TY - JOUR
AU - MacAdam, Angela
AB - Abstract Background Pharmacists, as healthcare professionals, have patients' well-being and safety as their primary concern. However, the safety and efficacy of treatments may be compromised by the availability of counterfeit medicine (CFM) which could have serious consequences for public health. Objectives To assess pharmacist awareness and views towards CFM in Lebanon. Methods The study used convenience sampling and selected pharmacists based on their willingness to participate and used a questionnaire as a tool to determine their experiences and views towards CFM. The questionnaires were completed in different regions in Lebanon. Key findings A total of 223 pharmacists participated in the study, and all were able to define CFM, however were inconsistent in their definitions. The majority reported identifying CFM by the medicine’s effect (67.7%), followed by cost (66.8%). Almost 43% reported knowing of pharmacists who dispensed CFM. Additionally, participants reported that they believed that pharmacists who dealt with CFM were unprofessional (89.2%) and unethical (86.5%), and that they did it for the ‘easy money’ (87.9%) and large profit (86.5%). Conclusion The study highlighted the need for additional CFM awareness campaigns with an emphasis on the role that pharmacists have in protecting patients from using CFM. In addition, there is a need for an official CFM definition that distinguishes between the different types of counterfeiting. Furthermore, the Lebanese Ministry of Public Health and regulatory authorities should control and secure the supply chain of medicine in the country and enforce the law. awareness, counterfeit medicine, Pharmacist, public health, views Introduction Counterfeit products are illegal, generally lower priced and often of lower qualities than their originals, and pose a significant problem that is growing all over the world.[1,2] Any well-known and popular brand product is prone to be counterfeited.[3] Counterfeiting is so diverse to include pharmaceuticals, clothes, food and computer software, to name a few. According to the World Health Organization (WHO),[4] about 1% of prescribed medicines in the developed world and about 10–50% in parts of the developing world are estimated to be counterfeits.[5–7] The European Commission estimates 15% of the global medicines supply chain could be counterfeit.[8] Counterfeit medicines (CFM) pose significant risks to public health safety,[9–11] ranging from ineffectiveness and toxicity to more serious outcomes such as antibiotic resistance leading to increased rates of morbidity and mortality.[12–15] The enforcement of regulations on CFMs differs between low income to developed countries.[16] Lebanon is a developing country with a total area similar to that of Jamaica with a population of 4 million.[17,18] During the civil war in 1982, factories around the capital were reported to counterfeit around 57 different medicines. Hoechst Pharmaceuticals warned that a counterfeit version of their medicine Daonil® (glibenclamide) was being produced.[5] The government failed to stop this CFM production during the civil war (1975–1990), and thus, it thrived.[19,20] After the civil war, production ceased when the government regained its control.[21] Medicines in Lebanon have to be registered and approved for importation by the Ministry of Public Health (MoPH). They are available only from pharmacies and dispensed by registered pharmacists,[17] unlike other developing countries, where medicines may be dispensed by different retailers.[16,19] The practice of pharmacy in Lebanon is controlled through the MoPH.[21] In 2004, a 3D hologram with the slogan ‘from the producer to the citizen/consumer’ was used to indicate that the medicine had been imported through an unbroken chain of responsibilities directly from the producer to the consumer, however, not all importers use the hologram.[21] In 2008, a CFM campaign was launched and guides, posters and brochures were distributed for pharmacists, doctors and the public.[23] In 2010, a CFM scandal took place closing nine pharmacies and four warehouses for having counterfeit Plavix® (Clopidogrel).