Today went for the CASE's talk on medicine

The talk was interesting - it kept going on generic drugs and patent drugs, but I feel that it really missed out on services pertaining to issuance of medication. I can give you all the best drugs in the world, but if lousy advice was dispensed, what is the use? It may even kill you.

Generics - drugs that have expired patents - so they can be copied and sold e.g. Dhamol (paracetamol / acetominophen)
Patent drugs - aka original innovator, innovator, proprietary, brand drugs e.g. Panadol (paracetamol / acetominophen)

So far I hope the general public have learnt the following about generic and patent drugs:
- Generic drugs and patent drugs are very similar : I quote Miss Fatimah, "... both will take you to your destination..." Patent drugs may be likened to Mercedes Benz and generics likened to Hyundai - Mercedes may look nicer
- Patent drugs go through a lot of human testing and the cost of bringing it from day one to the market is a lot higher.
- Generics just required to show bioequivalence: meaning that it works physiologically the same as the patent drug, active ingredients are the same, etc.
- Generics are usually a lot cheaper
- Patent drugs are usually more costly but there's no choice when generics are not available
- If generic substitution was done properly, the cost savings can be tremendous.
- Expiry dates between generics and branded drugs are similar. The pharmacist will not be that unethical to sell close to expiry drugs.

Others
- Pharmacists can help check for potential drug interactions
- HSA's responsible for mainly registered drugs
- MOH is in charge of spot checking doctors (practice issue)
- Singapore-treated patients pay only about 10% of the healthcare cost in terms of drugs - compared with 11 - 14 % in USA and UK and as high as 30% in the Philippines and Vietnam
- Please bring ALL YOUR MEDICATIONS that you are taking when youre admitted or going for your regular appointment: this aids in Drug Recon(solidation), the pharmacist will calculate what you need and in any case if changes in drug therapy, pack your drugs to be stopped or continued and add on drugs that your current amount may not fulfill.
- SMA provides a Medik Awas card service for those with known drug allergies.
- The expiry date of drugs is usually a date when the drug degrade to 90% potency (e.g. 10mg -> 9mg)

However, these were not mentioned (to simplify things):
- Studies on humans are done large scale on patent drugs only
- Some pharmacists and doctors prefer to use patent drugs for certain more critical diseases.
- Some hospitals may use innovator drugs to treat patients at low cost: if they make it to formulary or if the tender given is a very good deal.
- The % cost of healthcare in the form of drugs is so low because diagnostics cost a lot more - perhaps a subsidy for diagnostics now?
- Carry along your entire prescription listing on admission: it helps in immediate ER treatment.

I poised a question to Dr Tan, spokesperson for SMA about sharing responsibilities in patient care between doctors and pharmacists in a community setting:

"So far, we have heard about generic drugs and brand drugs - products mainly. I would like to seek the opinion or perhaps the stand of SMA on the concept of sharing the responsibilities of patient care in a community setting?

For example, certain drugs with an increased potential for abuse and special instructions and storage requirements to pass through a second checkpoint -i.e. asking a patient to bring a doctor's precription to a pharmacy instead of being packed and given by a clinic assistant.

Let me elaborate in 2 scenarios
- in the recent hoo-ha about Dormicum and Subutex, perhaps the issues evolved could be better managed if 2 checkpoints were implemented: 1st is the doctor's assessment, 2nd is through the pharmacist. In such a way, only patients with a real need for such medication will go through the appropriate steps to get their medication.

- Drugs with special storage conditions such as Angised sublingual (check price in CASE here). During my pharmacy training, I was quite appalled when patients come in with Angised in plastic containers dispensed by clinics, saying that the medication is no longer effective for their chest pains and they had to take more potent drugs which may cost higher and more side effects (I had to coax some patients to tell me about their previous medications - some were prescribed Herbesser, chew before swallowing).

I think it would be best to make full use of a pharmacist knowledge to benefit consumers even though it may use some initial opportunity cost.

So would it be better if for the consumer if certain drugs can only be given through a pharmacist with a doctor's prescription if we want to give the patient the best care possible?"

His answer basically covered with the following points [ if there's any discepancies, pls post comments hor - didn't copy answer, only stand there jittery and red as I saw some one with a passive annoyed look liaoz]
- Singapore, Malaysia and other parts of the region, doctors are allowed to dispense compared with UK and USA.
- So far the system works, patients have immediate access to their medication
- As for such issues, complaints can be lodge with the SMA (or SMC - can't really decipher)
- SMA feels that the clinics that are dispensing medications are good and do not have any issues
- There's no need for 2 checkpoints
- and here comes the standard answer - "Here is not the forum to discuss such issues" (3rd time I heard this liaoz =.=)

Perhaps I was too jittery about what I was going to say (some people reach an age where they become so concious about what they are about to say that they did not dare to say it anymore - skin thinning liaoz), or my timing was off again, or doctors were trained to counter such discussion or I was too chong hey. But I hope to drive home the point about our place in the healthcare sector.

I'm not interested in what market share but more interested in patient care.

Frontline community pharmacies can do a lot given the chance, but we will have to take first baby steps by convincing the public about our usefulness.

Take on the responsibilities before you can be given the rights. (Something I always say to people who discuss with me dispensing issues - even to doctors and medical students) - It's like gardening- why want a plant when you can't even nurture it?

I hope I didn't miss out any pointers or write anything wrong in this post - correct me via a comment plox