TO the undiscerning eye, there appears to be no shortage of self-proclaimed pharmacists in Pakistan. Pharmacies or medical stores are found at every nook and corner of almost all urban areas. However, despite the existence of pharmacy departments in universities across the country, one rarely comes across a qualified pharmacist, someone who actually studied the profession, except perhaps at large private hospitals.

Not only are most medicine retailers unqualified to be pharmacists, many have also had limited education, learning their trade from others like them over a period of time. These medicine salesmen not only dispense medication but also counsel patients on their use.

In contrast, in the developed world, where community pharmacies are considered the cornerstone of the healthcare infrastructure, pharmacists are among the most accessible and trustworthy healthcare professionals. For instance, the UK and Australia are relying on their services to administer Covid-19 vaccines. However, since qualified pharmacists are scarce, they have enacted policies to hasten the immigration process of these professionals.

The role of a pharmacist is two-pronged. On the one hand, they are responsible for ensuring proper storage and error-free delivery of medication, on the other they must be watchful of counteracting medications being prescribed to a patient. It is also the legal responsibility of a pharmacist to counsel the patient about the proper usage and possible side effects of the medication.

Discounts on medicine may compromise patient safety.

But these considerations are largely missing in Pakistan where the overabundance of medical stores and their operations rely on low-quality human resource. Moreover, many large medical stores also offer discounts on a number of medications. Though, this practice appears to make sense in a country where around 85 million people live in poverty, it actually ends up compromising patient safety in many ways.

All medications registered with the Drug Regulatory Authority of Pakistan have two prices: the trade price and maximum selling price. The trade price is the cost at which the medical store buys the medication from the distributor or manufacturer. The maximum selling price is the price identified by DRAP on which the medication is sold to patients. Usually, the difference between the trade price and maximum selling price is 15 per cent, though it can as high as 40pc depending on the manufacturer. To improve sales and make medicines slightly more affordable, medical sellers tend to offer discounts on the maximum selling price based on the margin given — 15-40pc. However, in doing so medical store owners tend to compensate for the cut in profits by hiring underqualified staff or limiting the use of electricity by compromising proper storage of drugs.

The practice of giving discounts on medicines’ prices is not followed anywhere in the developed world. Although lowering costs of medicines results in better sales, benefiting drug manufacturers, distributors, retailers and the public, the concern regarding affordability tends to overshadow other critical aspects of the profession. By lowering medicine costs, sellers make more sales, but compromise pharmaceutical vigilance. Salesmen with little understanding of the pharmaceutical effects of drugs and their side effects can’t be trusted to give sound advice to patients regarding dosage and precautions.

According to a recent study, 237m medication errors occur annually in the UK, where the profession is highly regulated. The study further revealed that such errors cost the NHS £98,462,582 every year and contributed to around 1,700 deaths. Imagine the scale of such errors in Pakistan where there is negligible regulation of the health sector. Thus, the primary role of pharmacists is to reduce medication errors that not only impact the life of a patient by causing harm but also burden the pocket and the economy of countries.

Unlike in Pakistan where medical stores pay minimum wage to medicine salesmen, pharmacists in developed countries are paid for their services like a doctor ie the billing of the medication dispensed. In the UK, US and Canada, the pharmacists’ compensation is estimated by the cost of medicines dispensed in addition to service charges. Since pharmacists have no direct link with the sale of medication, their advice to patients tends to remain unclouded. Pharmacists have a right to question or not act upon any prescription they feel is not appropriate for the patient.

The government can help by establishing a network of community pharmacies in the country. A qualified pharmacist should be hired to oversee the operations of the said pharmacy under the umbrella of the federal health ministry. This would not only help regulate the sale of medicines but would also reduce losses to the economy incurred through under-the-table sale of medicines.

The writer works as manager pharmacy at Lady Reading Hospital Peshawar.

Published in Dawn, November 23rd, 2021