[24,25] It was reported that the official hologram and security label on the boxes were forged.[25] Providing enhanced pharmaceutical services would not be enough when the safety and efficacy of medicine may be compromised by the availability of CFM.[26] By implementing the WHO good pharmacy practice guidelines, pharmacists' role in combating CFM is ensuring the imported and dispensed medicines are safe, effective and of quality.[27–29] CFM have raised questions as to where pharmacists stand with respect to the trust placed in them, when facing the challenges of ensuring and assuring medicine’s safety and efficacy.[30] A study in California,[31] examined pharmacists' knowledge of CFM and revealed that of the 155 respondents, almost two-thirds reported believing that CFM posed a problem to the profession. Pharmacists reported that lack of awareness and resources were barriers to detecting CFM, and that pharmacists had a role in educating patients about CFM.[31] A study in Jordan[32] reported that 76% (47/62) were aware of the CFM problem, and current laws and regulations. Another in Iran[33] reported 21.5% (158/734) of pharmacists were aware of CFM, and the study highlighted the lack of legislation and regulatory control of supply chain.[33] Both studies suggested designing and implementing educational programmes for pharmacists.[32,33] A study in Yemen[34] and another in Sudan[35] reported that CFM is a serious problem because medicines are expensive, hard to access and unaffordable. Additionally, the lack of knowledge,[35] standards, regulations and laws is affecting the practice and endangering public health.[34] There is a paucity of studies in Lebanon regarding pharmacists' knowledge, views and involvement in controlling and limiting the availability of CFM, and their role in educating the public about CFM. Additionally, the literature search did not reveal any studies related to pharmacists and CFM in Lebanon. Aim of the study To assess pharmacists' awareness and views towards CFM, and of other pharmacists who deal with CFM. Methods Study design This was a questionnaire-based cross-sectional survey of community pharmacists in selected areas of Lebanon. Setting and study population The study was conducted using a convenience sample of community pharmacies (223) in the six governorates in Lebanon: Beirut (capital), Mount Lebanon (ML), Bekaa, North, South and Nabatiyeh. Ethical requirements The Research Ethics Committee at the University of Brighton School of Pharmacy and Biomolecular Sciences approved the study (approval number 1351). Verbal consent was obtained before individuals completed the questionnaire. Questionnaire design A questionnaire was used to assess Lebanese pharmacists' awareness and views towards CFM. The questionnaire content was informed by a thorough literature review of pharmacists' awareness of CFM, how they dealt with CFM, their reported experiences and their role with CFM in Asia, Europe, Africa and USA. An electronic search was carried out through PubMed, Scopus, Cochrane Library, ScienceDirect and Medline databases using the following keywords: poor quality/product/substandard/fake/counterfeit drug/medicine/pharmaceuticals; pharmacist/healthcare professional; pharmacist awareness/attitude/views/perceptions; and questionnaires/surveys. The literature search was conducted between October 2010 and February 2011 and was not restricted to a time frame. The search excluded editorials, letters, reflections, and studies on CFM analysis, generic, and expired medicine (if not counterfeit), dietary products, food, clothes, cosmetics, and herbal products (Figure 1). Figure 1 Open in new tabDownload slide Flow chart of the procedure used to search and choose the relevant articles. *Counterfeit medicine definition, as per the World Health Organization. **Using PubMed, Scopus, Cochrane Librarty, ScienceDirect and Medline databases. *Articles/studies. **Excluded editorials, letters, reflections, and studies on CFM analysis, generics, expired medicine, dietary products, food, clothes, cosmetics, and herbal products. The questionnaire was composed of open-ended and multiple-choice questions, plus Likert-type scale statements, and divided into three parts; Part I) pharmacists' professional