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Pharmacy in China

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Pharmacy in China involves the activities engaged in the preparation, standardization and dispensing of drugs, and its scope includes the cultivation of plants that are used as drugs, the synthesis of chemical compounds of medicinal value, and the analysis of medicinal agents. Pharmacists in China are responsible for the preparation of the dosage forms of drugs, such as tablets, capsules, and sterile solutions for injection. They compound physicians', dentists', and veterinarians' prescriptions for drugs. Pharmacological activities are also closely related to pharmacy in China.

There are two main streams of pharmaceutical practice in China, traditional Chinese medicine (TCM) and modern pharmacy. Hospital and community pharmacies are responsible for the dispensing of medicinals used for both streams of pharmaceutical practice.

Around fifty colleges of pharmacy offer pharmacy education, half of which provide a Western medicine approach and the other half traditional Chinese medicine. Both types of colleges offer a four-year curriculum with options for specialization. Graduate study is also available. Most of the graduates work in hospital pharmacies. Hospital pharmacies participate in the bulk manufacture of drugs and parenteral fluids. A bulk dispensing system is used by some hospitals; individual patient doses are dispensed in others.

Recently, clinical pharmacy services in China have been developed and training courses begun. Curricula with specialization in clinical pharmacy have also been established by colleges of pharmacy.

It is anticipated that through increased awareness of the potential contribution of pharmacists in China's health-care system, more opportunities for educating pharmacists would be made available to meet the vast need of the country. Development of clinical pharmacy services have also been expected to improve the quality of care provided.

Ancient history

The beginnings of pharmacy in China are ancient (see Chinese alchemy). Shennong is said to have tasted hundreds of herbs to test their medical value. The most well-known work attributed to Shennong is the The Divine Farmer's Herb-Root Classic. This work is considered to be the earliest Chinese pharmacopoeia. It includes 365 medicines derived from minerals, plants, and animals. Shennong is credited with identifying hundreds of medical (and poisonous) herbs by personally testing their properties, which was crucial to the development of Traditional Chinese medicine.

Separation of prescribing from dispensing

Unlike the prevailing practice in other, particularly Western countries, the duties of the pharmacist and physician are not entirely separated. Chinese doctors are allowed to dispense drugs themselves and the practice of pharmacy is sometimes integrated with that of the physician, particularly in traditional Chinese medicine. The idea of separating the two professions has been debated as the trend for specialization has increased in the health sciences. Other countries such as South Korea, Japan and Taiwan have successfully separated the jurisidications to legally separate the practice of prescribing from the practice of dispensing. That legislation has also specified that only pharmacists may supply scheduled pharmaceuticals to the public, and that pharmacists cannot form business partnerships with physicians or give them "kickback" payments. Possible reform for this area is being considered by the Chinese regulatory authorities.

Pharmacist role

Since the economic reform period of the 1980s, the development of the Chinese pharmaceutical industry has led to the introduction of new and effective drug substances. It also changed the role of the pharmacist. The scope for extemporaneous compounding of medicines was much diminished and with it the need for the manipulative skills that were previously applied by the pharmacist to the preparation of bougies, cachets, pills, plasters, and liquids. Pharmacists continue, however, to fulfill the prescriber's intentions by providing advice and information; by formulating, storing, and providing correct dosage forms; and by assuring the efficacy and quality of the dispensed or supplied medicinal product.

In the future, pharmacists are expected to become more integral within the health care system. Rather than only dispensing medication and other routine duties, pharmacists are to be involved more in patient care with their particular knowledge and skills.

Hospital pharmacy

Since 1949, health care in China has improved. The number of hospitals has increased. While medicines previously were scarce, China now produces approximately 75 percent of the drugs it needs. China has a long history of traditional medicine; although there are attempts to integrate the concepts of traditional and Western medicine, the practices are still segregated. All hospital pharmacies in China have the responsibilities to guarantee the safe and effective use of drugs within the hospital and to do research. Even though Chinese factories manufacture many pharmaceutical products, the hospital pharmacy must manufacture many more.

