of education. My request is: help your students to be human. Your efforts must never produce learned monsters, skilled psychopaths, or educated Eichmanns. Reading and writing and spelling and history and arithmetic are only important if they serve to make our students human."

- Anonymous

An inquiry regarding PITC's legal mandate

Last November 24 I wrote the Philippine International Trading Corporation (PITC) through pitc@pitc.gov.ph asking for clarification regarding its legal mandate.* In my letter, I asked the following:

"Isn't it that under Section 10 of the Generics Act of 1988, only raw materials and not finished drug products are to be imported 'during periods of critical shortage and absolute necessity' and that the government agency authorized under that law 'to import raw materials of which there is a shortage for the use of Filipino-owned or controlled drug establishments to be marketed and sold exclusively under generic nomenclature' is the Department of Health?"

Today, when I opened my mailbox, I found out I got a reply from Mr. Steve Francis A. Roldan, PITC's Legal Officer V, and this was his response:

Thank you very much for your e-mail dated November 24, 2006 expressing your support for PITC’s efforts in bringing down the prices of medicines to benefit the majority of our countrymen. In your e-mail, you seek clarification on PITC’s legal mandate, vis-à-vis Section 10 of the Generics Act of 1988.

In response to your query, please be informed of the following:

1. Under Section 11, Article XIII of the Constitution, the government is mandated to “…adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all people at affordable cost …”

2. In order to “[r]educe by half the cost of medicines through increased and improved distribution importation through PITC and local sourcing, partnership with the pharmaceutical Industry, resolution of patent issues increased use of generic products, community based initiatives”[1] and consistent with the earlier quoted provision of the Constitution, the President issued Executive Order No. 442 on July 4, 2005, designating PITC as the lead coordinating agency to make quality medicines available, affordable and accessible to the greater masses of Filipinos.

3. PITC, as an agency under the Office of the President, is mandated under Section 1, EO 442, to “…establish retail outlets nationwide and supply these outlets with low priced quality medicines…”

As can be gleaned from the foregoing, while Section 10 of the Generics Act of 1988 authorizes the Department of Health to import raw materials for the use of Filipino-owned or controlled drug establishments to be marketed and sold exclusively under generic nomenclature during periods of critical shortage and absolute necessity, PITC’s mandate is distinct from, and is not precluded by, said Section 10.
We hope to have clarified matters.

_________________

* http://www.pitc.gov.ph/mandates.html

Dr. Kenneth speaks

Quote of the day
"Imagine a doctor who made a mistake, and then there are no pharmacists to countercheck or provide warnings to patients and consumers."
- Dr. Kenneth Y. Hartigan Go
As quoted in the article "Dispensing doctors? A controversy in the offing."Medical Observer vol. 6 no. 6 June 1997:29-31.

Doctors prescribing Cytotec

Misoprostol (Cytotec), an unregistered drug product was featured last Saturday in the television show Imbestigador (Channel 7). Although the Bureau of Food and Drugs had already issued BFAD Advisory No. 02-02, * warning against dispensing/selling and using this drug product, there are still doctors who prescribe it and, sad to say, the illegal market still proliferates (Quiapo was identified in Imbestigador).

The BFAD Advisory enjoins all concerned parties "to report to BFAD... or police authorities any information that may lead to the apprehension of persons dealing with the subject drug."

You may report through these e-mail addresses:

ntlanuza@bfad.gov.ph and tmgutierrez@bfad.gov.ph.

_____________________________

* To view the full text of this BFAD Advisory, visit the BFAD website at www.bfad.gov.ph (Click the heading "Advisory".)

MedExpress: changing the image of community drugstores

If there's one drugstore chain that is changing the image of community drugstores in the country, it is Med Express. This new retail drugstore chain "offers not only delivery and drive-thru pick-up but most importantly professional pharmacy services."*

"Medication safety issues [are] addressed by ensuring that only pharmacists will man all branches and call centers; strictly implementing a "No Rx, No Dispensing" policy; compliance packaging (patient's medication for a week is prepared in unit dose packaging); medication counselling; medication review; confidential medication profile system (a computer system that enables pharmacists to keep track of the patient's drug utilization and provide relevant pharmacist notes); and a patient compliance program (computer system that keeps track of the patient's supply of maintenance medications and enables pharmacists to monitor patient's adherence to medication regimen).

There are Med Express Drugstores in Ortigas Avenue, Mindanao Avenue and Filinvest Alabang.** Patronize this drugstore chain.

SAY NO TO DRUGSTORES WHO SELL PRESCRIPTION DRUGS LIKE CANDIES IN SARI-SARI STORES!

________________________

Source:

* "MedExpress: A New Concept in Community Pharmacy Practice." The Hygeian. December 2005.

