Letters

Abstract

We are pleased that our initial letter to the editor, “The PharmD Degree in Developing Countries,” received attention and resulted in several letters of response being published.1 We would like to summarize some of the issues raised by other colleagues. In the letter “Controversy of PharmD Degree,” published in AJPE, the principal author opinionated the similarity of pharmacy degrees issued throughout the world. We found it difficult to agree with this perspective--that the “PharmD tag” is the only solution-because the curriculum is neither fully industry-oriented nor clinically aligned. In contrast, the letter penned by Ghayur not only deserves merit but energizes us to share the experiences we had during 3 months in pharmacy institutes and pharmacies in Pakistan.2 In fact, the doctor of pharmacy (PharmD) degree in Pakistan was started without any planning. Thus, it is not incorrect to say that the PharmD degree is just a tool to help students qualify for job opportunities in Gulf countries1 as well as to make the so-called “doctors” eligible to sit for the license examination in the United States or elsewhere. While working on my PhD project in Pakistan, I (S.J.) had an opportunity to interview final-year PharmD students at 3 public and 3 private universities. The students were apprehensive about their future because “this new curriculum, without any proper clinical attachment, with just a couple of visits to hospitals, would serve the purpose is a doubtful issue.” They expressed a strong sense of discontentment over the forced conversion from the 4-year bachelor's degree program for which they were admitted to a 5-year PharmD program without their consent. Not even proper clinical affiliation with inadequately trained staff (in one instance clinical pharmacy was taught by a zoologist) they perceived the PharmD degree program as a mere “hoax” with no light at the end of tunnel. Likewise, the co-author of this letter (Z.B.), while delivering a lecture as a Malaysian pharmacy expert to pharmacy institutes in Pakistan, was speechless to answer one pharmacy student's question: “Sir, why in Pakistan, clinical pharmacy comes under the umbrella of Pharmaceutics”? Just to endorse the views penned down by Ghayur2 regarding non-availability of pharmacists on pharmacies as well as selling of prescription drugs without prescription, we would like to describe our experience here. A visit to a pharmacy in Karachi, Pakistan, being run by non-professionally trained drug sellers, exhibited not only brand substitutions without the consent of a doctor but also antibiotic dispensing without a prescription. The most nerve-racking observation was the supply of benzodiazepine available on consumer demand. Interestingly 25 consumers mentioned different names of the benzodiazepine class of drugs and bought a whole month's supply without a prescription.3 Interestingly, despite the absence of pharmacists, every pharmacy has a license to sell medicines thanks to many of our fellow pharmacists who lease their degrees annually to any layman who wants to open a chemist shop or pharmacy. With gaps even in the bachelor of pharmacy curriculum, accompanied with sparse recognition of pharmacists as healthcare providers in the healthcare system of Pakistan, we are unable to comprehend to what extent switching to the PharmD degree would be justified. The PharmD could be required in developing countries; however, a systematic plan of action would be needed to give due recognition to pharmacists as they are still an underrated group of health professionals. Regarding India's recent scheme for adding the PharmD, the Health Ministry has paved the way for Indian pharmacy practice training and education by giving formal approval for PharmD regulations.4 The PharmD course is comprised of 6 academic years, with 5 years of study and 1 year of internship and residency. Six months of the internship and residency is spent in a general medicine department and 2 months each in other speciality departments. The clerkship, coupled with a research project covering areas of biostatistics and research methodology, as well as concepts of pharmacoeconomics and clinical research, is also in place.4 However the effectiveness of any such scheme largely depends on its delivery and execution, as well as the availability of clinical pharmacy staff members. Shazia Jamshed Universiti Sains Malaysia Zaheer-ud-din Babar University of Aukland, New Zealand Mohamed Izham Mohamed Ibrahim Universiti Sains Malaysia