Circular No. 1813, 16th October, 1999

We reproduced below the Submission of the Estate Doctors Association to the Health Panel of the Legislative Council dated 21.9.1999 for your information. The Submission was also sent to the press and media on 27.9.1999.

Control of Sale of Drugs

EDA with 1,500 doctors mainly in private practice, actively involved in delivery of health care particularly to public housing residents, all members together serving up to half of Hong Kong population, has played an important role in promoting good medical care not only to them but to all Hong Kong citizens, through public education, preventive care and advising government on health issues etc.

We believe patients should not be deprived of their right of choice of drug dispensing. Doctors and pharmacists are partners in health care delivery. Our ultimate aim is common and is to improve the health of the community. Therefore the two professions should work in harmony. Doctors help in patient consultation, order investigations, make diagnosis and dispense or prescribe drugs to treat patients. Pharmacists are to manufacture drugs, new or old, to dispense drugs on doctors' prescriptions and to give advice to patients on over-the-counter products on self-medication.

Naturally if the doctor also gives medicine as is the practice here in Hong Kong, he gives the one he means the patients to have. The worry that an outdated or wrong medicine may be given presumes the doctor not wanting the result he wants the patients to have, i.e., to get better. The wrong reasoning also assumes the generic medication is not the correct drug. But in fact the category of non- patented drugs once they are accepted for registration means they have satisfied the Health Department as genuine and fit for consumption. What the media and public has been led to believe is that the so called counterfeited medicine is not the real chemical in question but something less than the equivalent amount contained in the patented drug or even a different substance altogether. This is of course not true. No doubt it seems totally unfair for the inventor but patents do run out and many drugs we now use such as equivalents of original drugs like panadol, valium and many antibiotics are widely used here, in China and in the world elsewhere in form of generic equivalents. Tylenol so well known to Hong Kong migrants in Canada and USA is a well known example. Don't mistake it to be counterfeited medicine or inferior to the original PANADOL. Equivalents are manufactured all over the world under strict supervision just as the inventor company. It is the price and the reputation of the firm that make the difference.

As for the suggested requirement for doctors to remind patients of their right to have medicine dispensed at either the doctor or the pharmacy, can we not say the same principle should apply to the pharmacist? The latter will then be required to remind each patient that he must have previously obtained a prescription written by a doctor for prescription medicines. And should we also suggest that he must also remind the patient to have a follow up consultation particularly if he does not improve or has side effects, and that he must explain all possible side effects to each patient who comes to purchase medicines. We can see how superfluous therefore the requirement of the doctor to remind patients of their rights each time of seeing him and of giving a prescription first before asking if they want medicine dispensed at doctor's clinics or pharmacies. It boils down to professional self discipline is adequate for both professions.

Irregularities are bound to occur in both professions. Such irregularities are small in number and should be dealt with properly by authorities concerned. These should not be taken as the excuse to take away the intrinsic roles of either the doctor or the pharmacist. EDA members get the general impression that their patients want the present system of obtaining medication from doctors retained. We do believe that doctors on dispensing give patients more choice, more convenience, more confidence and more cost-effectiveness to receive their medical treatment. After all, as stated in the Harvard Report on Health Care Reform, the consultation fee which includes medication is comparatively cheap in Hong Kong than elsewhere.

We do support the pharmacists' suggestion of closer supervision and tighter control of drugstores. The reason behind the Health Department's enforcement of drugstores inspection was to check whether unauthorised dispensing by the drugstores occur. But to suggest the Health Department to inspect doctors' office forgets that doctors at present have the legal right to dispense and have not broken the law. Thank you for your kind attention.