Monday, August 15, 2011


I read with great interest, the government's proposal to ask patients not to throw medications that they do not wish to take, away into the dusk bin, but to throw it into a re-cycling bin, so that the drugs can be re-cycled. This "joke" appeared in the front page of the STAR on Sunday. While it is true that some medication is wasted by patients who throw them away, I do not think that re-cycling medication is the way to go to save money.
Firstly, if the government agrees that medication is good for the patient then they should find out why patient throw away medication? Is it because of poor medical care?, is it due to poly-pharmacy, is it poor communication between healthcare provider and patient? is it that you do not treasure things that are given free?, is it because of side effects? As always, in science, we need to know the reason why, if we believe that medication can help and save lives. Just accepting that people throw away medications, without finding out why, will not solve the problem. Whatever you do thereafter, there will still be wastage, as the problem have not been corrected. This morning, I read in the STAR again, that the government is saying that their doctors are prescribing too many medications, thereby causing wastage. This also may be true, as the standard of medical graduates from our 30+ medical schools is poor and getting poorer. We have written about this before. There is now a moratorium on the building of medical schools, but as always, we are shutting the gates after the horse has bolted, or after the cronies have "stolen the cake".
If the government is serious about saving money and not spending so much on drugs and medicines, the easiest way ( by the stroke of the pen ), is too stop the " Pharmaniaga Scam". This Pharmaniaga scam has been going on for years.
What is the Pharmaniaga scam? This is bolehland's way of procuring medication for government hospitals. Let me illustrate. The government hospital needs drug A for hypertension treatment. He identifies the medication and orders it. Now, the importing company for drug A cannot sell it directly to the ministry of health. That will be too clean and too simple. He must sell it to Company X ( I am sure we know who owns company X ). Company X who does not know anything about drugs, who does not even need to see the drug A, buys the drug and sells it to Pharmaniaga, who then sells it to the ministry of health. Lets say that the drug for hypertension cost RM 10 to the importer, who would normally have sold it for RM 15 to the government ( the mark-up to cover cost or storage, transport, administration etc ). Now he does not and cannot do that. The importer sells it to Company X at RM 15. Company X sells it to Pharmaniaga at RM 30 ( remember company X does not even take delivery or sees the drug, he just paper passes it on ), and Pharmaniaga then sells it to the government for RM 45.
We call this layering and leakages. I am sure we all know who company X and Pharmaniaga belongs to. If the government wish to save taxpayer's money, stop the layering, that will save almost half the healthcare pharmacy budget, plain and simple. But then their UMNO middlemen will have no money to spend.
Coming back to the Sunday STAR, are the poor who seek care in Public Hospital so neglected as to be given re-cycled medications? with the risk of poor storage, uncertain efficacy, uncertain expiry, poor handling, mixed up in pills? Are we that bad off that we have to used pills picked up from the garbage box? Do our poor patients deserve that?
As we say in private practice, the biggest gain to the private practice in Malaysia is to have a fumbling government with poor policies and execution. Poor government healthcare service is the cause of a thriving private healthcare service. In other words, the way to limit private healthcare profits, is to have a good public service. For some reason, the government does not wish to improve public healthcare service. These hair brain schemes of re-cycling medications and bringing out poorly qualified doctors into public service is the cause of the rise in healthcare cost. If public hospitals are good, private hospitals will be affected. But there again, in Malaysia, is the same as asking if pigs can fly.


pilocarpine said...

great honest piece of commentary...

thliew said...

What is the incentive for patients to return unused medications? Relying solely on 'responsibility' and 'goodwill' is unlikely to yield substantial results. Anyway what happens to the returned meds? Will they be dished out to the next patient? Has the meds been stored properly? A couple of hours of being left in the car in the sun, can raise the temperature to 60C (kids have been killed), while most meds are to be stored at or below 30C. Will returned meds be good enough to be dispensed to Cabinet Ministers?

Kristin and TK said...
This comment has been removed by the author.
vagus said...

totally agree

msforty5 said...

I thot there is also similar policy in some private hospitals as I've returned unused medications reasons :
1. Side effect
2. Given 1mth supply, but felt better or no effect after 2 weeks & doctor who prescribed says can return & ask for refund or exchange for other medication or supplements

thliew said...

msforty5, have you considered the possibility that the medications that were dispensed to you "had no effect and you did not feel better" BECAUSE they had been stored inappropriately (eg in the heat of the sun) by another patient who had been prescribed them earlier, and who had returned them? :)

msforty5 said...

thliew, I did not think of that as the hospital policy is "that the returned or unused medication must be intact (not the loose ones)" and being a responsible patient, I will rather return the "poison" than keep it or throw it away. And I'm relating my experience with two leading private hospitals in KL. I do it in good faith and I will expect the same from the hospital.

Do we question the pharmacists that medication prescribed to us has never been recycled ?

thliew said...

No we do not question the pharmacists whether the medication which are dispensed to us had been recycled or not, and we SHOULD NOT have to - imho ALL returned medications should NEVER be dispensed to another patient. It is immaterial whether the medications are still in intact blister packs or not, since it is NOT the physical appearance that matters but the efficacy or potency of the medication that is important. We cannot be sure whether the medications had been stored properly eg under proper temperature storage conditions of under 30C. Medicines which had been kept in the car where temperatures can go up to 65C (trapped children have been killed) will lose its efficacy.
A responsible pharmacist should NOT "recycle" ie re-dispense medication which had been returned by patients.
This too is the policy of National Association of Boards of Pharmacy (NABP) which represents the state boards of pharmacy in all 50 United States, the District of Columbia, Guam, Puerto Rico, the Virgin Islands, Australia, eight Canadian Provinces, and New Zealand.

Here's the "Position Statement on the Return and Reuse of Prescription Medications in the Community Pharmacy Setting"
as per National Association of Boards of Pharmacy, NABP (pdf format)

" Medications that have been delivered to the patient cannot be returned and reused."
“[a] pharmacist should not return drug products to his stock once they have been out of his possession” because of the inability to assure drug “strength, quality, purity or identity.”

Would you accept it, if there is a notice outside a pharmacy stating,
"Be forewarned that the medication which you receive MAY or MAY NOT have been returned to us unused after being dispensed. The efficacy of returned medications cannot be guaranteed since storage conditions may not have been optimal. However we hope you will understand that this policy is in place to save costs."

chandra said...

Awesome and every one have to agree!