Highlights of the Safe Medication Disposal Practices Roundtable

WORDS LIM TECK CHOON

Alpro Pharmacy hosted an industry roundtable, called Safe Medication Disposal Practices in Malaysia–Past, Present & Future, on 15th December 2022 at Monash University Malaysia.

Highlight 1
THE NEED FOR PROPER DISPOSAL OF MEDICINES
  • According to Foon Hwei Foong from Malaysian Community Pharmacy Guild, unwanted medications disposed into landfills are reabsorbed by water streams. This means that these medications eventually leads back to the water that we drink.
  • Dr Saw Pui San, a lecturer from Monash University Malaysia’s School of Pharmacy, cited how irresponsibly discarded contraceptive medicines ended up in our waterways and caused the sterilization of fishes.
  • Antibiotics are strictly regulated prescription medication, and many efforts were made to prevent antibiotic resistance. However, another often overlooked possible cause of antibiotic resistance is the leakage of improperly discarded antibiotics into our water systems.
Highlight 2
THE POLICY IS THERE, BUT THE AWARENESS AMONG THE PUBLIC IS LACKING
  • Amrahi Buang, President of the Malaysian Pharmacists Society, stated that laws and policies are in place across all access points of medication distribution in this country, with the Malaysian National Medicines Policy (MNPP) clearly stating the measurements and governance in place for medication safety.
  • He opined that health and medication literacy is still lacking within the Malaysia public, hence the need for an pharmaceutical industry medium to act as an education platform for the public.
  • Furthermore, he stated that pharmacists are strongly encouraged to start working collaboratively with their colleagues as well as other key players in the pharmaceutical industry to educate on, implement, and practice safe medication disposal.
  • Ostwin Paw, the CEO of Alpro Foundation, called for leaders in the industry to kickstart the conversation on the impact and risks of unsafe medication disposal methods on the environment.
Highlight 3
ALPRO PHARMACY HELPS TO LEAD THE WAY 
  • Lim En Ni, the Chief Pharmacist of Alpro Pharmacy, shared that Alpro Pharmacy launched the Safe Medication Disposal campaign in 2021 in a joint effort with several key pharmaceutical companies in the country.
  • To date, the initiative has safely disposed more than 1,000 kg of medication waste as well as garnered more than 100,000 signatures from the community pledging their support within 3 months since July 2022.
One of the key initiatives of the Safe Medication Disposal campaign is the placement of dedicated medication disposal bins at all Alpro Pharmacy outlets nationwide to collect excess medicines for proper and ethical disposal. For more information on this as well as on proper medical disposal, click here to visit the Safe Medical Disposal Campaign webpage (link opens in a new tab).

Is Antimicrobial Resistance the Next Global Threat After COVID-19? Let’s Find Out

WORDS PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR

FEATURED EXPERT
PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR
Infectious Disease Professor
University Malaya Medical Centre (UMMC)

As Malaysia and most of the world transitioned to the endemic phase of COVID-19, it’s easy to forget that just two years ago, the pandemic had led to millions of lives lost, rise in unemployment rates, and the near-collapse of healthcare systems due to the tsunami of cases. Today, thanks to the quick development of medical innovations such as COVID-19 vaccines, we are now able to continue living our lives in the new normal, resuming productivity, and building towards economic recovery and growth.

Now that we have seen the long-lasting and devastating impact that a pandemic can leave, it is vital that we draw our attention to tackling another urgent public health crisis—antimicrobial resistance, which continues to rise to alarming levels across the world.

A SILENT PANDEMIC

Over the years, antimicrobial resistance has become an urgent health challenge on a global scale. This is because microbes such as bacteria, fungi, and viruses no longer respond to commonly used medicines, resulting in infections becoming harder to treat.

How antibiotic resistance happens. Click the image above for a larger, clearer version.

Antimicrobial treatment no longer serves their desired effect, which in turn will increase the risk of poor outcomes in patients with an infection caused by antimicrobial resistance.

During the COVID-19 pandemic, there was a significant increase in antibiotic prescriptions despite a relatively low bacterial co-infection rate.

