Have we really gone heartless?

Some members of the Sigma Rho fraternity are on hot seats nowadays for the alleged hazing of UP Public Administration student, Cris Mendez, that resulted to his untimely death.

This is not the first time that we hear of senseless deaths involving campus fraternities.

And to think that these fraternities are composed of supposedly educated individuals!

The truth is, I am now reminded of someone who had written, "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."

What about the pharmacist who irresponsibly dispenses prescription drugs nowadays like candies in sari-sari stores?

Or the one who is not bothered by the illegal selling of misoprostol which is used as abortifacient?

Or our inaction to the unethical practice of our profession?

Have we really gone heartless?

Surely, I want to hear more of Michael Jackson singing:

"Heal The World

Make It A Better Place

For You And For Me

And The Entire Human Race

There Are People Dying

If You Care Enough

For The Living

Make A Better Place

For You And For Me"

I really hope that would help...

More on "look-alike" and "sound-alike" dispensing errors

I'm beginning to notice that dispensing errors that have caught media attention or have landed in courtrooms were due to failure to observe dispensing rules and regulations under the Generics Act of 1988.

If, for example, "the lady at the counter" paid more attention to generics, she might have refused to fill the prescription for Methergin if the generic name was not written on it. Or, if the generic name was written, she might have thought it as an "impossible prescription" if she have interpreted the brand name as Melleril. [1]

A.O. 63 s. 1989 specifically states that "[v]iolative and impossible prescriptions as defined in A.O. 62 (Generic Prescribing) shall not be filled. The pharmacist shall advise the prescriber of the problem and/or instruct the customer to get the proper prescription..." (Section 4, 4.1)

The dermatologist who prescribed Thiamine had observed generic prescribing but the pharmacist's failure to practice what was required under the law had led to a dispensing error by filling the prescription with Thorazine. [2] (Oral doses of thiamine is being used as an mosquito repellant.) [3]

References:

1. "Wow mali" by Joy Gonzalez at http://www.manilastandardtoday.com/?page=goodLife02_sept_2003 [cited Aug.16, 2007]

2. http://ca.supremecourt.go/cardis/CV83632.pdf [cited Aug. 16, 2007]

3. "Avoiding Mosquito Bites" at http://www.infomediko.com.ph/past_episodes.html#061107avoiding [cited Aug. 26, 2007]

"Look-alike" and "sound-alike" dispensing error

Today, while browsing the internet, I came across an article in the May 29, 2007 issue of the Sunstar Manila* entitled “High court upholds damage suit v. drugstore chain”.

Here is part of that news article:

“… on Nov. 25, 1993, [Sebastian] Baking went to the clinic of Dr. Cesar Sy for a medical checkup. After undergoing an ECG, blood and hematology examinations, the doctor found that Baking's blood sugar and triglycerides were above normal levels, for which he gave two medical prescriptions -- Benalize tablets for his triglycerides and Diamicron for his blood sugar.

"Baking proceeded to Mercury Drug-Alabang branch to buy the prescribed medicines.

"However, the saleslady misread the prescription for Diamicron as a prescription for Dormicum, a potent sleeping tablet, and sold it to Baking, unaware that it was the wrong medicine.

"On the third day of taking Dormicum, Baking figured in a vehicular accident when he fell asleep while driving his car and it collided with another car. He said that he could not remember anything about the collision or felt its impact.

"Suspecting that the tablet he took may have a bearing on his physical and mental state at the time of the collision, Baking returned to Dr. Sy's clinic.”Upon being shown the medicine, the physician was shocked to find that what was sold to him was Dormicum, instead of Diamicron, prompting Baking to file a complaint for damages before the Quezon City RTC.”

Finally, this year, the Supreme Court has ordered Mercury to pay damages to Mr. Baking for the dispensing error “that caused him to fall asleep and figure in a vehicular accident.”

*****

Although the said article was way back in May 2007, I still decided to write the editor to comment:

Here’s what I wrote:

Dear Editor,

I just would like to comment on the article "High court upholds damage suit v. drugstore chain" (May 29, 2007 issue).

It is my opinion that the error in dispensing Dormicum instead of Diamicron is in the first place an error in prescribing the drug by its brand name.

Medication errors due to "sound-alike" and "look-alike drugs" happen and the article did not mention whether the doctor prescribed the drug by its generic name, because if he did, the drug will most likely be dispensed correctly.

This is because the generic name of Diamicron is gliclazide while midazolam is that of Dormicum. (Both generic names are not "sound-alike and "look-alike".)

Under the Generics Act of 1988, drugs prescribed by their brand names only should not be filled. So if, in this case, the drug was prescribed in its brand name (Diamicron) without the doctor writing the generic name (gliclazide), the drug store chain's employee indeed violated the law in the same manner that the doctor violated the same law.

Then I would say that if only the prescriber and drug store chain employee complied with the Generics Act, none of this thing would happen to the patient.

*****

I shared the above article to my colleagues and there were questions that came up in relation to the case:

1. How come the saleslady had access to a regulated drug, such as midazolam? (Pharmacists are the only ones authorized to have access to regulated and restricted drugs. These drugs are kept locked in their storage areas.)

2. Was there a pharmacist at that time? Should he/she be held liable?

3. Was there a dosage strength written on the prescription? If there was, how come she did not doubt the correctness of the drug that she dispensed? (Dormicum is available as 15 mg per tablet while Diamicron is available as 80 mg per tablet.; Diamicron MR is available as 30 mg per tablet)

*****

In the above case, the Supreme Court ruled that “ ’It is generally recognized that the drugstore business is imbued with public interest. The health and safety of the people will be put into jeopardy if drugstore employees will not exercise the highest degree of care and diligence in selling medicines’ ”.

I hope that every pharmacist who reads this learns that we have a social responsibility to guard the public health and by being negligent of our duty to properly dispense drugs, we certainly have a price to pay for our shortcomings. Pharmacy assistants or clerks should never be allowed to do the job that we are licensed to do. Let alone, to dispense a drug without regard to its classification as prescription or OTC drug.


*Source:
http://www.sunstar.com.ph/static/man/2007/05/29/news/high.court.upholds.damage.suit.v..drugstore.chain.html

Questionable promotional material

Section 6 (c) of the Generics Act of 1988 states that "Any organization or company involved in the manufacture, importation, repacking, marketing and/or distribution of drugs and medicines shall indicate prominently the generic name of the product. In any case of brand name products, the generic name shall appear prominently and immediately above the brand name in all product labels as well as in advertising and other promotional materials."

Last July 21, I wrote the Bureau of Food and Drugs inquiring whether drug companies are now allowed to advertise their drug products with the brand name above the boxed generic name.

My concern is regarding the 2 billboards of a popular cold preparation along the east service road of the South Super Highway. One is located near Sucat tollway and the other is located before the Skyway in Bicutan.

I was on my way today for work and while I was travelling the South Super Highway, I remember about this matter. So I checked and saw that the 2 billboards were already changed into a multivitamin product which complies with Section 6 (c) of the Generics Act of 1988.

I am not sure whether it was because of my inquiry that the 2 billboards were changed but if it was BFAD's action to my letter, I'm thankful that it was done accordingly.