Hospitals have established Agreed Prescription programs, whereby drugs are manufactured in large batches, repackaged, and distributed to other hospital pharmacies in the area if needed. Quality is assessed chemically and by modern techniques when equipment is available. Most large hospitals now have automated facilities to manufacture sterile solutions. Each hospital has a medical supply committee that supervises the procurement of medical supplies and the reasonable use of drugs.

A government resolution mandates that every hospital pharmacy do research. A primary focus of their research is the integration of traditional and Western medicine. Concepts of traditional and Western medicine are taught in separate pharmacy schools. Most pharmacy undergraduate programs are four years, but some schools recently changed to five years. Challenges for hospital pharmacists in China have been to develop the theoretical and technological knowledge of pharmacy, and to expand the scientific and technical information system that is necessary to do research.

Education

The course of instruction leading to a bachelor of science in pharmacy extends at least four years. The first and frequently the second year of training, embracing general education subjects, are often provided by a school of arts and sciences. Many institutions also offer graduate courses in pharmacy and cognate sciences leading to the degrees of master of science and doctor of philosophy in pharmacy, pharmacology, or related disciplines. These advanced courses are intended especially for those who are preparing for careers in research, manufacturing, or teaching in the field of pharmacy.

Since the treatment with drugs encompasses a wide field of knowledge in the biological and physical sciences, an understanding of these sciences is included for pharmaceutical training. The basic four-year curriculum in the colleges of pharmacy, for example, embraces physics, chemistry, biology, bacteriology, physiology, pharmacology, and many other specialized courses. As the pharmacist is engaged in a business as well as a profession, special training is provided in merchandising, accounting, computer techniques, and pharmaceutical jurisprudence.

Pharmacy schools

The pharmacy schools in China are experiencing the dramatic changes, together with the booming economy and continuous education reform. In the last ten years, one major structural change in the higher educational system was the merger of several medical and pharmacy schools with several major universities. The environment for these pharmacy schools have been changing dramatically from independent or medical university settings into being affiliated to comprehensive and multidisciplinary Universities. It presented the similar situation as those happened in the US during last century, when some state universities expanded into pharmacy education or merged with independent pharmacy schools.

List:

Hong Kong

Macau


TCM colleges:

  • Anhui Chinese Medicine College - Department of Chinese Traditional Medicine
  • Beijing College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Changchun College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Chengdu College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Guangxi College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Guangzhou College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Guiyang College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Heilongjiang College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Heilongjiang Commerce College - Department of Chinese Traditional Medicine
  • Henan College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Hubei College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Jiangxi Chinese Medicine College - Department of Pharmacy
  • Jiangxi College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Liaoning College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Nanjing University of Traditional Chinese Medicine - Department of Chinese Pharmacy
  • Shandong College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Shanghai College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Tianjin University of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Shanxi College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine
  • Yunnan College of Traditional Chinese Medicine - Department of Chinese Traditional Medicine

Licensing and regulation

To practice pharmacy in China in which a license is required, an applicant must be qualified by graduation from a recognized college of pharmacy, meet specific requirements for experience, and pass an examination conducted by the Chinese Pharmaceutical Association as appointed by the government.

Pharmacy laws generally include the regulations for the practice of pharmacy, the sale of liquids, the dispensing of narcotics, and the labeling and sale of dangerous drugs. The pharmacist sells and dispenses drugs within the provisions of the food and drug laws of the country in which he practices. These laws recognize the national pharmacopoeia (which defines products used in medicine, their purity, dosages, and other pertinent data) as the standard for drugs.

Regulatory bodies with responsibilities related to pharmacy are:

  • General Administration of Quality Supervision, Inspection and Quarantine
  • Ministry of Health
  • State Food and Drug Administration
  • National Institute for the Control of Pharmaceutical and Biological Products
  • Ministry of Agriculture

Research

Pharmaceutical research, in Chinese schools of pharmacy, embraces the organic chemical synthesis of new chemical agents for use as drugs and is also concerned with the isolation and purification of plant constituents that might be useful as drugs. Research in pharmacy also includes formulation of dosage forms of medicaments and study of their stability, methods of assay, and standardization.