** http://www.manilatimes.net/national/2005/jul/19/yehey/life/20050719lif1.html

http://www.mb.com.ph/issues/2005/05/16/TECH2005051634854.html

http://www.mb.com.ph/issues/2005/06/12/HLTH2005061236258.html

Second lecture on counterfeit drugs

The second lecture on "Counterfeit Drugs" for our CE last Wednesday was given by Mrs. Maria Theresa M. Gutierrez, Food-Drug Regulation Officer IV, of the Bureau of Food and Drugs.

During the lecture, she mentioned that pharmacists who want to attend conventions, seminars and similar events which require them to be physically absent in the drugstores where they are hired to work, should file a leave of absence and have it received by the owners to protect themselves just in case the owners decide to run the business without a pharmacist on duty.

She was also very accommodating in answering our questions and I was very happy that she gave me her contact number and e-mail address just in case I have something to report to their office.

To report any malpractice or violation of existing provisions of the Pharmacy Law, Mrs. Gutierrez may be reached at (0919) 430-96-49 or at her e-mail address, tmgutierrez@bfad.gov.ph

Failure as guardians of the public health

You'll never know how easy it is to buy prescription drugs in community drugstores without a prescription from a medical doctor unless you have tried it. (You can even fake the name of the patient that the drugstore clerk writes on the receipt.) And you'll never know how severe the effects of drug misuse and abuse unless you have worked in a hospital...

It only means that the laxity in drugstores is a reflection of how we have failed as guardians of the public health.

Quote of the day

Will pharmacists be covered by the Medical Malpractice Act? Go to any drugstore today without a prescription and ask the person on the counter what is the best medicine for this and that and they will sell you something. While BFAD classifies a number of medicines as over-the-counter, every doctor knows that even aspirin taken for the wrong ailment can cause a patient to bleed to death or die of an acute allergic reaction.

Or if there should be a mis-dispensing of drugs at the drugstore,who shall be liable the doctor because of his handwriting, or the drugstore clerk? It is an open secret that many drugstores are running only on the 'borrowed licenses' of pharmacists. Only a few drugstores can produce the 'pharmacist on duty' on a bright and sunny day within one minute.

- Erwin L.Espinosa, MD on his article "Legislation and the law of unintended effect" dated September 16, 2002

Considerations in generic dispensing

Michael L. Tan had written an article entitled "Generics again."* Although it was written last year, I have read it only last September. Nevertheless, I still sent the editor my feedback on the article.

Here's my feedback:

Dear Sir,

While it is true that the Generics Act of 1988 requires that consumers be informed of the choices available to them in the selection of drugs with the same active ingredient (generic name of the drug), there are cases when the dispensing pharmacist should be cautious in doing so for reasons that may have undesirable effects to the patient.

This is because, based on bioequivalence studies, there are certain drugs made by different manufacturers that do not produce the same blood levels (bioavailability) and subsequent effects to the patient.

For example, here in the Philippines, Appendix T of the latest edition of the Philippine National Drug Formulary (vol. 1 6th ed., 2005) contains a list of "Drugs Requiring Stict Precaution in Prescribing, Dispensing and Use Because of Bioavailability Problem and Availability in Philippine Market in Several Brands/Manufacturers; Prescription Must be Filled According to the Specified International Non-proprietary Name (INN) and Brand Name (B)."

I would say that if a patient was already started with a certain brand of drug that is included in the list, it is safer to stick to that brand than to obtain varying levels and effects because of switching from one brand to another brand. It may be helpful also to consult first the prescriber before attempting to change brands.

Of course, an informed consumer can start with a cheaper and still effective drug if pharmacists provide the information required of them under the law.

Two of the drugs you mentioned in your aritcle (atenolol and propranolol) are included in Appendix T of the PNDF and better control of hypertension may be achieved if only one brand of those drugs is to be taken as maintenance therapy.

Also, R.J. Taylor (a pyschiatrist), in writing to the Australian Prescriber (vol. 28 no. 4, Aug. 2005)**, said that "we should remember that we are NOT just prescribing the active ingredient when we prescribe. There is the issue of varying particle size and varying excipients that may make a difference." As an example, he mentioned that "I once had a pyschotic patient with lactose intolerance and I had to work to identify which brands (or even which strengths of the same brand) of antipyschotics were lactose free." (Lactose is used as a base in some prescription drugs and over-the-counter medications.)

Indeed, there are excipients (and other pharmaceutical ingredients) added to the active component (the drug itself) to produce a drug product (i.e., drug + excipients) that sometimes make the difference. Some of these excipients may produce allergic reactions to susceptible patients which explain why some patients are "hiyang" to certain brands of drugs having the same active ingredient.

