# \[e-drug\] Dispensing Doctors Monitor article (cont'd) **URL:** \ **Category:** e-drug\ **Created:** [September 10, 2003, 9:02am UTC](https://talk.edrugplus.org/t/e-drug-dispensing-doctors-monitor-article-contd/17613 "2003-09-10T09:02:49Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![Birna\_Trap](https://avatars.discourse-cdn.com/v4/letter/b/d2c977/32.png) [@Birna\_Trap](https://talk.edrugplus.org/u/Birna_Trap)\ **Post date:** [September 10, 2003, 9:02am UTC](https://talk.edrugplus.org/t/e-drug-dispensing-doctors-monitor-article-contd/17613/1 "2003-09-10T09:02:49Z")
E-drug: Dispensing Doctors Monitor article (cont'd) ------------------------------------------------------------------------- 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 -- To send a message to E-Drug, write to: e-drug@healthnet.org To subscribe or unsubscribe, write to: majordomo@healthnet.org in the body of the message type: subscribe e-drug OR unsubscribe e-drug To contact a person, send a message to: e-drug-help@healthnet.org Information and archives: [http://www.essentialdrugs.org/edrug](http://www.essentialdrugs.org/edrug)