During a GSK-sponsored media briefing at Pinto Art Museum, I listened as PMA President Dr. Oscar Tinio shared the results of their study on how to improve best practice medicine. Dr Tinio discussed 4 points that concerned them with regards to prescribing drugs. And as I jot down notes, I tried to see how I, as a patient, can relate to these points.
1. Availability. Not all drugs are distributed nationwide. The stocks that drugstores carry are limited especially those found in isolated regions. Even in the metro, some doctors are unaware that some drugs they prescribe are no longer distributed by major drugstores. I have been prescribed several times with medicine that are no longer being carried by Mercury Drugstore. So I tend to ask the pharmacists for similar drugs with no knowledge that a prescribed drug is preferred due to efficiency. I just want what's available and since most drugs are new to me, I have no way of knowing unless I try.
2. Affordability. If the medicine is for my son, the price doesn't usually matter. We follow what is prescribed. But since I also use a lot of pain relievers and medicine for my allergies, I try different brands and doses. And yes, I have tried cheaper brands that do not actually make me better. They may work for some, but they certainly don't for me.
3. Patient Compliance. Oops! I am guilty of this, especially to my allergist. But yes, I have since realized what he has been trying to warn me about when I was prescribed a higher dose of antibiotic in 2008.
4. Third party influence with the Treatment Plan. Patients taking food supplement and vitamins should always inform their physician what they are taking. Even certain vitamins and supplements have contrasting effects. Like Vitamin C should not be taken together with Calcium.
One factor that detriments compliance to drug prescription, according to Dr Tinio, is the practice of pharmacists 'prescribing' alternative medicine to patients. I think this scenario is exacerbated by small drug stores that do not employ pharmacists. Instead, non-qualified salespersons prescribe alternative drugs. To emphasize this point, there is a lack in implementing guidelines in the establishment and operation of drugstores.
Once upon a time, I thought only pharmacists were licensed to dispose medicine. However, having been to many hospitals (government-run and private), drugstores do not necessarily employ pharmacists. I have met a licensed pharmacist once and she confessed having her license used for a fee. So I assume drugstores must be manned by licensed pharmacists. What are the implications for drugstores who do not employ licensed pharmacists?
We used to have a neighbor who imported drugs and sold them directly to doctors and drugstores. The drugs were way cheaper than retail prices (both my parents take medicine for Hypertension and they used to be our neighbor's suki). Doctors would still get a cut from the revenue of selling these imported drugs. One of my dad's doctor friends used to buy from him, too.
This dealer may be small in terms of the reach of pharma companies, but I would be playing dumb and deaf to see that these drugs were legally getting past the Bureau of Customs. If the labels indicate 'For Distribution in Bangladesh', for instance, are they being imported legally? With the prices they are being sold, I would bet they are not even taxed.
So the law that only doctors should prescribe medication is now curtailed by pharmacists prescribing alternative drugs. Worse and more alarming, non-pharmacists are selling/dispensing alternative drugs versus doctor-prescribed medicine. On the side, I cannot help but ponder over some doctors' prejudice of referring other drugs over others because they are expecting something in return from pharma companies.
I would say that trust is a non-negotiable matter between the doctor and his patient. And patient compliance will increase if patients can trust their doctors with their lives.