Constituted bodies clash on medicines prescription reform

The Malta Independent online
26 March 2010

Two medical professional bodies, and a trade organisation, were verbally at each other’s throat yesterday, and the instigator of the colourful spat between the Medical Association of Malta, the pharmacists’ Kamra ta’ l-Ispizjara ta’ Malta, and the GRTU, chamber for small enterprises, would seem to be the Health Ministry, which “surprised and disappointed” the MAM.

The MAM statement arose from a proposed reform which, according to the MAM, allows non-physicians to prescribe medicines. And the MAM also accused pharmacists of abandoning “a critical aspect of patient care”.

But the prescribing by non-physicians was not the only effect the proposed reform would have, according to the MAM. Among other effects mentioned are conflicts of interest, unsafe practices, and what Humphrey Appleby would call a “courageous decision” – a rise in the price of medicines.

The first salvo, after the ministry blast, was fired by the MAM. It opened the gates of hell, because it was followed by a highly volatile pharmacists’ statement issued in reaction, and another statement by the GRTU, which described itself as the national representative of owners of pharmacies in the community.

The MAM said the ministry is considering abandoning the ethical principles in the prescription of medicines. “Patients have the right to be diagnosed by a registered medical practitioner before a medicine can be prescribed,” it said. “This is a basic tenet of patient safety.”

The Medicines Act prevents medical practitioners from dispensing medicines to protect patients from a potential conflict of interest between the prescriber and the dispenser who profits from the sale of medicines.

“The council of the Medical Association of Malta condemns any attempt to allow anybody who is not a registered physician to diagnose and prescribe and then dispense a medicine.

“MAM would like to suggest that a more appropriate reform would be the liberalisation of pharmacy licences to encourage competition which would then drive down the cost of medicines.

“The proposed reform to allow non-physician prescribing will lead to unsafe practice and a conflict of interest which will further raise the price of medicines. Furthermore MAM insists that it is time for the ministry to impose on pharmacies to stock drugs used in medical emergencies. A dangerous lacuna has been created as most have decided to abandon this critical aspect of patient care, and focus on cosmetic products which have nothing to do with the practice of medicine or pharmacy,” the MAM said.

The Kamra ta’ l-Ispizjara ta’ Malta retorted it “is flabbergasted to say the least at the misinformation which is rampantly evident in the MAM’s kneejerk press release issued today (yesterday), on the Minister of Health’s proposal for development of Pharmaceutical Care practices by pharmacists in the best interest of patient outcomes”.

“It is inconceivable that, our sister profession should lambast the fact that the Minister of Health has proposed that Malta should follow certain trends which are and have been, long in place and evolving in countries such as the UK and the US. The MAM should seek synergies to enhance teamwork rather than propose long exhausted, feeble, non sequitur arguments on liberalisation of pharmacy licences and prices of medicines,” the Kamra said.

“MAM is offensive in attempting to deprecate pharmacists who are independent health care professionals whose prime interest is to ensure the highest quality of patient care.

“The Kamra reiterates its full support of the innovative and forward-looking stance taken by the Minister of Health. It takes bona fide professionals to change a mentality and move with the times.”

Not to be outdone, the GRTU called the MAM’s statement an “unwarranted attack”.

The pharmacy licence system operated in Malta, it said, is the system “that has provided privately run and owned pharmacies in the community that has given excellent service to patients throughout Malta and Gozo and that has been solely responsible for the dispensing of medicine to most Maltese at no additional cost to patients, except the controlled price mark-up established at law”.

Pharmacies in the community have no economic power to impose prices that are above the margins marked on importers. “It is therefore incredible that an association of professionals can be so naïve and ignorant of elementary facts of economics to issue a press release so infantile and replete of errors as the one issued by MAM to comment on an issue which is really far out of its remit,” the GRTU said in its flowery statement.

“It is absolutely untrue, and a figment of one’s imagination, to declare that more pharmacies would mean more competition that would drive down the cost of medicines. In countries like Iceland, and Norway, (where) the free market was allowed to reign and governments did not impose a system similar to Malta, the result has been that pharmacies in the peripheries closed down leaving business to flow to pharmacies in the centres with the resultant hardship to the patients in the suburbs and peripheries, who suffered as a result of their lack of accessibility to medicines,” the GRTU said.

The Ministry of Health did not join in the fracas. Maybe it was digesting all that had been said.

http://www.independent.com.mt/news.asp?newsitemid=103651