I am also in support of the Generics Act but these are two of the exemptions which I think should be remembered in choosing cheaper generic drugs over certain expensive branded drugs."

pinoypharmacist's note: I have limited knowledge in pharmacokinetics and biopharmaceutics. If there is anything that is not correct regarding my understanding of the subjects, kindly inform me. It shall be greatly appreciated.

_______________________________

* http://news.inq7.net/opinion/index.php?index=2&story_id=53269
** http://www.australianprescriber.com/upload/pdf/articles/695.pdf

What's wrong with an official receipt and a piece of paper?

One of the drugstores that I have recently reported to the Regulation Division I of the Bureau of Food and Drugs had issued me an official receipt with a different address of the drug outlet (probably that of the other branch) for prescription drugs which I purposely purchased without a prescription. (This was not the first time I have encountered such malpractice.)

On another occasion, the same drugstore issued me just a piece of paper as receipt for my purchased medicines. So, aside from reporting this drugstore to the BFAD, I also reported to the Bureau of Internal Revenue through no-or-complaint@bir.gov.ph. This is where complaints on non-issuance of Official Receipts (OR) by business establishments are being reported to the BIR.

Quote of the day: On deterioration of pharmacy's social standing

"Regrettably, most of those who use pharmacy to advance their own aims and many pharmacists have as their mission the accumulation of wealth. Once taken up, that goal obscures every value the professional holds dear: standards of excellence are eased to accommodate profit potentials, the sense of responsibility to community and profession is undermined, rules of conduct are relaxed, efforts by management to ease entry into its educational system become apparent, and its social standing begins to deteriorate."

- R. David Anderson

Not without a prescription

I was on my way home from the supermarket last Monday morning when I met a kababayan along the way.

She asked me if I can buy a certain drug product for her hypertension in the hospital pharmacy where I work since the price there is cheaper.

I asked if she had a prescription and she replied, "Wala. Kilala ka naman doon."

I learned that the last time she had a check up and diagnosed with hypertension was 2 years ago. Since then, she has taken the drug product every time she feels dizzy which she thinks is due to hypertension.

I advise her to consult a doctor again and assured her of my assistance to buy her medicine if she already has the prescription.

Quote of the day: On implementing pharmaceutical care

"Are pharmacists willing to provide pharmaceutical care and do they have the capabilities to do so? In fact, many pharmacists have been providing elements of pharmaceutical care for years, but they may not have been consistent or systematic in doing so, or they may not have been documenting their patient care activities. Individually, each practitioner must address his or her own degree of willingness. Implementing pharmaceutical care is not easy, and pharmacists need to establish their own motivations for providing pharmaceutical care to their patients. This effort can be extremely challenging; yet by taking small steps forward, pharmacists can overcome many obstacles to converting their practices to the new philosophy."

- Randy P. McDonough

Source: Intervention to Improve Patient Pharmaceutical Care Outcomes.

Journal of the American Pharmaceutical Association. Vol. NS 36 No. 7

(July 1996) 453-466.

A forwarded message about MedExpress

This is a forwarded text message sent by one of our interns:

IT'S ALL ABOUT TIME!
Have your medicines delivered right at your doorstep!Just give us a call at (02) 6343333...
Our on-line licensed pharmacist will take your call...
Another first from MedExpress, the 3 in 1 drugstore!
Breakthrough services for your ultimate convenience...
Pls. pass this message and let your friends experience the MedExpress services...
MedExpress also offers the following services:
1. Patient compliance program
2. Confidential medication profile
3. Medication counselling
4. Daily dose pack

MedExpress also caters walk-in and drive thru customers, just give us a call at (02)6343333 and know more about us.

Quote of the day: On type of pharmacist of the future

"What type of a pharmacist do we want to graduate?... The pharmacist of the future should not only be knowledgeable, creative, and an effective communicator but also be a motivated professional ready to learn new concepts and function as a team player. Keeping these attributes in mind, we must think beyond time spent on education and training; quality not just the credit hours of our courses, should be evaluated. A teacher should demonstrate an enthusiasm and excitement for the subject, genuine concern for the student, and a process of learning the material. The students should learn how to raise and answer important questions. An intellectually stimulating session can produce larger payoffs than simple one-way transfer of facts. It is my experience that once students become enthusiastic about the subject matter, they work hard to learn both within and outside the classroom."

- Milap C. Nahata

Issues Facing Clinical Pharmacy Education for Undergraduate Students. DICP - The Annals of Pharmacotherapy Vol. 23 No. 3 (March 1989): 250 - 251.

Try mnemonics

To istine:

Try MNEMONICS - a technique of improving the efficiency of the memory.

For example, if you were asked what is the major intracellular/extracellular cation, just think of PISO -- Potassium In, Sodium Out!

