Cutting edge regulatory framework should be beneficial for hospitals, industry as well as patients


Pakistan Society of Health-System Pharmacists annual meeting
Cutting edge regulatory framework should be 
beneficial for hospitals, industry as well as patients

India has half a million pharmacists and over 70% of Indian
Drug market consists of Branded Generics - Dr. Rehan A. Khan

Pharmacists need proper recognition so that they can play an
important role in Healthcare - Prof. Peerzada Qasim

Clinically trained pharmacists should be part of team making 
ward rounds as it saves lives - Mr. Khalid Yousuf

KARACHI: India has over half a million qualified trained pharmacists. Indian Drug market is worth seventy thousand crores of rupees with 15% annual growth. There are over twenty seven thousand brands, twenty five thousand drug manufacturers and over 70% of Indian Drug Market consists of branded generics. It is important that cutting edge regulatory framework should be beneficial for the hospitals, industry as well as the patients. This was stated by Dr. Rehan A. Khan Managing Director of Abbott India in his key note address at the annual meeting of Pakistan Society of Health-System Pharmacists held here on July 6th 2013. Giving further details about the Pharma industry as well as nutraceuticals in India, Dr. Rehan said that India has a huge population with twenty eight States. Consumer industry is evolving rapidly. We have a large middle class which is growing and we also have a lot of hidden potential.

Mr. Khalid Yousuf President PSHP presenting a mementoes to
Prof. Peerzada Qasim Vice Chancellor of Ziauddin University
who was the chief guest at the inaugural session of Pakistan Society of
Health-System Pharmacists annual meeting held at Karachi recently. On extreme
left is Dr. Rehan the Keynote Speaker from India while Mr. Jamshed Ahmad GS of PSHP.

Many things which are good for India are also good for Pakistan for various reasons. From the marketing point of view there is great potential in small towns in various States hence it is important that one should look beyond big cities for markets. In India, it is the private savings which has funded lot of industry and not the government investments. Indian pharmaceutical industry is worth over seventy billion US dollars. It includes traditional medicines, Food items like nutraceuticals. Multinationals have a presence in India, Pakistan, Bangladesh and Nepal. Surprisingly in all these countries in this region we have some people with over nutrition and then we also have people who suffer from malnutrition. Those who are under-nourished do not get enough calories and micronutrients. Some are nutrition deficient though they get lot of calories and suffer from obesity. Since India has almost 60% population which is vegetarian, hence it is also one of the reasons for under nutrition in some cases. Dr. Rehan was of the view that it is important that the doctors should be educated on nutrition. Nutraceuticals are highly priced and some of the manufacturers lack credibility hence proper regulations are needed to ensure quality. We need to consume balanced diet. There is great deficiency of Vitamin D in the sub-continent and it leads to lot of diseases.
Pharmaceutical industry in India, Dr. Rehan further stated is dominated by the national pharmaceutical industry. Abbott is the No. 1 Pharma company in India. We have acquired a local company and our pharmaceutical market share is just 6%. Almost 70% of the Pharma market is held by the Indian National companies and the rest by the multinational companies, he added. In the days to come the specialty therapeutics market will grow but there wont be much growth in analgesics, pain killers etc. Another important development taking place in India is that many hospitals are becoming part of big hospital chain and they will have central control of purchases. With the revolution in the information technology and easy access to the internet, patients are much better educated today and they come and ask questions to their physicians about their diagnosis and treatment. Chemists and pharmacists will become much more important. Many patients cannot afford to consult the doctor and they will go direct to the chemists and pharmacists and will start taking drugs asking for the best advice. This situation is not going to change for quite some time. In all these countries i.e. India, Pakistan, Bangladesh, Nepal, we do not have enough number of doctors as compared to our population. While there is a need for proper regulation but the government as well as the bureaucrats need to be educated in these areas to take rational decisions.

PSHP held its annual conference at Karachi recently. Group Photograph taken during the conference
shown from (L to R) are Kamran Ali Zaman, Shoaib Ahmed, Sunny Mohiuddin, Umaimah Muzammil
(Dy MM, LNH), Arif Arien (Children Cancer Hsop), Dr. Obaid Ali (Dy. Drug controller), Syed Jamshed Ahmed
(Gen. Sec PSHSP), Khalid Yousuf (President PSHSP), Syed Asif Ali (Chief Pharmacist, NICVD),
Imran A. Malik (Chief Pharmacist, DUHS), Aslam Shah (Chief Pharmacist, Indus Hospital)

