And the assault continues...

It seems like a bad month for GPs.

Here's the latest letter on the issue of clinics dispensing drugs and drug costs:


Liberalise distribution of prescriptive drugs

THE letter, 'High prices for common drugs in HDB heartland' (ST, Feb 21), by Madam Gan Siok Wah clearly shows the price of medicine in Singapore can be exorbitant.

A member of my family was charged more than $40 by a doctor just for a small rash, but the medicine proved totally ineffective. In all, the person spent over $100 with various doctors without success. Instead, the rash was later cured quickly and effectively with a $6 non- prescriptive ointment from a pharmacy which was recommended by the attendant pharmacist.

One way to counter high prices of medical care is to liberalise the distribution of prescriptive medicine via pharmacies. I have already petitioned the Government on this. Other countries that are more advanced medically have done this, so why not Singapore?

Furthermore, university-trained pharmacists are well-versed in the use of prescription medicine so why are they not allowed to dispense them via pharmacies? In the current situation, the pharmacist may need a prescription from the doctor just to use a prescriptive medicine on himself.

If medicine becomes too expensive, more people will prefer to sleep away their common illnesses - but for one thing. If one is working or studying, one's employer or school will accept only a doctor's medical certificate to excuse one's absence.

So even if one is treated by, say, a certified physician of traditional Chinese medicine (TCM), whose charges tend to be cheaper, an MC from him is useless. One must still pay a doctor to get a recognised MC. This adds unnecessarily to the cost of health care.

Why is TCM, which is part and parcel of our traditional Asian culture, not given the respect it deserves - especially when the physician has been certified by the authorities.

Besides, some people respond better to herbal medicine just as some do to Western medicine.

I therefore suggest that the Government liberalise the distribution of prescriptive Western medicine via pharmacies and give legal recognition to MCs issued by pharmacists and certified physicians.

I believe the cost of Western medicine has driven some people in other countries to buy them via legitimate outlets on the Internet, saving them a lot of money.

To give an indication, the demand for online medicine is so great that last year the Canadian government said it could not afford to jeopardise its national supply of medicine by selling it via online pharmacies.

Chia Hern Keng


I won't discuss the merits behind deregulating or liberalising drug prescription. I did try to read through the Medicines Act and the Poisons Act, but found them rather incomprehensible, and in any case not very enlightening - they tell you what the law is, but not why it is so.

Certainly more and more drugs are being deregulated and no longer require a doctor's prescription to be dispensed. I doubt the staunchest supporter of liberalisation will advocate deregulation of all drugs (including opiates and other potentially addictive drugs), so the argument will probably be one of which drugs to deregulate.

What interests me is Mr Chia's lines of argument (assuming the letter had not been edited beyond recognition of the author).

Mr Chia begins his letter by a personal anecdote: a family member was given expensive prescription drugs which did not cure his condition, and eventually a non-prescription drug did the trick.

Assuming that the condition resolved as a direct result of the non-prescription drug and of that drug only, I don't see how this episode argues for the deregulation of prescription drugs. Afterall, isn't that effective drug already 'non-prescription'? How would adding other ineffective drugs to the 'non-prescription' pool help anyone?

In effect Mr Chia is saying: a family member of mine had a condition that didn't get better with prescription drugs and only got better with a non-prescription drug, so the government should liberalise the distribution of prescription drugs. I don't think I quite follow that.

Or is his point: cheaper drugs are better than expensive drugs, so we should make all drugs cheaper by deregulating them?

I do agree with him regarding the need for MCs accounting for unnecessary healthcare costs. The reason for the need for MC is however usually social or legal, and if our employers and schools could trust employees and students to be honest about calling in sick, a lot of unnecessary time and money would have been saved by all sides.

(Some employers are even stricter with MCs, accepting only MCs from government hospitals and clinics, and some even requiring a patient/casualty to be seen at a polyclinic before he can be brought to the emergency department, but that's another topic altogether).

However, his argument for recognising MCs from TCM practitioner is a bit off the mark.

The point of a medical certificate is to certify a patients fitness (or unfitness) for school or work. Whether a healthcare system is part of our traditional Asian culture or not, and whether or not some people respond better to herbal medicine is not really relevant to the issue. MCs from 'Western' doctors are accepted not because they are a part of our Asian culture, nor because everyone respond better to 'Western' medicine rather than herbal medicine. In any case, I don't believe TCM has a tradition of issuing MCs.

Again, it is the social and legal considerations behind the non-acceptance of MCs from TCM practitioners rather than the efficacy of TCM as a means of healing or as a part our heritage that must be addressed.

The final paragraphs of his letter seem to argue for deregulation simply because people can circumvent regulation by buying drugs off the internet anyway. That is like arguing for deregulation of any other form of contraband simply because they are legal in their country of origin and because there are always ways people can smuggle them in. It would apply for alcohol, tobacco, pornography, subversive literature, uncensored movies, and endangered animals. Even if you consider smuggling of prescription drugs a victimless crime, I think this line of argument will not find favour with the authorities.