A friend and colleague of mine once told me not to assign new interns in her area during weekdays. Before I misinterpret her request, she was quick to explain that she has a deadline to meet and that she may not be able to give a thorough orientation to them. So, we agreed to assign new interns on Saturdays when her workload is lighter.

For more than a decade now that I work with her, she is known for not giving "half-cooked" orientation to interns and new employees and feels guilty when she does.

QUOTE OF THE DAY

"Under the Generics Act of 1988, the pharmacist is not only a dispenser of drugs. He is also a teacher; he has been given the responsibility of informing the consumer what are the available generically-equivalent drug products and their prices. To discharge this responsibility properly the pharmacist himself must be professionally competent and must also be well-informed on the provisions of the Generics Act and the current developments in the pharmaceutical field."

- Quintin L. Kintanar, M.D. Ph.D.

former Assistant Secretary for Standards and Regulation

and Director of the Bureau of Food and Drugs

Here's my feedback to the article "PHAP answers PCIJ's questions" (Malaya, Sept. 29, 2006)* sent to malayanews@yahoo.com:

Dear Sir,
I agree with the statement of the PHAP that "to reduce medicine prices, the government has to strictly implement the generics law."
We often point to the pharmaceutical companies and doctors as to why the law has failed to bring down the prices of medicines.
I think that the success or failure of such law is also right at the counter of every drugstore or pharmacy where pharmacists are required NOT to fill prescriptions that are not in accordance with the said law [DOH A.O. 63 s. 1989 Section 4 (4.1)].
That pharmacists, aside from being required to "inform every buyer on available products that meet the prescription" [Section 5 (5.4)], are also required "to report to the nearest DOH office cases of violative, erroneous, and/or impossible prescriptions within three months after receipt of such prescriptions." [Section 5 (5.7)]

___________________________

* http://www.malaya.com.ph/sep29/edreader.htm

Last Wednesday was our Continuing Education (CE) Lecture and the topic was about "Counterfeit Drugs." We had as our lecturer the Chief of the Regulation I Division of the Bureau of Food and Drugs, Mrs. Nazarita T. Lanuza. She was very accommodating in answering our questions after the lecture that she encouraged us to ask more questions even if these were not related to the topic anymore.

I was given the chance to ask several questions and because we were already going over time, I finally asked if we can report or complain to her e-mail address that was on the last slide of her lecture. She smiled and told us that it was purposely included in the lecture to encourage us to report or complain directly to her office. She even gave us her mobile phone number.

_________________________________

pinoypharmacist's note: To anyone who would like to report drug establishments and outlets selling counterfeit drugs or are violating existing pharmacy laws, you can e-mail Mrs. Lanuza at ntlanuza@bfad.gov.ph or you can call or text her at (0918) 6980842.

It's nice to see previous interns especially when you discover that they are doing good in their chosen field. There are some, however, who seem to be losing their professional values despite their school, talent and intelligence.

For example, I've talked to a brilliant young doctor who happens to be a former intern of ours. During our conversation, I have mentioned that I've been keeping myself away from sponsorship of pharmaceutical companies in attending conventions, symposiums, seminars and other related activities. It's because these company expenses are eventually added to the prices of their drug products.

He replied by saying,"If we will not take it, others will. So, we might as well take it."

So, the next time I met with our interns I wrote on the white board one of my most favorite statement from R. David Anderson just before they came in because I find it relevant in our time:

"...Pharmacy's practice component is losing its control over the breeding of pharmacists; unfortunately, hospital pharmacy has never exerted any effective control at the undergraduate level. Entry into the profession is largely regulated by the colleges of pharmacy, though they frequently plead for assistance from alumni and practitioners. Students are selected primarily on the basis of grades and the ability to meet demanding curriculum requirements. Little, if any, attention is given to identifying and rejecting those who would violate professional ideals and morality."

I told the incident to the interns without explaining what was written on the board. I just hope that they got the message and do something about it in their time.

_________________

pinoypharmacist's note:R.David Anderson's Harvey A. K. Whitney Award Lecture can be read in the American Journal of Health-System Pharmacy vol. 61, Nov. 15, 2004 issue (p 2373-2379).

Our interns from Isabela (there are 8 of them) left me a personalized mug as a token of appreciation shortly before they went back to their province. Unfortunately, I didn't have the chance to thank them personally since it was my day off.

Anyway, GOOD LUCK TO ALL OF YOU, GUYS! I hope that we were able to meet your expectations.

I am a Pharmacist

<> I am a specialist in medications

I supply medicines and pharmaceuticals to those who need them.

I prepare and compound special dosage forms.

I control the storage and preservation of all medications in my care.

<> I am a custodian of medical information

My library is a ready source of drug knowledge.

My files contain thousands of specific drug names and tens of thousands of facts about them.

My records include the medication and health history of entire families.

My journals and meetings report advances in pharmacy from around the world.