The misuse of antibiotics in these patients can result in increased selective pressure for antimicrobial resistance leading to a lasting consequence of the COVID-19 pandemic .

Apart from overprescribing of antibiotics unnecessarily, the increased risk of antimicrobial resistance is compounded by the lack of awareness of appropriate antibiotic use and a poor understanding on the consequences of misusing antibiotics among the public .

It is estimated that drug resistance claims 700,000 lives every year, and this toll is projected to increase exponentially to 10 million a year by 2050 without immediate action.

CONCERNING IMPACTS OF ANTIMICROBIAL RESISTANCE

Development of new antibiotics may not be fast enough to replace those that have become less effective due to antimicrobial resistance

The discovery of antibiotics was a turning point in human history, revolutionizing medicine and increasing the survival rates of infected patients over time.

However, the growing burden of antimicrobial resistance threatens the return to a world with a scarcity of effective treatments for even common bacterial infections such as urinary tract infection, pneumonia, skin infection, and surgical site infections.

As the effects of antimicrobial resistance continue to increase today, the discovery and development of new antimicrobials is not able to keep up against the emergence of AMR.

There is an urgent need for new antibacterial drugs in the market, but with this, comes the importance of ensuring that these antibiotics are used wisely.

Patients should be prescribed antibiotics only when needed, at the right dose, frequency, and duration. Otherwise the new antibiotics will also suffer the same fate as its predecessors and eventually lose effectiveness .

Antimicrobial resistance can also result in productivity loss caused by sickness and premature death, as well as rise of healthcare cost that stems from prolonged hospital stays and care

Without effective tools for the prevention and adequate treatment of drug-resistant infections, treatment may fail for an increasing number of patients. There will also be an increased risk in major medical procedures such as surgery, chemotherapy, and organ transplants .

WHAT CAN WE DO TO REDUCE & PREVENT ANTIMICROBIAL RESISTANCE?
  1. We should only take antibiotics when prescribed by a doctor and correctly follow the prescription directions.
  2. Don’t demand for antibiotics and buy medication without a prescription, or share or take leftover antibiotics.
  3. Maintain strict infection prevention measures such as hand hygiene to reduce the spread of antimicrobial resistance organisms.
  4. There is now increasing evidence that certain vaccines currently available for infectious diseases can decrease the risks of AMR by preventing bacterial and viral infections. Keeping up to date on vaccination schedules. particularly for children and elderlies, may be able to reduce the use of antibiotics, and thus prevent antibiotic-resistant infections.
A CALL TO STAKEHOLDERS TO RISE UP & REDUCE THE SPREAD OF ANTIMICROBIAL RESISTANCE

Besides creating awareness among consumers and healthcare professionals, combatting antimicrobial resistance also requires action from governments, policymakers, and industry players to really address the crux of the issue.

Investment is required in antibiotic research and development, both as a tool to control novel disease outbreaks, and to treat known pathogens developing resistance to currently available treatments.

We must learn from the COVID-19 pandemic to address the next global and public health threat. We have seen that it is indeed possible for all parties to work together to reduce the spread of COVID-19—from citizens adhering to new SOPs, pharmaceutical companies driving innovations that led to the creation of vaccines and COVID-19 treatment, and governments who put in place and enforced guidelines for the people, while also supporting the R&D of these innovations.

The same urgency is needed so that we can prevent the next public health crisis.

Diabetes Experts Reflect on Present & Future Diabetes Awareness Efforts

WORDS LIM TECK CHOON

DIABETES EDUCATION TO PROTECT TOMORROW

The theme of World Diabetes Day in 2022 is Education to Protect Tomorrow, which calls for the need for better access to quality diabetes education for healthcare professionals and people living with diabetes.

During the recent World Diabetes Day (WDD) 2022 celebration in Putrajaya, which was jointly organized by the Endocrine Institute of Putrajaya Hospital, the Malaysian Endocrine & Metabolic Society (MEMS), and Novo Nordisk Pharma Malaysia, the experts present reflected on the need to raise public awareness among Malaysians on diabetes.

