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"New SMA Publication- The Medical Profession and Pharmaceuticals"

"The Medical Profession and Pharmaceuticals" is a 3-part publication consisting of "In-Clinic Dispensing: Principles and Practice", "Relationship Between the Medical Profession and the Pharmaceutical Industry" and "Training of Certified Healthcare Assistants as Clinic Dispensers". The general principles of the 3 sections are reproduced below.

Perhaps the most relevant portion to the majority of our readers is the section in Part 1, dealing with rational pricing of medicine dispensed from the clinic. The SMA expects that there will be more and more requests for clinic charges to be split in the future. If the charge for medicine dispensed is to be specified, a rational and defensible method of arriving at this charge is important to prevent misunderstandings from arising.

Members should receive their free copy of the "The Medical Profession and Pharmaceuticals" in the next mailbag. It is available to non-members at $10.00.


Part I: "In-clinic dispensing: principles and practice"

This section sets out the basic principles and suggests some practices of in-clinic dispensing, namely principles of pricing and standards of good dispensing practice. There is presently a wide variation in the methods of pricing medicines dispensed from clinics. This is because of the various ways Practice Costs are assigned to Medicine Charge and Consultation Fees. We hope that these principles when used in conjunction with the SMA Guideline on Consultation Fees, will lead to less variability in computing Medicine Charges.


General principles

1. In-clinic dispensing of medicine offers several advantages to the patient. Beyond obvious convenience, the patient can be sure that the medicines he has been prescribed will be stocked. Moreover, he will have the added confidence that his prescription indeed reflects the medicines that the physician considers optimal for his individual case (rather than less suitable ones, chosen simply because they are more likely to be available at a pharmacy).

2. Offering these benefits to the patient carries a cost. The clinic needs to buy the necessary medicines in bulk, to repack them into single-user packs, and to cover the costs of spoilage, spillage, broken tablets, etc. The cost of trained staff to man the dispensary during all hours that it is open, rather than just office hours, is not insignificant, especially as the standards of dispensing practice should be high- comparable to those offered in a pharmacy. A margin to cover these and other additional costs is thus reasonable.

3. In spite of both of the above points, the SMA still recommends that the price of medicine charged to the patient should be comparable to what he would have to pay, if he were to choose to fill the prescription at a pharmacy instead. In computing this Medicine Charge for drugs dispensed from the clinic, the SMA assumes that its existing Guideline On Fees for consultation and other professional fees is followed. (Please refer to explanatory note). This latter covers the costs of running the clinic and providing all services (the "Practice Cost"), and permits the Medicine Charge to be comparable to the "pharmacy price" as recommended above.

4. The pricing methods for medicines dispensed from clinics should be simple in practice, easy to remember, and fair to all parties.

5. The patient retains the right to choose whether to fill the prescription in the clinic, or externally at a pharmacy.


Part II: "Relationship between the medical profession and the pharmaceutical industry"

The joint paper is the combined effort of the Singapore Association for Pharmaceutical Industries (SAPI) and the Singapore Medical Association (SMA). It is based on concepts originating from the last SMA Ethics Convention in 1997. It adopts existing SAPI guidelines for responsible marketing of pharmaceutical products, CME, gifts and travel grants, sponsorship and consultancy, and relates them to what is permitted by the Medical Code of Ethics for doctors. It also spells out what are permitted for public medical talks sponsored by pharmaceutical companies.

It is important to be transparent in these matters, as Singapore quickly develops as a regional centre for pharmaceutical research and high-tech drug manufacture. With this development, doctors will increasingly be involved in various professional activities with these companies. It is our hope that this document will serve as a useful guide to facilitate a better working relationship between the two groups in this regard.

General principles

1.1 The medical profession and the pharmaceutical industry are important partners in the delivery of healthcare to patients and the public. The medical profession is expected to place patients’ health and welfare above financial or commercial gains. The pharmaceutical industry is expected to invest in research and development, to develop new and improved treatment options for the benefit of patients and market them ethically.

1.2 In the relationship between the medical profession and the pharmaceutical industry, strict and professional conduct is necessary to prevent abuses. This relationship must always be seen to be impartial, honest and in compliance with the SMA Ethical Code, SMC Ethical Code and the SAPI Code of Marketing Practices. This is to ensure that patients’ and public’s interests are always upheld.

1.3 The medical profession at large and the individual physician in particular must assure and demonstrate to the patient and public that the medical treatment offered is the most appropriate for the patient (considering benefits, side-effects and costs) and not primarily influenced by commercial or financial gains. The physician must not compromise nor be regarded by others as likely to have compromised their independent professional judgement in prescribing.

1.4 Public confidence and patients’ trust in the healthcare delivery system can only be preserved by:

a) responsible prescribing by the physician based on scientific and clinical integrity and,

b) responsible marketing by the pharmaceutical industry.

1.5 Physicians must ensure their professional judgement and impartial clinical assessment of drugs is not impaired by the receipts of gifts, hospitality, travel grants nor research grants.

1.6 Educational medical meetings sponsored by the pharmaceutical industry must always preserve scientific and educational aims foremost. The level of accompanying hospitality should not exceed the level which the physicians might normally adopt when paying for themselves.

1.7 Scientific research carried out in collaboration with the pharmaceutical industry must be of high scientific merit, properly planned, approved by an ethics committee and professionally executed. Proper accounting procedures are to be adopted with independent audit and fulfilling all legal requirements.

1.8 Conflict of interests, if any, must be declared by speakers, researchers, medical institutions and pharmaceutical companies at meetings, presentations and publications.


Part III: "Training of certified healthcare assistants as clinic dispensers"

The third section of this publication outlines the requirements of healthcare assistants by ITE, the detailed programmes of the various training modules as well as other relevant information relating to the existing training scheme, which leads to the ITE qualification "Certified Healthcare Assistant".

The training of healthcare assistants has now been established for more than a decade. As of December 1997, a total of 2,286 healthcare assistants have participated in the Course and received ITE certification. Many clinics now have at least one employee who has been formally trained and state-certified in this manner. The SMA will continue to help doctors provide quality care to their patients by ensuring that their clinic staff is adequately trained. Soon, continuing education will also be introduced for Healthcare Assistants to keep them up-to-date. Six workshops have been planned for 1999 as part of Continuing Medical Education for the clinic assistants. SMA encourages clinics to set targets for themselves for the training of their staff so that in time, the majority of clinics will have certified healthcare assistants as dispensers.