responsibility and knowledge about CFM; Part II) questions about counterfeit products to determine the views towards counterfeiting in general; Part III) demographic data to determine the relationship between respondents' demographics and the provided answers. The questionnaire was assessed for face validity and clarity by three faculty experts in the field (the primary author’s PhD advisors, at the time of the study) at the University of Brighton School of Pharmacy[36,37] and required no modification at this stage. The questionnaire was then piloted by the researcher on a set date by choosing the first two pharmacies that accepted to participate. They found the questionnaire long, but clear and easy to follow, and their comments were documented and included in the discussion. The layout was changed by dividing the questionnaire into more sections and shortened by four questions (Appendix S1). As an alternative option, the questionnaire was translated into Arabic and independently back-translated for verification.[38] Study samples The total number of community pharmacies at the time was 2109,[39] and as this is the first study to address this topic, the target sample size for this exploratory[40] study was between 150 and 250. Data collection The study used convenience sampling where researchers walked down the streets and chose any pharmacy they saw.[41,42] The inclusion criteria were any practising pharmacist willing to participate and able to speak and read English/Arabic. Researchers explained verbally the purpose of the study and the approximate time needed to complete the questionnaire (around 15 min), and returned to pick it up after 30 min. Due to the sensitivity of the topic, researchers were asked to leave and not ask questions if participants refused to participate to minimise their risk and avoid any conflict. Data analysis The data were analysed using descriptive statistics and are expressed as numbers and percentages.[43] Bivariate analyses were performed to determine whether a relationship exists between variables, and the Chi-square test to check how likely it is that an observation was due to chance. For the Likert-type statements, responses were analysed after dichotomising them to strongly agree/agree and strongly disagree/disagree. Content analysis was used for open-ended questions and coded before being processed for computer analysis.[44] Cronbach-α test was used for internal consistency to determine the reliability of respondents' responses to three related questions (10, 13, and 14) within the questionnaire.[45–48] Results The response rate for the study was 93% (223/240), 7% (17/240) refused to participate. The pharmacists who refused to participate were abrupt and not welcoming. The distribution of non-responders according to regions was as follows: five (29.4%) Beirut, one (6%) ML, five (29.4%) Bekaa, three (17.6%) North and three (17.6%) South. Using Cronbach-α, the statements from questions 10, 13 and 14 were used to check for consistency, and the Cronbach-α value for all the items was 0.66. Although the value was <0.7, the results of the questionnaire were considered reliable,[45–48] and respondents were consistent in their responses as the test used only three items. Eighty-seven (39.2%) of respondents were aged 31–40 years, and 90 (42.5%) of respondents were female. The pharmacy location for the majority was in the ML region 99 (46%) (Table 1). Table 1 Demographics of respondents Demographics . Total (N = 223) N (%) . Age (N = 222) 21–30 62 (27.9) 31–40 87 (39.2) 41–50 51 (23.0) >50 22 (9.9) Gender (N = 212) Male 122 (57.5) Female 90 (42.5) Location of the Pharmacy (N = 215) Mount Lebanon 99 (46.0) Beirut 66 (30.7) North 37 (17.2) South/Nabatiyeh 10 (4.7) Bekaa 3 (1.4) Years practicing pharmacy Less than 5 years 70 (31.4) 5–10 years 45 (20.2) Greater than 10 years 108 (48.4) Socioeconomic Status of patientsa Upper Class 49 (21.9) Middle Class 176 (78.9) Lower Class 43 (19.3) Country of diploma Lebanon 179 (80.3) Others 44 (19.7) Demographics . Total (N = 223) N (%) . Age (N = 222) 21–30 62 (27.9) 31–40 87 (39.2) 41–50 51 (23.0) >50 22 (9.9) Gender (N = 212) Male 122 (57.5) Female 90 (42.5) Location of the Pharmacy (N = 215) Mount Lebanon 99 (46.0) Beirut 66 (30.7) North 37 (17.2) South/Nabatiyeh 10 (4.7) Bekaa 3 (1.4) Years practicing pharmacy Less than 5 years 70 (31.4) 5–10 years 45 (20.2) Greater than 10 years 108 (48.4) Socioeconomic Status of patientsa Upper Class 49 (21.9) Middle Class 176 (78.9) Lower Class 43 (19.3) Country of diploma Lebanon 179 (80.3) Others 44 (19.7) a N = 268, respondents checked more than one answer. Open in new tab Table 1 Demographics of respondents Demographics . Total (N = 223) N (%) . Age (N = 222) 21–30 62 (27.9) 31–40 87 (39.2) 41–50 51 (23.0) >50 22 (9.9) Gender (N = 212) Male 122 (57.5) Female 90 (42.5) Location of the Pharmacy (N = 215) Mount Lebanon 99 (46.0) Beirut 66 (30.7) North 37 (17.2) South/Nabatiyeh 10 (4.7) Bekaa 3 (1.4) Years practicing pharmacy Less than 5 years 70 (31.4) 5–10 years 45 (20.2) Greater than 10 years 108 (48.4) Socioeconomic Status of patientsa Upper Class 49 (21.9) Middle Class 176 (78.9) Lower Class 43 (19.3) Country of diploma Lebanon 179 (80.3) Others 44 (19.7) Demographics . Total (N = 223) N (%) . Age (N = 222) 21–30 62 (27.9) 31–40 87 (39.2) 41–50 51 (23.0) >50 22 (9.9) Gender (N = 212) Male 122 (57.5) Female 90 (42.5) Location of the Pharmacy (N = 215) Mount Lebanon 99 (46.0) Beirut 66 (30.7) North 37 (17.2) South/Nabatiyeh 10 (4.7) Bekaa 3 (1.4) Years practicing pharmacy Less than 5 years 70 (31.4) 5–10 years 45 (20.2) Greater than 10 years 108 (48.4) Socioeconomic Status of patientsa Upper Class 49 (21.9) Middle Class 176 (78.9) Lower Class 43 (19.3) Country of diploma Lebanon 179 (80.3) Others 44 (19.7) a N = 268, respondents checked more than one answer. Open in new tab The analysis of the open-ended question on defining CFM showed that 117 (57.5%) of pharmacists defined CFM as a medicine from an unknown source or of inferior quality and 24 (11.8%) as containing the wrong ingredients. Analysis on the source of CFM showed that almost 82 (38.7%) of respondents believed the main source to be China, 50 (23.6%) reported India, 38 (17.9%) reported the Arab countries, 19 (9%) reported Lebanon and 51 (24.1%) did not know. As for how respondents became aware of CFM, 88 (39.5%) was through TV, and 81 (36.3%) the MoPH, Lebanese Order of Pharmacists (OPL) and WHO. Only nine (4%) reported awareness from the CFM campaign and 48 (21%) through their experience/practice/education. The question on awareness of any CFM campaign showed that 123 (55.2%) of respondents were aware and 66 (29.6%) were not. The majority of respondents 155 (67.7%) reported differentiating between CFM and their originals by the medicine’s effect and 147 (65.9%) by the hologram (Table 2). Table 2 How respondents reported differentiating cfma from their original Item . n (%)b . Medicine effect (n = 223) 151 (67.7) Cost (n = 223) 149 (66.8) Hologram (n = 223) 147 (65.9) Suppliers (n = 223) 143 (64.1) Packaging (n = 223) 133 (59.6) Package insert information (n = 223) 67 (30.0) Other (n = 223) 34 (15.2) Item . n (%)b . Medicine effect (n = 223) 151 (67.7) Cost (n = 223) 149 (66.8) Hologram (n = 223) 147 (65.9) Suppliers (n = 223) 143 (64.1) Packaging (n = 223) 133 (59.6) Package insert information (n = 223) 67 (30.0) Other (n = 223) 34 (15.2) a Counterfeit medicine. bTotal >100% because respondents chose more than one answer. Open in new tab Table 2 How respondents reported differentiating cfma from their original Item . n (%)b . Medicine effect (n = 223) 151 (67.7) Cost (n = 223) 149 (66.8) Hologram (n = 223) 147 (65.9) Suppliers (n = 223) 143 (64.1) Packaging (n = 223) 133 (59.6) Package insert information (n = 223) 67 (30.0) Other (n = 223) 34 (15.2) Item . n (%)b . Medicine effect (n = 223) 151 (67.7) Cost (n = 223) 149 (66.8) Hologram (n = 223) 147 (65.9) Suppliers (n = 223) 143 (64.1) Packaging (n = 223) 133 (59.6) Package insert information (n = 223) 67 (30.0) Other (n = 223) 34 (15.2) a Counterfeit medicine. bTotal >100% because respondents chose more than one answer. Open in new tab Using the Chi-square test, a statistically significant difference was only observed with gender with 70 (77.7%) of female pharmacists reported believing they could identify CFM from the original by the effect of the medicine versus 76 (62.3%) of male respondents, χ2(1) = 5.79 and P < 