After all, the latest National Health and Morbidity Survey reported 1 in 5 adult Malaysians has type 2 diabetes!

EFFORTS NEED TO BE DOUBLED TO STOP RISING PREVALENCE 

Dato’ Dr Asmayani Khalib, the Deputy Director-General (Medical), Ministry of Health Malaysia, said: “The rising number of people affected by diabetes is putting added strain on healthcare systems. Healthcare professionals require quality diabetes education on how to detect and diagnose the condition early and provide the best possible care; while people living with diabetes need access to ongoing education to understand their condition and carry out the daily self-care essential to staying healthy and avoiding complications.”

Datuk Dr. Zanariah bt Hussein, the Head of the Endocrinology Subspecialty Service of the Malaysian Ministry of Health, felt that, as more Malaysians are diagnosed with diabetes, current efforts need to be doubled to stop this rising number from escalating further.

“Access to quality diabetes education is a goal we must all strive in, to educate and empower not only patients and the community but also family members who are providing support and care,” she said.

DIABETES EDUCATION KEY TO SUSTAINABLE LONG-TERM DIABETES CARE

“The focus on access to diabetes education is a critical aspect that will enable sustainable long-term care, with both healthcare providers and people living with diabetes receiving quality diabetes education,”  said Richard Abela, the Vice President and General Manager of Novo Nordisk Pharma Malaysia. “This is an essential component of diabetes care as we develop a patient-centric approach in care, that is sustainable for lifelong chronic disease management.”

A Health-Centric Wishlist for the Malaysian GE15

WORDS ANWAR ANIS

FEATURED EXPERT
ANWAR ANIS
Executive Director
ALTY Orthopaedic Hospital
FORMATION OF A LONG-TERM PARTNERSHIP BETWEEN PUBLIC & PRIVATE HEALTHCARE

Building upon the successful collaboration between public and private healthcare during the pandemic, a long-term policy on greater partnership will benefit both the government and the private sector, with all Malaysians being the key beneficiary.

There still are waiting lists for procedures in the public hospitals, and these can certainly be reduced if there is a structure long term arrangement for the private hospitals and centres to assist in reducing and maintaining a short wait time, especially for elective procedures which can greatly enhance an individual’s productivity, although it may not be life threatening.

GREATER FOCUS ON AN AGEING SOCIETY

These include the necessary social safety nets, proper care facilities and also post hospitalization care and support.

Here, the government should consider partnering the many physio and home care organizations to ensure patients have good compliance to post hospital care, including physio, wound care and others.

An aging population also typically means reduced mobility due to various issue—for example orthopaedic-related issues, where it can be address with proper intervention, and where needed surgery.

Government subsidy for implants, such as knee and hip implants can reduce the burden for the uninsured (which is a large majority of those who need such care) – and thus ensuring they have good mobility and thus independence even as they age.

INNOVATION IN HEALTHCARE WITH ROBOTICS, 3D PRINTING & OTHER NEW TECHNOLOGIES

The government should consider encouraging the adoption of such technologies especially in healthcare.

Grants or even personal subsidies to access such health technologies where appropriate can propel the adoption and perhaps even development of such tech.

For example, 3D printed casts or prosthesis will improve recovery and long-term quality of life. The regulatory framework also needs to support the faster adoption of such health technologies, to ensure Malaysia is able to maintain its advantage as a healthcare travel destination.

COMPETITIVE & FACILITATIVE IMMIGRATION POLICIES

Competitive and facilitative immigration policies, for healthcare travelers especially, will allow Malaysia to be serve a greater no of patients, which in turn lowers the cost of investment in health-related technologies and equipment, thus enabling more Malaysians to access it as well.

Some of our neighbouring countries continue to attract patients from a number of different countries, despite being less competitive overall than Malaysia, primarily due to the ease of arriving into the country.

Thus, they are able to invest in technology such as proton beam, as fee-paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.

Empowering Pharmacists to Better Serve The Nation

WORDS LIM EN NI

FEATURED EXPERT
LIM EN NI
Chief Pharmacist
Alpro Pharmacy

For the longest time, the role of a pharmacist has been seen by many, even among those in the profession, as retailer of supplements and other healthcare products. However, due to the COVID-19 pandemic, the general public have come to recognize the values community pharmacists bring.