<> I am a companion of the physician

I am a partner in the case of every patient who takes any kind of medication.

I am a consultant on the merits of different therapeutic agents.

I am the connecting link between physician and patient and the final check on the safety of medicines.

<> I am a counselor to the patient

I help the patient understand the proper use of prescription medication.

I assist in the patient's choice of nonprescription drugs or in the decision to consult a physician.

I advice the patient on matters of prescription storage and potency.

<> I am a guardian of the public health

My pharmacy is a center for health-care information.

I encourage and promote sound personal health practices.

My services are available to all at all times.

<> This is my calling <>This is my pride

_________________

Source: Pharmaceutical Dosage Forms and Drug Delivery Systems, 6th ed.

Recently, I was lucky to be chosen as one of the participants in a Post Graduate Course in Occupational Health and Safety. On our last day, one of the topics discussed to us was about drug and substance abuse. Our course coordinator and lecturer is a softspoken and kind doctor of medicine who told us that the subject was part of a commitment she made years ago in campaigning against illegal drugs.

During the lecture (and much to my embarassment), she commented on the laxity of pharmacists in our country in dispensing regulated drugs as compared with other countries where pharmacy laws are strictly implemented.

I learned later that 2 of my classmates in that course are pharmacists who are now doctors of medicine. So, I wonder if they are as embarrassed as I am with that comment.

It is unfortunate that while I have just included in the orientation of interns the BFAD Advisory No. 00-04 "Warning against dispensing expired drugs," an intern reported to me an incident that happened in one of our dispensing outlets whereby a donated drug that was already expired was dispensed to a doctor who said "pwede pa yan" to the pharmacist.

I was able to talk to the senior pharmacist of the area who confirmed the incident and told her I will send a copy of the advisory and news report of similar incident from another hospital* and requested that she retrieve the drug as soon as possible.

I also reported the incident to the supervisor who made follow up for the retrieval of the drug. Luckily, the drug was retrieved and not administered to a patient.

This incident happened despite existing procedure on monitoring expiring drugs in our dispensing outlets.

______________________

* http://news.inq7.net/nation/index.php?index=1&story_id=16683

Today I read in The Manila Times (October 26, 2006 issue) an article entitled "Public told to report doctors insisting branded drugs."* After reading the article, I decided to write to the editor. This is what I wrote:

Dear Editor,

... I agree that "the skyrocketing cost of medicines in the country may be partly blamed on the continuing practice of some doctors of disregarding the generic drugs in favor of the branded ones that are usually endorsed to them by sales representatives of various pharmaceutical companies."

It should be noted, however, that PHARMACISTS ARE REQUIRED NOT TO FILL VIOLATIVE PRESCRIPTIONS (i.e., those written in brand names only) and that these "shall be kept and reported by the pharmacist or other interested parties to the nearest DOH office for appropriate action." (DOH Administrative Order No. 63 series of 1989). Failure of the dispensers and drug outlets to report violative prescriptions within three months after receipt of such prescriptions" is a violation of the said Administrative Order that may be sanctioned by "suspension, or revocation of the license to operate the drug outlet by the Secretary of Health" and that "professionals directly involved in the violations shall be recommended by the Secretary of Health for appropriate administrative sanctions by the PRC."

________________________

* http://www.manilatimes.net/national/2006/oct/26/yehey/prov/20061026pro5.html

To get a picture of what is happening in the way we practice pharmacy, I have been encouraging pharmacy students to write about their internship experience. Early this year, I finally got one from among our long-term interns. She had her short-term internship in another hospital and this is what she wrote:

I am a student of (name of school)... I have chosen (name of hospital) as my hospital minor internship expecting that... it would expose me to various cases that entails the application of my knowledge in pharmacy. Unfortunately, I was disappointed.

From our university, they accepted 20 students to have their internship, aside from students in other universities. In my perception, the number of students is not a question if only the pharmacy could accommodate all of us, but it seems that the large number of students would not purposely teach us but instead formed a crowd and hindrance inside the pharmacy.

Our major daily activity was to [dispose of] expired donated drugs. I agree that it was part of the proper disposal and management of drugs, however bulk of expired medicines were disposed due to their control of dispensing of these medicines. As I observed, there are drugs that are still available and yet they told the patients that they have none and should buy the medicines outside. This system of dispensing could be the cause of bulk of medicines stored, disposed and did not serve its purpose.

Once I was assigned [to] a night shift from 6 PM to 6 AM. The pharmacy [was] open 24 hours daily but the pharmacists on duty did not attend to [their]... responsibility by sleeping after 10 o'clock. As a result, the students could creep easily outside the pharmacy... [non-pharmacy personnel could get inside and may [steal] items that [may be] used [for purposes] unknown to me.