0.05, and 37 (41.1%) of females versus 27 (22.1%) of males believing that they could distinguish a CFM from the package insert information, with χ2(1) = 8.85 and P < 0.05. Ninety-one (42.9%) of respondents reported knowing of other pharmacists who dispensed CFM, and 61 (63.5%) believed that those pharmacists were aware they (not themselves) were dispensing CFM. Additionally, 181 (85.4%) of respondents reported believing those pharmacists should face consequences, and 47 (51.1%) reported either a fine or prison sentence, and almost one-third believed they should have their licence withdrawn or their pharmacy closed. Respondents who were among the age group >50 years were less likely to report knowing about pharmacists dispensing CFM 11 (11.8%) than those in the age group 31–40 years 33 (35.4%), χ2(4) = 5.43 and P < 0.05. For pharmacy location, statistical significance was observed with respondents from the Bekaa, being the least likely to report knowing about pharmacists dispensing CFM 2 (2.2%), with the most likely to report from the ML region 40 (43%), χ2(5) = 13.52 and P < 0.05. The statements describing pharmacists who deal or dispense CFM were analysed after dichotomising the answers to strongly agree/agree and strongly disagree/disagree (Table 3). The majority of respondents agreed that dispensing CFM was unprofessional 199 (89.2%) and unethical 193 (86.5%), and that pharmacists who dispensed CFM did it for the easy money 196 (87.9%). One of the pilot pharmacists reported that ‘… the competition among colleagues made some pharmacists commit this crime, and get carried away by easy money and large profit'. Table 3 Respondents' responses to statements describing pharmacists who deal with CFMa Statement . Strongly Agree/Agree N (%) . Pharmacists that knowingly dispense CFM are very clever 42 (18.8) Pharmacists that knowingly dispense CFM are good businessmen/women 65 (29.1) Pharmacists that knowingly dispense CFM are unprofessional 199 (89.2) Pharmacist that knowingly dispense CFM are unethical 193 (86.5) Pharmacists carry CFM in their pharmacy because it is easy money 196 (87.9) Pharmacists carry CFM in their pharmacy for the big profit 193 (86.5) Pharmacists carry CFM in their pharmacy because the quality is acceptable 58 (26.0) Statement . Strongly Agree/Agree N (%) . Pharmacists that knowingly dispense CFM are very clever 42 (18.8) Pharmacists that knowingly dispense CFM are good businessmen/women 65 (29.1) Pharmacists that knowingly dispense CFM are unprofessional 199 (89.2) Pharmacist that knowingly dispense CFM are unethical 193 (86.5) Pharmacists carry CFM in their pharmacy because it is easy money 196 (87.9) Pharmacists carry CFM in their pharmacy for the big profit 193 (86.5) Pharmacists carry CFM in their pharmacy because the quality is acceptable 58 (26.0) Counterfeit medicine. Open in new tab Table 3 Respondents' responses to statements describing pharmacists who deal with CFMa Statement . Strongly Agree/Agree N (%) . Pharmacists that knowingly dispense CFM are very clever 42 (18.8) Pharmacists that knowingly dispense CFM are good businessmen/women 65 (29.1) Pharmacists that knowingly dispense CFM are unprofessional 199 (89.2) Pharmacist that knowingly dispense CFM are unethical 193 (86.5) Pharmacists carry CFM in their pharmacy because it is easy money 196 (87.9) Pharmacists carry CFM in their pharmacy for the big profit 193 (86.5) Pharmacists carry CFM in their pharmacy because the quality is acceptable 58 (26.0) Statement . Strongly Agree/Agree N (%) . Pharmacists that knowingly dispense CFM are very clever 42 (18.8) Pharmacists that knowingly dispense CFM are good businessmen/women 65 (29.1) Pharmacists that knowingly dispense CFM are unprofessional 199 (89.2) Pharmacist that knowingly dispense CFM are unethical 193 (86.5) Pharmacists carry CFM in their pharmacy because it is easy money 196 (87.9) Pharmacists carry CFM in their pharmacy for the big profit 193 (86.5) Pharmacists carry CFM in their pharmacy because the quality is acceptable 58 (26.0) Counterfeit medicine. Open in new tab Three related statements were used to determine respondents' views and perception towards the law and risks related to CFM, and 207 (92.8%) of respondents agreed that