Dr.Tilak Fernando

In order to prevent or reduce harm to patients and to improve public health, mechanisms for evaluating and monitoring the safety of medicines in clinical use are vital. Equally qualified pharmacists are expected to be professional in their duty, with the knowledge and expertise to provide authoritative information to medicines.

In Sri Lanka, law specifically warrants ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”PharmacistsƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ to hold a professional certificate. Despite such laws, what is taking place is many qualified registered pharmacists while displaying their licence overtly employ ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”unqualified cashiersƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ to dispense medicine to the public.

Press reports recently indicated that the Cosmetic Devices and Drugs Control Authority, out of a glut of complaints from the public against pharmacies, raided countrywide and heavy fines were imposed on those who violated relevant regulations.

Illegal activities

During such sorties the common cause for private pharmacies to thrive on illegal activities has been a case of hiring ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”ordinaryƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ unqualified staff as cashiersƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ to sell drugs by displaying official ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”PharmacyƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ signs. The major impediment for such abuses of health regulations is believed to be the inadequacy of ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”special Health Ministry InspectorsƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ to monitor and raid pharmacies regularly and not having an effective pharmacovigilance system.

The disappointing factor in Sri Lanka today is that anyone wearing a white overall can act as a pharmacist behind a counter and hand out anything to the public, even without a prescription.

It is mandatory to give clear details of the drug and potency on the receptacle when pharmacists hand over drugs to the public. In Sri Lanka such norms seem to override international procedures and place drugs into small envelopes (with only tds or bd information). Unorthodox procedures not only leave patients in naivety but pose a problem if the patient decides to consult a different medical officer with unidentified drugs. In Western countries the General (family) Practitioner maintains all records; whenever a patient is referred to a specialist or a hospital there is always interaction with the patientsƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ regular GP.

Medical officer

UK uses ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”GP computer softwareƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ programmes where patientsƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ history is stored. When the GP decides on the medication he simply types out the name of the drug(s) to be prescribed and a computer printout throws out the drug and its potency with a counterfoil to the patient. Such advanced systems help both the patient and the GP, especially when it comes to ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”repeat-prescriptionsƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢. Contrary to such sophisticated methods, ordinary piece of paper is used in Sri Lanka to write-down a prescription by some with only the doctorƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s name or signature, which is accepted by some pharmacies.

Recently, in a private hospital I witnessed how a patient was given four types of drugs from its pharmacy in four small white envelopes. The patientƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s request to a female (inside the Pharmacy who did not wear any identification tag to indicate she was the chemist) to write-down the names of the drugs on each envelope was responded with a haughty rebuff stating: ƒÆ’‚¢ƒ¢-¡‚¬ƒ…-ItƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s all written on the drugsƒÆ’‚¢ƒ¢-¡‚¬ƒ”š‚.

My personal inspection of the drugs revealed only Lasarten Potassium (Cosart 50 ml) and the Omeprazole were the only drugs in a sealed pack from manufactures. The other envelopes contained Statins for Cholesterol and some pills without any brand name or potency which the patient was expected to swallow blindly!

Prescribed drugs

The difference between the West and Sri Lanka is that in the West a patient has a right to open his/her mouth and say he/she is entitled to know what patients are asked to swallowƒÆ’‚¢ƒ¢-¡‚¬ƒ”š‚! The medical officer on the other hand will explain to his/her patient in detail about the prescribed drugs. But to put up with nonsensical statements as indicated above from half backed so called ƒÆ’‚¢ƒ¢-¡‚¬ƒ”¹…”pharmacistsƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢ scattered round the island would be annoying. After all, itƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s the patient body, life and his/her money that one has to bear in mind.

There does not seem to have a uniform law in Sri Lanka or it is not strictly implemented with regard to the issuance of drugs with or without a prescription. Recently a friend known to me had to go through a maze to find out about a cancer drug, Arimdex (1mg).

Price difference

Despite the huge price difference in two major pharmaceutical institutions in Sri Lanka the irony is why the lives of cancer patients have been made much harder and added more pain and misery to their desolation by making such an important drug a rare commodity and exorbitant prices! How many cancer patients among low-income groups can afford to buy such a drug? Are we, as a society, prepared to consign such patients into a death row labeling them as terminal patients with no hope at all?

Cancer sufferers are evidently on the increase and this is an area for health authorities to look into with wide open eyes when they are strengthening the health regulations by amending the cosmetic Devices and Drugs Act 27 of 1980 imposing severe punishments of Rs. 100,000 or one year jail sentence or both for violators of health regulations.

What Sri Lanka needs is a strict Pharmacovigilance system similar to that of in the European Union. Why is such a system very vital? The answer would be to monitor the safety of medicines and taking action to reduce the risks and increase the benefits of medicines.

Our society is changing and the expectations of our citizens are also changing. There is a need to ensure that we too have a system which is robust but also transparent and effective.

tilakfernando@yahoo.co.uk