With increase in income, people are taking more oily foods and coupled with sedentary life style, we are seeing an increase in diseases like diabetes, cardiovascular diseases. Affluent and middle class can buy drugs and in the coming days over the counter sale of drugs is going to increase, he remarked. He also briefly talked about the Vaccines and biological market and said that Generics are playing an important role in increasing acceptability of drugs.
Replying to a question regarding unethical marketing practices by the pharmaceutical industry in India, Dr. Rehan said that OPPI has a strict code of ethics. If any company is found violating it, it is properly investigated on receipt of complaint and punitive actions are taken if they are found guilty of any unethical marketing practices. Similarly Medical Council of India also has a code of ethics and they also monitor the relationship between the physicians and the Pharma industry. He wished that both India and Pakistan Government should have an open mind and open heart so that professionals travel between our two countries becomes easier and we can share our knowledge and experience and benefit from the talent which is available in abundance in India as well as Pakistan.
Prof. Peerzada Qasim Vice Chancellor of Ziauddin University who was the chief guest on this occasion in his speech said that pharmacists can play an important role as regards patient safety. Their role must be recognized so that they can play their role in the national healthcare. They are an important source for ensuring safe use of drugs. Not only that now there is an ever expanding role for the pharmacists. They are considered as patient oriented specialists. Pharmacy practice should focus on patient care. Studies conducted at Ziauddin University hospital has showed that with the presence of pharmacists the number of medication errors has reduced to a great extent. Now they are considered a part of the healthcare team.
Earlier Mr. Khalid Yousuf President of Pakistan Society of Health-System Pharmacists in his welcome address said that so far pharmacist’s role has remained neglected. We need them in almost every hospital. Patients visiting hospitals need the best care and when we have the best physicians and surgeons, why not have the best pharmacists to ensure that after diagnosis, patients get the best medication, therapeutics in appropriate dosage for better outcome. It is here where the expertise of the pharmacists is needed. They are trained as clinical pharmacists. Appointing qualified pharmacists in hospitals is not expenditure but an investment because it will save lot of lives. He was of the view that clinically trained pharmacists should be part of team making ward rounds as it saves lives.
Mr. Khalid Yousuf also recalled that sometime ago Supreme Court of Pakistan had remarked that we should have one pharmacists for fifty beds in the hospitals. JCI requires that pharmacists make formulary, select, purchase, store and dispense medications. They review patient charts, monitor adverse drug reactions, counsel the patients, monitor therapeutic outcome. Good hospitals providing quality care will attract lot of medical tourism. Pharmacists also assist in designing drug treatment plans. Hence we need pharmacists in our hospitals to carry out all these important tasks for which doctors have no time as they are already over burdened. In addition, pharmacists also play an important role in running and managing poison control centers, designing and conducting drug trials, they are important members of pharmacy Therapeutics Committees. They are the best judge to advice as to which drug should be included in the Formulary, they can prepare drug purchase guidelines, they can also offer counseling to patients on prescription as well as non-prescription drugs. They can pay attention to dosage of drugs which need therapeutic monitoring. In addition the pharmacists now also have new roles like Patient Safety Officers, Medication Safety Specialists, they are helpful in bioterrorism preparedness and response, dealing with public health threats, healthcare research and inter-disciplinary care, he added.

Doctors Panel Discussion

The scientific programme consisted of a few panel discussions. In the first panel discussion which consisted of doctors, the panel of experts included Prof. Ejaz Ahmad Vohra from Ziauddin University Hospital, Prof. Jamal Raza, Director National institute of Child Health, Dr. Tufail Chief of Memon Medical Institute and Prof. Abdul Bari Khan Chief Operating Officer of Indus Hospital.

Prof. Ejaz Ahmad Vohra in his brief address said that we need to change our mindset. Keeping in view the complexities in patient care, we need to have a team. This calls for inviting and involving the allied healthcare workers like nurses, pharmacists and other allied healthcare professionals. It is difficult but we need to learn to make a Team. Clinical pharmacists are playing an important role in Ziauddin Hospital and we do invite them while we are making hospital rounds. They should be recognized as an important member of the healthcare team. Medical profession and all others need to recognize the role of pharmacists. They can and should also play their role in community pharmacy. We now see chain of pharmacies being established by various groups and their services are being utilized there at community level. Interest of the patient should be safeguarded at all cost. Continuing Prof Ejaz Ahmad Vohra said that unfortunately Health has become a business industry and in a profit motivated society, there is a tendency to buy economically priced drugs but the industry is tempted to sell drugs at a high cost. Seth mentality of those running the healthcare facilities has its own problems, he remarked.

Prof. Jamal Raza said that pharmacists can better explain the side effects to the patients than the doctors who have no time as they are supposed to see a large number of patients. They can also do counseling as to how the patients should use the drugs. Usually doctors do not tell and the patients do not ask about these things in the busy OPDs. Pharmacists can help hospitals in designing drug policy; they can also help in suggesting how to store drugs. In fact they have multiple roles and they can be extremely helpful for the hospital administration.