Another facet of pharmaceutical research that has attracted wide medical attention is the "availability" to the body (bioavailability) of various dosage forms of drugs. Exact methods of determining levels of drugs in blood and organs have revealed that slight changes in the mode of manufacture or the incorporation of a small amount of inert ingredient in a tablet may diminish or completely prevent its absorption from the gastrointestinal tract, thus nullifying the action of the drug. Ingenious methods have been devised to test the bioavailability of dosage forms. Although such in vitro, or test-tube, methods are useful and indicative, the ultimate test of bioavailability is the patient's response to the dosage form of the drug.

Licensing systems for new medicinal products in China demand increasingly extensive and costly investigation and testing in the laboratory and in clinical trials to establish the efficacy and safety of new products in relation to the claims to be made for their use. Proprietary rights for innovation by the grant of patents and by the registration of trademarks have become increasingly important in the growth of the domestic pharmaceutical industry and its development internationally.

Journals

The results of research in pharmacy are usually published in such journals as the:

  • Acta Pharmaceutica Sinica
  • Adverse Drug Reaction Journal
  • China Journal of Traditional Chinese Medicine and Pharmacy
  • China Pharmacist
  • Chinese Journal of Antibiotics
  • Chinese Journal of Clinical Pharmacy
  • Chinese Journal of Hospital Pharmacy
  • Chinese Journal of Modern Applied Pharmacy
  • Chinese Journal of Natural Medicines
  • Chinese Journal of New Drugs
  • Chinese Journal of New Drugs and Clinical Remedies
  • Chinese Journal of Pharmaceutical Analysis
  • Chinese Journal of Pharmaceuticals
  • Chinese Journal of Pharmacoepidemiology
  • Chinese Pharmaceutical Journal
  • Chinese Traditional and Herbal Drugs
  • Herald of Medicine
  • Journal of Beijing University of Traditional Chinese Medicine
  • Journal of China Pharmacy
  • Journal of China Pharmaceutical University
  • Journal of Chinese Materia Medica
  • Journal of Traditional Chinese Medicine
  • Pharmaceutical Care and Research

Organizations

There are numerous pharmacy-related organizations. The Chinese Pharmaceutical Association (CPA) is the national organization of pharmacists and pharmaceutical scientists with the mission to represent and serve pharmacy and pharmaceutical sciences development in China. CPA was founded in 1907, it now has nearly 3000 senior individual members and 35 group members. Through its group members, CPA connects, represents and serves more than 105,000 pharmacists and pharmaceutical scientists around the country. The CPA is a member of the International Pharmaceutial Federation.

There are also other societies in which history, teaching, and the military aspects of pharmacy are given special emphasis.

Retail (community) pharmacy

About 120,000 retail pharmacies operate in China. Most of them are quite small--less than 200 m2--but a few are as large as 1,000 m2 or more. The majority are licensed to carry medicines (prescription and over-the-counter [OTC]), traditional Chinese medicines, health foods (designated by the jian shi characters at the beginning of the registration certificate), and family planning products. Some retail pharmacies are also licensed to carry cosmetic products. It is relatively simple to add products the Chinese government classifies as cosmetics to a pharmacy's operating license. Chinese retail pharmacies do not carry products frequently found in US pharmacies, such as shampoo, diapers, nail polish, and batteries. China's pharmacies, however, sell products such as imported skin creams, specialty hair-care products (such as dyes or masks), and feminine-hygiene products.