the law against CFM should be strengthened and 208 (93.2%) agreed this for those who sell/deal with CFM. The percentage of pharmacists aware of CFM in Lebanon according to the 180 (80.7%) who responded, was reported between 80 and 100% for 118 (65.6%) of respondents. There was a statistically significant difference with pharmacists in ML 80 (46%) and Beirut 56 (32.2%), who believed that pharmacists had a greater awareness of CFM compared with pharmacists in the South 4 (2.3%) and Bekaa 4 (2.3%), with χ2(20) = 45.49 and P < 0.05. The integrity of medicine suppliers was checked on daily basis as reported by 74 (35.1%) of pharmacists, versus 43 (20.4%) on yearly basis. Almost 80% (177) of respondents reported that no medicines were found to be counterfeit in their pharmacies, and 27 (12%) reported having medicine confirmed as counterfeit. Around 48% (107) reported having been offered CFM. Discussion The results of this exploratory study revealed that in Lebanon, respondents defined CFM as a bad-quality medicine or one of an unknown source. They reported knowing of other pharmacists who dispensed CFM and considered them to be unprofessional and unethical, and doing it for easy money and large profit. Respondents believed in strengthening the law against CFM. This study had three limitations: (1) respondents were selected conveniently rather than randomly; (2) the questionnaire did not include enough questions on pharmacists' experiences and views towards CFM; and (3) the small number of respondents from the North, South and the Bekaa. A related study reported the extent of CFM in Lebanon to be lower in ML (3%) and higher in the Bekaa and South (12%),[49] and other references reported that ML has the largest number of pharmacies followed by the South, Bekaa, North and Beirut.[50] Therefore, having more respondents from the North, South and the Bekaa might have provided different results. Additionally, the results showed that male pharmacists were over-represented, for the ratio of male to female pharmacists in Lebanon is 2 : 1.[50] Male pharmacists might have been more interested and willing to share their views about CFM. The inconsistency of respondents' CFM definition could be due to a gap in knowledge towards CFM.[32–35] As there is no declared CFM definition in Lebanon, a publicised agreement by responsible authorities on a definition would be essential for consistency in identifying/labelling counterfeits.[51] The study’s respondents, who became aware of CFM through experience or education, support the study in California that academic institutions could play a key role in educating healthcare professionals about CFM.[31] Input from academia would allow future pharmacists to better understand the risks and consequences regarding CFM. The UK General Pharmaceutical Council’s standards of conduct, ethics and performance for pharmacists[28] were used as a reference in this study as Lebanon does not have a recognised Code of Ethics for pharmacists. Thus there is a need for the OPL to introduce a Code of Ethics for pharmacists. One code states that ‘pharmacists need to develop their professional knowledge and competence through continuing education'.[28] According to respondents, the CFM campaign was not considered a source of awareness, thus, in accordance with other studies,[27,33–35] additional educational programmes would be essential, provided they are accessible to all pharmacists in Lebanon. The 2010 CFM scandal could explain why the hologram was considered third by respondents when identifying CFM. One of the two pilot pharmacists reported seeing packages of CFM with the original hologram. A related study[49] showed that the counterfeit packaging of counterfeit Plavix® had the original hologram on it. Other studies also demonstrated the difficulty in distinguishing CFM from originals through visual examination, even for experts.[5,49,52] Pharmacists practising in the Bekaa region were the least likely to report knowing about pharmacists dispensing CFM, possibly due to lack of CFM awareness, or were under-reporting due to organised crimes.