The issues [that arise] from the things I mentioned above are only part of my experiences in the said hospital but as I have talked to students from [another] university who were interns prior to my stay, said that there was a case that they were asked to erase the expiry date and dispensed it to patients. I understand, a six months allowance of the real expiry date is acceptable but I [am] opposed to the idea that the patients are not receiving the proper medication they needed.*

... I am [concerned] with [the] succeeding batch [of interns] that would experience these things. Supposedly, the ideal practice [taught] in... school should be the system in the field of work. [Although], I could not blame if in the... hospital like (name of hospital), cases like this happen because I know it could be lack of fund in the part of our government. However, there are news I received from my schoolmates that other hospitals have common idea about the internship, that we are tasked to clean the pharmacy, buy them favors to earn the hours we need and enclosed to clerical works than learn the pharmacist's responsibilities.

I am appealing not for my personal interest but for the succeeding students and future pharmacists and for the patients who could [hardly] buy medicines but [were victims] of [self-interest] of higher intellegence.

I would like to [address] this problem for the upliftment of our pharmacy course [and] to be known as part of the health care team and to improve the quality of pharmacists here in our country.

As a student, I have already talked to our internship [coordinators] about this issue and they agree not to recommend the said hospital for internship. They can only monitor the activities of the student through activity reports as always but I guess the problem [is] deeply rooted from the pharmacists today that tolerated the students not to learn the essence of discipline in the field of work.

I am blessed that I have been accepted as an intern in your institution... I hope other hospitals have the same internship program, have the same concern and appreciation to interns and the same protection of the welfare and interest to our course.

_________________

pinoypharmacist's note:

* The Bureau of Food and Drugs has already issued BFAD Advisory No. 00-04 dated May 10, 2000 "Warning against Dispensing Expired Drugs." For the full text of the Advisory, visit the BFAD website at www.bfad.gov.ph

Last year, I made a comment on an article that was featured in the April-June issue of Health.Care magazine. Surprisingly, my comment was published in the "letters to the editor" section of that magazine sometime in July 2006.

Here is what I wrote to the editor:

I just would like to comment on the article "Unibranded medicines: Affordable Treatment for Better Health" which appeared on the April-June 2005 issue of the Health.Care (vol.3, no.2, p. 50).

It is true that "a lot of patients are not aware...that failure to complete their antibiotic treatment may contribute to bacterial resistance". However, patients' awareness to the proper use of antibiotics should be provided by health professionals as part of the entire health care plan (e.g., during consult with a medical doctor, at the time the antibiotic is dispensed by a pharmacist and when a nurse administers the drug).

A patient who is not properly informed about his or [her] medications reflects a discrepancy in the quality of health care provided by health professionals.

It has been said that improper antibiotic use is prevalent in the Philippines and "is a result of misconceptions, financial constraints, prescription recycling and widespread self-medication." (1)

As a pharmacist, my concern regarding the inappropriate use of antibiotics is about "the practice by pharmacists and drug sellers of conducting transactions without a prescription [that] unfortunately reinforces the behavior". (1)

I really feel that we "strictly implement the Pharmacy law" and "restrict over-the-counter availability of antimicrobials". (2)

A patient who has no access to antimicrobials (or any other prescription drugs) over the counter has a lesser chance to self-medicate. There will be no prescription recycling if pharmacists retain prescriptions that are fully filled.

This should be the pharmacist's contribution to affordable treatment to better health.

_____________________

References:

1. "Improper antibiotic use prevalent in Philippines." Philippine Daily

Inquirer 9 Jan. 1999, Sec D:3.

2. Carlos, Celia C. "The problem of antimicrobial resistance:RDU Update vol.4 No. 3 1995:1-4.

Last month four interns gave me a gift I will never forget. It was a beautifully framed prayer which they gave out of their appreciation for the opportunity and memorable experience they have in our institution. (Well, you know who you are!)

Sometimes I feel guilty for not having enough time to guide them during their internship because of my busy schedule and workload but I hope that the little things I shared with them they will not forget.

I also hope that once in a while, whatever it is that they will be doing in their professional life, they will still have time to say...

A PHARMACIST'S PRAYER

O God, great Master

Of the healing arts,

Bless my slow unwieldy hands;

Make skilled and sensitive

My fingertips for all demands;

As counter for disaster,

Fill my mental starts

With keenness; let me live

That other lives may through

Deft Medium of my science,

Pursuance find in health.

Let each capsule that I count

Yield strength rewarding wealth;

Each ointment for appliance,

In all and each amount

Be healing prayer.

Let me ne'er forget

Thy generous Providence

Held within my trembling hands.

Help me justly execute, dispense.

And be cautious of my ware --

And while Life's hour-glass yet

Runs, with the doctor guide its sands.