MEDICATION SAFETY

Very often, patients with multiple non-communicable diseases (NCDs) were prescribed with medications by different doctors, they might not be aware of possible medical contradictions. They brought these medications to community pharmacists like me, and we helped them review and explain the dosage and possible side effects of each medicine. Most importantly, pharmacists ensure the safety of patients from medication errors.

ACCESSIBILITY

Pharmacies are usually open for long hours and pharmacists offer informal, appointment-free consultation. At the height of the pandemic when clinics and hospitals required COVID-19 screening prior to consultation with doctors and patients avoided going to high-risk places, community pharmacists filled the gap by offering advice on COVID-19 and other health related matters including basic health screening and re-filling much needed chronic prescriptions through collaboration with telemedicine providers.

SOLUTION-BASED SERVICES

In recent years, many product-based retail pharmacists have transited to community pharmacists with solution-based services, such as wound-care, smoking cessation service, and diabetic-care.

THUS, COMMUNITY PHARMACIES INFLUENCE NATIONAL HEALTH CARE PROGRESSION IN POSITIVE WAYS

It is high time for the Government to endorse community pharmacists as an integral part of community health and wellness by allocating funding for programmes in support of the Government’s efforts in creating a smoke-free generation, battling against NCDs and providing preventive care for the ageing population.

The inclusion of community pharmacists in the Government’s outreach plan will benefit the country as a whole, as it will ultimately reduce medical costs, improve population health, increase the quality of healthcare in Malaysia and contribute to the country’s GDP.

This year, The International Pharmaceutical Federation announced the theme of World Pharmacist Day 2022 as “Pharmacy United in Action for a Healthier World”. This theme invites comrades from all sectors of the pharmacy profession to take part in the campaign. Regardless of culture or point of view, the core duty of every pharmacist remains—to safeguard medication safety for everyone.

Reflections of a Pharmacist on Solidarity, Price Wars & Public Service

WORDS LIM KELVIN

FEATURED EXPERT
LIM KELVIN
Pharmacist

The views and opinions expressed in this article are the author’s own. They do not reflect the opinions of his colleagues, associates, employer, and organizations he is affiliated with.

THE 25TH OF SEPTEMBER IS WORLD PHARMACISTS DAY

The official theme of the year is ‘Pharmacy united in action for a healthier world’.

The aim of this theme is to showcase the positive impact of pharmacists on health around the world and to further strengthen solidarity among the profession.

The keywords here are ‘united’ and ‘positive impact’.

THE POSITIVE IMPACT OF PHARMACISTS

In today’s healthcare landscape, pharmacists find themselves playing a new role, bestowed upon them by the public: they are the fact checkers and encyclopaedia for members of the public when it comes to everything and anything related to health. In other words, pharmacists are the new Alexa or Siri whenever someone has a question about health!

Pharmacists didn’t necessarily ask for or want this role, but it is one thrust upon us by a public that not only view us as the most accessible healthcare professionals in our society—members of the public also develop a trust in our knowledge after forming a rapport with us.

Our clients usually just walk into our outlet and obtain valuable health advice easily, with low or no cost at all.

With the advent of social media, we tend to become THE go-to person they talk to whenever they want to verify a health claim or ask about the latest health fad.

How pharmacists can step up for this role

To perform this role well, pharmacists need to be competent in their core field of pharmacotherapy, as well as to know a bit of everything in the realm of healthcare.

This is not a small feat to achieve, but it’s one that we need, to be able to guide our clients, or at least point them to the correct direction when there is no direct answer to their queries.

Having good research and analytical skills and keeping up with current updates are the 2 main paths for a pharmacist to become a good source of information.

Apart from pharmacists taking the initiative to do the necessary, our universities play a big role in instilling these skills in our pharmacy undergraduates, to enable them to cope with this new demand. So perhaps our fellow academicians can put more emphasis in this aspect.

Does it make a difference though, if we play this new role well?

Yes. Immensely.