All retail pharmacies prior to January 2003 - when WTO rules took effect - had by law must have been government-owned. Many of the state-owned pharmacy companies had consolidated to establish chains or franchises, and many more have contracted day-to-day management to an entrepreneur who pays a small percentage of the profits to its hands-off government owner. In Beijing and Shanghai, the local governments stopped approving applications for new pharmacies about three years ago, but is allowing chain stores to increase their number of outlets. Therefore, any "new" retail pharmacy in these markets must be affiliated with an existing outlet. In Shanghai, pharmacies must also contend with a rule that prohibits chains from opening outlets within a certain distance of existing pharmacies.

Local administrations for industry and commerce and local health bureaus oversee and regulate the pharmacies. Their monitoring of retail outlets includes spot checks of the types of products being sold, follow-ups on consumer complaints, and verification that retail prices match registered prices. Government monitors also verify that products comply with government regulations on labeling and other matters, and that merchandising and advertising materials are compliant and registered.

Chinese pharmacies have been undergoing dramatic changes as the retail medicine market opens up. Under planned reforms, China's retail pharmacies will begin selling a much higher volume of prescription drugs, and hospital pharmacies will eventually be restricted to dispensing prescriptions for inpatient use. Retail pharmacies' businesses will consist more and more of high-volume prescription drug sales and high-margin healthcare and personal-care products, including OTC drugs, health foods, family planning products, and beauty products, similar to a European or North American drugstore model.

More and more patients have been willing to buy non-prescription medicines in convenient drugstores instead of registering and queuing in hospitals. Large numbers of drug wholesalers have also entered the retail market due to the expected returns. Domestic pharmaceutical giant Sanjiu Enterprise Group has planned to open 8,000 to 10,000 outlets at a cost of 1.3 billion yuan (US $157 million).

China Nepstar is the largest retail drugstore chain in China, based on the number of directly operated stores. As of September 2007, the company had 1,791 stores in 62 cities. Nepstar has also planned to establish 5,000 to 10,000 chain stores in the next five years. It provides pharmacy services as well as a wide variety of other merchandise, including over-the-counter drugs, herbal products, personal care products and nutritional supplements. The company also offers 1,108 private-label products under its own brand name. For the six months ended June 30, China Nepstar reported earnings of $4.6 million, after paying preferred dividends, on sales of $124.3 million.[1]

As of 2003, China had 196 pharmaceutical enterprises with chain stores, reporting an annual sales volume of nearly 8 billion yuan (US $967 milion). Most chain drugstores though are small in scale. Peace Pharmacy, one of China's largest drug store in Chongqing had only 300 chain stores. Besides medicines, medical equipment are also sold in Chinese drugstores. This has been to meet the demand of consumers who have begun to favor products for self-diagnosis and self-health care.

Rapid mergers and acquisitions, expansion in the retail industry is expected to gradually consolidate the sector.

Pharmacies, found in all towns, can help with minor injuries and ailments. Larger ones sometimes have a separate counter offering diagnosis and advice. Staff can usually help if the customer describes his or her symptoms. The selection of reliable Asian and Western products available is improving and it is possible to self-treat with herbal medicines. Contraceptives are widely available, as are antibiotics.

Good Pharmacy Practice

As a result of the development of society and national economy, the people's health care level and the sense of self-medication are gradually improving. Therefore, the demand for good pharmacy service especially for carrying out pharmaceutical care not only in hospital but also in community pharmacies are increasing.

The China Nonprescription Medicines Association (CNMA) is a guild of pharmaceutical manufacturers and distributors, especially of those manufacturers of non-prescription medicines and community pharmacies.[2] Based on the pharmaceutical care and licensed pharmacists system, the CNMA under the auspices of government and membership units, consulted the "International Good Pharmacy Practice for Developing Countries" and the "Standards for Quality of Pharmacy Services" and GPP documents of other countries available to constitute the Good Pharmacy Practice and Evaluation Standards of GPP especially for community pharmacies.

See also

References

  1. ^ China Nepstar Shares Gain in Debut
  2. ^ China Nonprescription Medicines Association
  • China World List of Pharmacy Schools, International Pharmaceutical Federation (FIP)

Further reading


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