Place within my heart

Alert and wholesome fear,

Lest I misweigh a single grain,

And Death comes stalking from my shelves.

Make impotent limbs to walk; pain

And sorrow's counterpart

With my potions disappear;

And God's give Hope unto themselves.

- Sister Mary Juanilla, O.S.F.

In 1999, I was invited to talk in a class of Pharmacy students about the "Problems and Prospects of an Improved Hospital Pharmacy Practice in the Philippines." I refused the invitation at first because I know that I am not in the best position to speak about the subject matter. The students, however, begged that I give them my time or they might fail in that subject. I finally agreed.

The discussion was informal. Their professor was there, too. Most of what I told this class was based on my personal experience, observation, reading and interaction with pharmacy interns. Nevertheless, it was still not an expert's opinion.

The students later asked for a summary of what I discussed with them. I have already forgotten what I wrote. I don't even remember where I keep the copy but early this year I found it somewhere in one of my files. This is what it says...

The greatest challenge facing hospital pharmacists in the Philippines today is the establishment of a clinical pharmacy program that is comparable to the standards of other countries where clinical pharmacy has reached a level of maturity.

The current concept of pharmaceutical care all over the United States further overwhelms our pharmacists in hospital settings.

The problems confronting us are many and any attempt to improve our present status is not easy. It greatly depends on the attitude of every practicing pharmacist.

The fact is, we lack skilled pharmacists for clinical functions. "If we can just see the problem and admit to it, we can fix it..." (Bleech and Mutchler)

More so, the future of our profession (at least, in our country) will be influenced also by the way we educate our future pharmacists.

The qualities of our graduates, according to Milap C. Nahata, a doctor of Pharmacy, should be the following:

1. knowledgeable
2. creative
3. effective communicator
4. motivated professional who is ready to learn new concepts, and
5. must be able to function as a team player

The probable future (i.e., the prospect/s) of a more advanced hospital pharmacy practice in our country will find our pharmacists actively and directly participating in patient care with other health professionals in a clinical setting if decentralization of our medication distribution system is applied...

We have to improve on our medication distribution system with emphasis on our unit dose drug distribution. I consider it an effective first step in bringing the pharmacy service closer to its clients. How to keep it even closer is another [step].

We have to remember that "many administrators as well as other professionals view drug distribution as the primary reason for a pharmacist's existence and poor performance in this area can undermine support for all other pharmacy programs."

Whether we admit it or not, support from outside the boundaries of pharmacy practice is vital. We need it even more towards pharmaceutical care, the future of clinical pharmacy.

Support is our first requirement if we must meet the challenge of pharmaceutical care. It is best exemplified by establishing a program that focuses on the improvement of the current systems in clinical pharmacy. Such program should consider not only the type of training and education, but the time a staff pharmacist should spend in a given clinical area, and entirely functioning as a clinician. Exposure and experience are provided in this setting and would facilitate greater advancement in the learning process.

Lack of incentive is often a problem in encouraging staff pharmacists to pursue further training. It is another hindrance to the concept of pharmaceutical care and is one of the major reasons why pharmacists are still reluctant to embrace clinical functions.

Availability and access to technology that would render the fastest, most accurate and up-to-date delivery of information will enhance the capability to provide pharmaceutical care. The establishment of a comprehensive and reliable drug information service is not only necessary but truly indispensable to its application.

Standardization in the practice of our profession should be made visible. The lack of it prevents pharmacists to view themselves on a professional level that encourages re-evaluation of systems that might drastically change the ever-existing picture of pharmacists as mere sellers and/or providers of medicines.

The present status of clinical pharmacy in the Philippines badly needs some overhauling before meeting the challenge of pharmaceutical care. The call for change is addressed not only to practicing pharmacists in hospitals, but in other fields within the pharmacy profession, especially in the academe.

What future pharmacists need is an improved curriculum that permits in-depth and hands-on training and not just concepts presented and confined within the classroom.

The demands of students for improved teaching methods, modernized technical facilities and upgraded reference materials, among others, should be taken into consideration. Pharmacy interns, either in community, hospital or pharmaceutical laboratory, are continually dissatisfied with their training. Some are even doing activities that are totally irrelevant and far less important to the practice of pharmacy. I believe that the change should make its mark in the way we educate our future pharmacists and how we view this profession in general.

"Success in clinical pharmacy can only come about by change in atttude and by the ability of the pharmacists to communicate with members of the health care team." This is still true in the concept of pharmaceutical care. If we are dedicated to the advancement of pharmacy practice in our country, our contributions to the present trends will make it a reality.

_______________

References:

1. Bleech, James M. and Mutchler David G., Let's Get Results, Not Excuses! Hollywood: Lifetime Books, Inc., 1997.

2. Brown, T.R. and Smith, M.C. Handbook of Institutional Pharmacy Practice, 2nd ed. Baltimore, MD: Williams & Wilkins, 1986.

