E-drug: Dispensing Doctors Monitor article (cont'd)
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Dear All,
In response to Bonnie and to continue the discussion that Richard
has started I would like to give the following comments. To ensure
access to medicines it has been necessary in several countries to
have doctors both prescribe and dispense drugs. Though this in
itself can constitute a problem with the lack of controls and
difficulties in adherence to Good Pharmacy Practices, a major
issue is if the dispensing is carried out on a for-profit basis or not. In
some countries doctors are allowed to dispense medicines in
emergency situations /to ensure access, but not on a for-profit
basis. This is the case in Denmark where the law does not allow
the same person to practice as both doctor and pharmacist and
thus prescribe and dispense drugs, but only in emergencies. In
Australia it is also allowed but as a not-for-profit service.
In most Commonwealth countries doctors can be allowed to
dispense drugs on a for-profit basis if there is no pharmacy nearby
(5 miles) at the time when the doctor applies to become a
dispensing doctor. When later the condition changes and a
pharmacist has established a pharmacy nearby, the DDs can
continue his services as a DD and the pharmacist would have to
pay the DD a sum related to the lost income for giving up
dispensing. A number of such settlements have been documented.
There will presumably always be a need for medicines to be
prescribed and dispensed by the same person in certain situations
(emergency, to ensure access etc), but the issue is not about
dispensing and prescribing by one and the same person but more
how to avoid a conflict of interest by ensuring that the dispensing is
a not-for-profit service for a prescriber - and thereby a none
attractive service which is only kept as long as it is needed.
The ethics we discuss is: are we allowed to earn money on sick
people - answer yes, but it has to be done in an ethical acceptable
and controlled manner where we do not exploit the vulnerability of
the sick patient, who is willing to do everything to get well/better.
The solution to this dilemma is not easy but I do think that
regulation and financial interventions are the way forward.
In this discussion it is important also to consider that in many
African countries the prescriber is not a medical doctor but a nurse.
The terminology should be a dispensing prescriber rather than a
dispensing doctor. The setup in many developing countries is
changing from a situation where drugs were dispensed 'for free' by
the prescriber. The cost of drugs has increased or will increase and
drugs are no longer or will no longer be free of cost to patient.
Moreover, we have a situation where the nurse prescribers are
also dispensing and selling drugs for profit. The number of
dispensing prescribers is on the increase globally and the loser will
be the patient.
We have a similar conflict of interest in most developed countries
where traditional medicine practitioners are both prescribers and
dispensers, selling their traditional remedies for profit and in most
cases in a non-regulated manner compared to the regulation
implemented in the allopathic health care system.
Regards
Birna Trap
Euro Health Group
Tinghojvej 77
DK-2860 Soborg
Denmark
e-mail: btrap@ehg.dk
www.ehg.dk
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