Sale of Medicine by Doctors [Dispensing of Medicines by Doctors in their Clinics]

In India, manufacturing, storing, transportation, distribution, and dispensing of drugs are licensed and regulated under the drugs and cosmetic act, 1940; Indian Medical Council Act, 1956; the Pharmacy Act, 1948; and the Narcotic Drugs and Psychotropic Substances Act, 1985. Prescribing and dispensing medicines at the same time to their patients by registered medical practitioners (RMPs) is a wellknown practice in all systems of medicine across the country. Further, the kind of branded medicines a patient gets from the clinics will come wrapped in a huge profit margin for RMPs, and this has been an alternative source of income to them.

Dispensing and selling of medicines by RMPs at their clinics to their patients may represent a significant potential conflict of interest with the medical ethical principles, namely autonomy, beneficence, and nonmaleficence and it raises various ethical and legal challenges. This videos focuses on the ethical and legal issues of this practice and emphasizes the need for a proactive and dynamic approach to meet the rising demand for quality healthcare in India.

The World Health Organization describes “Dispensing” as a process of preparing and giving medicine to a named person on the basis of a prescription from a registered practitioner. However, it is not uncommon to see the registered medical practitioners (RMPs) performing both the dual role of prescribing and dispensing medicine. This dual role of prescribing and dispensing of medication is common in all system of practice. This also includes home visits done by (RMPs), when medicines are carried in a doctor's bag to dispense to their patients. Although this practice is decreasing in major cities, it continues to be prevalent in semiurban and rural areas. A recent trend noted in metropolitan cities is that many RMPs are doing home visits to treat patients, especially in disabled and geriatric services. Initially, this provision was intended to address the needs of communities where there were no pharmacists. This practice of dispensing of medicine by RMPs was allowed so that consultation, prescription, treatmentrelated materials, and medicines are available inside the clinic so that a patient does not have to run to the pharmacy to get medicines that have been prescribed

RMPs selling medicines at their clinics to their patients may represent a significant potential conflict of interest against the medical ethical principles of autonomy, beneficence, and nonmaleficence.

The Professional Conduct, Etiquette and Ethics for RMPs and it is titled “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 (Amended on 2016).” In the above regulations, section 6.3 clearly states that an RMPs should not run an open shop for sale of medicine for dispensing prescriptions prescribed by RMPs other than himself or for sale of medical or surgical appliances. It is not unethical for RMPs to prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient. Drugs prescribed by an RMPs for a patient should explicitly state the proprietary formulae as well as the generic name of the drug.

The challenges faced in the healthcare system cannot be viewed in isolation. A thorough evaluation indicates that corruption, in general, has pervaded the very fabric of society and is reflected in the medical profession also. Other major contributors are the commercialization of the medical education, gradual deterioration of the public health system, and poor political will to address this issue. The opportunities are as follows: investing in health, abolishing medical education based on the capitation fee, enhancing the rural population's access to quality health care, leveraging innovative technologies such as telemedicine to provide clinical care, improving the basic health infrastructure in rural areas, controlling corruption in the health sector, stopping the supply of substandard equipment and medications, encouraging online pharmacy, and stricter law

To conclude, doctor–patient relationships are of trust and confidence, where the fiduciary must act in the interests of the beneficiary and stop this inhouse pharmacy phenomenon. There are many medicines where the price varies across brands because they are not under price control. The price of the nonessential drugs has been left to the greed of the market. The cost of medicines makes treatment less affordable for most of the population. To curtail the nonuniform cost across the company, there is a need for strong political will to enforce “one medicine, one price” across all brands. Epharmacy is a new avenue may have the potential to alter the existing inhouse pharmacy practice of making a huge profit margin from patients.