Dr. Tufail said that Pharmacists are members of planning and therapeutics committee, they advice how to prepare the hospital formulary. Pharmacist should be the head and supervise pharmacy in every tertiary healthcare facility. There are thousands of drugs and it is not possible for the hospital to store all of them hence the pharmacists can help guide the hospital on which drug to purchase. They have a role in not only procurement of drugs but maintaining of drugs supply chain management.

Prof. Abdul Bari Khan said that they faced lot of difficulty when they were recruiting visionary people with missionary zeal for Indus Hospital as regards pharmacists. Health industry, he said is growing and people also want their rights, hence there are challenges as well. As such the pharmacists have to concentrate on developing their expertise.
During the discussion Prof. Ejaz Ahmad Vohra opined that pharmacists should undergo compulsory internship training like doctors after completing their studies to get clinical experience. This internship should be in clinical pharmacy but at present most of them do their training in Pharma industry. He further suggested that we should have accredited institutions for providing internship training to the pharmacists only then their training facilities will be improved. Pharmacists should be well versed in computer skills, use of different software. Dr. Tufail said that those pharmacists who come to their hospital for training come as voluntarily and there are no mandatory training requirements. If it is known as to what are their requirements, then better training facilities can be organized for clinical pharmacists.

Pharmacists Panel Discussion

Members of the panel which took part in the pharmacists panel discussion included Dr. Samina Badar, Mr. Nasir Jalil, Mr. Aslam Shah and Arif Ali Arian. Mr. Nasir pointed out that now pharmacists is accepted as a career just like medicine. Physicians in many hospitals are now trained in computerized orders, prescriptions and pharmacists help in planning hospital formulary.

Ms. Samina Badar opined that pharmacists should think of innovations. Pharmacist is not welcome by most doctors. We need to strengthen our training programme. Many a times they are over worked and we also need to pay them adequate remuneration with other privileges.

Mr. Aslam Shah said that we as pharmacists are now looking at patient care and if we are not doing this, we are not doing our job. We should think as to what better service we can do and our focus should remain on patient care. We should carefully look at the dose of the drug, do therapeutic monitoring and to get respect and due recognition we have to improve our capabilities and capacities. The situation was changing and now more and more doctors are accepting pharmacists as a member of the healthcare team. Mr. Arif Ali said that pharmacists should improve their knowledge, those working in NGOs and Trust Hospitals should be mindful of the fact as to how they can make savings for their establishment. Responding to a question it was pointed out that at present there are sixty pharmacists working at Liaquat National Hospital, six at Children Cancer Hospital, twelve at Indus Hospital and twelve at Shaukat Khanum Cancer Hospital. Ms. Samina Bandar highlighted the importance of TPN in critically ill patients and pointed out that it was important that the pharmacists know the compatibility of various drugs.

Regulator’s Panel Discussion

Mr. Obaid Ali moderated session devoted to regulators and the experts included Abdul Rasool Shaikh, Shafi Qureshi, Ms. Roohi Obaid and Mr. Salim Ishrat Hussain. It was pointed out that one of the main causes of the tragedy at Punjab Institute of Cardiology which resulted in many deaths was that the pharmacists were not being allowed to play their role. Mr. Ishrat Hussain said that sometime ago they had given a proposal to establish a Directorate of Pharmacy in Sindh health department. At present most of the people working in health department are doctors, they understand the problems of doctors but when it comes to drugs and pharmacy, they are not able to understand their intricacies and take appropriate decisions. We had also suggested having separate departments in this directorate related to quality control, hospital pharmacy and drug testing. Had this proposal been implemented, we could have seen lot of improvement and thus saved many mishaps. He was of the view that most of the students in pharmacy schools just like medical colleges are girls and most of them do not work after getting married; hence we face shortage of doctors as well as pharmacists. Some of the female participants did not agree with this assessment and felt that if females are provided better comfortable working environment and lucrative remuneration they will be too glad to work. Responding to another question it was stated that practice is never and should not be regulated but it is advised and monitored. Training of pharmacists in community pharmacy also figured in the discussion and it was stated that they should not give their certificates to people to get new licenses. No new licenses to non-pharmacists are now being issued and hopefully in the coming year’s community pharmacists will have lot of job opportunities.

Emerging role of pharmacists in national healthcare system was the theme of the conference and it was very well attended by pharmacists working in different hospitals, Pharma industry as well as in drug control departments in the government. In the concluding session Mr. Jamshed Ahmad General Secretary of the society thanked all those who worked hard to organize this meeting.

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