In this world of information overload (or rather the age of misinformation), any Tom, Dick, and Harry can broadcast ‘health advice’ on social media.

As a result, members of the public are bombarded with equal amounts of information and misinformation.

Not everyone will be able to separate fact from fiction, even after googling for the answers, perhaps due to a lack of understanding of the information they found or to use the information to make an informed conclusion.

Pharmacists with years of training and experience will be in a better position to help members of the public digest complex terms and ideas into simple statements that they can more readily absorb. Even more so for the elderly and uneducated.

So, being a trusted point of reference is of utmost importance for our society right now. Apart from carrying out our core duties of being the custodians of medications, this new role positions us to impact the health of the world most significantly, positively.

PHARMACISTS IN SOLIDARITY

Then we arrive at the other key aspect of this year’s theme: unity.

Unity is not something we commonly see among retail or community pharmacies. The supposed fellowship and camaraderie had eroded more substantially in the recent years, mainly due to the intense competition between big pharmacy chains as well as price wars.

Competition was originally thought to be a positive force in keeping market prices low for the benefit of the consumer. However, when competition goes too far, it becomes unhealthy to both the profession and the consumer.

‘Tribal war’ among pharmacists?

Pharmacists have become more and more hostile to their counterparts from another ‘tribe’, due to the aforementioned competition.

They view each other as adversaries or even enemies, instead of colleagues.

This hinders cooperation between pharmacy groups. Even in times of medication shortage, a pharmacist is less likely to seek cooperation/help from other ‘tribes’, which in turn negatively impacts their clients’ welfare and the image of our profession.

Furthermore, smaller pharmacies not belonging to any big ‘tribes’ sometimes face unnecessary hostility from bigger tribes when these tribes migrate and open next to them en masse.

Almost in every town you can see 4 to 5 different pharmacies opening in the same stretch of shop-houses, and price wars inevitably make it near impossible for a stand-alone pharmacists to practice their trade professionally.

Still, price wars are good for the consumer… right?

Unfortunately, this is not always true.

With drug prices being sold at cost or below cost, businesses have to to obtain profits through alternate channels. These channels can be additional sales of legitimate products or from some other less-ideal methods.

Either way, the interest of the client is not going to be the main focus anymore. Instead, sales, incentives, and targets take precedence over the client’s genuine needs.

This is NOT what most pharmacists want, but the nature of the industry is forcing more and more of them to sing to this tune. Furthermore, the end game for many price wars is monopolistic in nature, where absurd profits are to be reaped after a dominant force appears.

But what can pharmacists do about this? How do we unite?

Needless to say, it is going to be a gargantuan task, but we have to start somewhere.

Stay professional. Always be a pharmacist first, retailer or businessman second. I’m not asking you to go on strike or forego profits. Just be sure to put our client’s needs first in our every consideration.

From here, build bonds with your fellow pharmacists. Meet more pharmacists outside your workplace, so that you can find solutions to each other’s weaknesses. Cooperation not only benefits our customers in the long run; it also changes our views on competition.

Maintain mutual respect and keep competition healthy. Compete with each other to be the better pharmacist, to see who elevates our healthcare to a higher level. Don’t just compete in terms of profit and loss.

It’s up to us to create the future we want to live in. I always say I don’t want to grow old one day and have to doubt the advice given by my pharmacist for the fear of being ripped off or being coerced into buying something.

Talk to your management. Voice out what you feel is right or wrong whenever you have the opportunity. This doesn’t have to be confrontational, if we do it the right way. Only when there are enough voices saying the same thing, will things start to change.

Lastly, do actively support our professional body.With enough support and the right mindset, our profession can be more united to under this body, and we can all serve the public better.

A LAST NOTE: TO OUR CLIENTS

Cherish and support any pharmacist that gives you more value for your health rather than your wallet.

Granted, price is a big deciding factor when making any purchase, but as long as the difference is not too big, always support the one that truly cares for your health.

Hopefully with changes in the mindsets of both pharmacists and clients, the big divide caused by price and competition will slowly narrow and allow pharmacists can be more united in serving the public positively.