3. Bailey, David E. and Plein, E.M. "A study of clinical pharmacy practice in a small private hospital," Lippincott's Hospital Pharmacy, vol. 5 No. 8 (August 1970): 5-14.

4. Durgin, Sr. Jane and Hanan, Zachary. Pharmacy Practice for Technicians. New York: Delmar Publishers, Inc. 1994.

5. Nahata, Milap C. "Issues Facing Clinical Pharmacy Education for Undergraduate Students." DICP: The Annals of Pharmacotherapy, vol 23 no. 3 (March 1989): 250-251.

Last week I saw an ad posted at the counter of a drug outlet near my house. It reads "WANTED: Sales Clerk. High School Graduate -- Stay-in." I shook my head at the sight of it and thought why things like this still happen in the way we practice pharmacy.

While our foreign counterparts have licensed pharmacy technicians, we still settle for the services of high school graduates who have no or little pharmaceutical background. Not to mention that we also have colleges and schools of pharmacy that offer pharmacy technician course. What's worse about it is the fact that these sales clerks are left alone in most drug stores without the direct supervision of a licensed pharmacist.

A few days ago, I posed as a customer of this drug outlet. I was able to purchase one tablet of captopril 50 mg without a prescription and two tablets of aspirin 80 mg. To check if I'll be given the right information, I asked if the captopril tablet can be divided since what will be needed is 25 mg per dose. (The truth is, I later donated the drugs to our patients in the ICU.) She replied in the affirmative. But when I asked if both drugs can be taken at the same time, she nodded her head without looking at me.

I know she was not sure about her answer but did not bother to call the pharmacist. I don't even expect the pharmacist to be there at 6 AM, anyway!

I have already filed a complaint against this drug outlet early last year for not having a full time pharmacist who will supervise during business hours. Although BFAD has acted on it by referring it to the DOH Center for Health Development, I am still waiting for the report regarding the latest status of the complaint.

In the meantime, I wonder how many will still get wrong information about the drugs they buy from this drug outlet...

Yesterday I saw a familiar face on the ground floor of the hospital where I work. She was a former head nurse of the ICU where I was assigned way back in 1995 or 1996. She did not see me so I rushed to her and after some exchange of pleasantries, she mentioned that she is now based in the province working also as a hospital nurse.

In our conversation, she commented about the pharmacists in their hospital. "Iba talaga," she told me. "Here we can easily ask you anything about drugs, like incompatibilities, and get answers. Doon wala...wala talaga silang pakialam. Probinsya kasi."

She is presently in Manila to train in the toxicology unit of our hospital along with other nurses from the Visayas and Mindanao areas. So I told her that they may have to train here also. It was nearly her time to report for the training so I bid her goodbye hoping that I will meet her again before she return to the province.

Later, I shared this encounter with my colleagues and although they were quiet amused by the way I mimic her remarks (with matching provincial accent), at the back of my mind I knew I felt uncomfortable about what she said.

As I travel to get home that night (I was in the bus), I reached for my pen and notebook, gathered my thoughts and record this experience. I hope that by writing this and posting it in my blog I can leave to the readers something to think about.

Nevertheless, it's really a great feeling to realize that we were able to gain the trust and confidence of the nurse we have worked with in the past. What's more about it is the recognition that we were their partners in caring for their patients in the ICU. They did not forget...Neither will I.

WELCOME TO pinoypharmacist!!

I hope that I will not bore you to death in visiting this site. If you're a student or someone who is lucky to have your "professional" license, it is my hope that you will not find what will be written and featured here as something irrelevant to your present state of mind. I assure you that you will find here some unconventional and unexpected approaches in dealing with the subjects in pharmacy and your curiosity might be awakened in every step of the way.

But before anything else, I will apologize for the unusual attack that may arise from the pages of this site. This is not to say, however, that I've learned to hate this profession and regret to have practiced it since 1992.

On the contrary, I have learned to love it more than most of those that I've known in my professional life. I have also learned to appreciate the efforts of my colleagues who, even though not recognized in the mainstream, were like heroes that marched and brought Pharmacy practice in the Philippines to a higher level in their own unique way. Their stories (and mine, too) will be written on this site.

So what is pinoypharmacist all about?

Pinoypharmacist is about putting heart and soul to the Pinoy way of practicing Pharmacy. It is about aspirations, experiences, frustations and opportunities. It's about sharing of ideas, of learning and unlearning. It is about facing the realities of our profession and taking actions to correct and improve it.

Most of the time we will be challenged by the pinoypharmacist. We can choose to ignore it, contemplate on it, or just laugh about it. We can even talk about it. And at the end of the day, what we will have then, we most likely deserve.