[53–55] Similarly, studies in Jordan[32] and Iran[33] reported pharmacists being aware of other pharmacies that have dealt with CFM, yet did not inform authorities. Moreover, the reported decrease in pharmacists' minimum wages to USD1350/month[56] could be an additional reason that lead some pharmacists to deal with/dispense CFM. Based on the UK Code of Ethics ‘Use your professional judgement in the interests of patients and the public’,[28] pharmacists have an obligation to adhere to the code and inform the authorities.[29] When a pharmacist, in good faith and in the publics' best interest, discloses and resolves a significant deficiency in the quality or safety of health care, would be referred to as a ‘whistleblower’.[57] Whistleblowing would be a cultural change for Lebanese pharmacists that would encourage them to take actions against pharmacists not abiding by the ethical standards of this profession. Aware and informed pharmacists can play a major role in supporting authorities incorporate appropriate measures to safeguard patients and minimise the risk of using CFM. Pharmacists should be involved in the supply chain management, by being selective of their sources and using only authorised distributors.[58] Rarely do incidences occur through the legitimate supply chain;[28,30,59] nevertheless, regular checking would be considered a good practice, supporting the few respondents' who check daily. The study’s recommendations are in accordance with other studies[33–36,51] on the need for responsible authorities to: (1) provide regular educational programmes/updates regarding CFM, emphasising the pharmacists' role in educating/protecting patients, (2) implement and enforce the law against CFM and offenders, (3) control the safety, quality and efficacy of medicine through the supply chain, and (4) adopt an official CFM definition. Additional more specific recommendations for Lebanon are described in Table 4. Table 4 The additional recommendations for Lebanon to limit the availability of CFMa Recommendations . Justification . Create a CFM reporting system Due to the fact that there is no CFM reporting system in Lebanon. Establishing one would allow pharmacists and othersb to report any suspected CFM Adopt a Code of Ethics for pharmacists There is not a recognised Code of ethics for pharmacists in Lebanon. Therefore, OPLc should establish a code of ethics that states publicly the principles that define the roles and responsibilities of pharmacists towards their patients, other healthcare professionals, community and society.29 Introduce whistleblowing Since whistleblowing is not part of the Lebanese culture, it would be essential to introduce it, to encourage pharmacists and others to act against other pharmacists or offenders who dispense or deal with CFM Reactivate the national laboratory The national laboratory was established 1952 but its work was halted during the civil war 1975–1990.60 The Laboratory can be reactivated to randomly test the quality and safety of both the imported and locally manufactured medicines that are available in the country Recommendations . Justification . Create a CFM reporting system Due to the fact that there is no CFM reporting system in Lebanon. Establishing one would allow pharmacists and othersb to report any suspected CFM Adopt a Code of Ethics for pharmacists There is not a recognised Code of ethics for pharmacists in Lebanon. Therefore, OPLc should establish a code of ethics that states publicly the principles that define the roles and responsibilities of pharmacists towards their patients, other healthcare professionals, community and society.29 Introduce whistleblowing Since whistleblowing is not part of the Lebanese culture, it would be essential to introduce it, to encourage pharmacists and others to act against other pharmacists or offenders who dispense or deal with CFM Reactivate the national laboratory The national laboratory was established 1952 but its work was halted during the civil war 1975–1990.60 The Laboratory can be reactivated to randomly test the quality and safety of both the imported and locally manufactured medicines that are available in the country aCounterfeit medicine, bCan be other healthcare professionals or members of the public, cLebanese Order of Pharmacists. Open in new tab Table 4 The additional recommendations for Lebanon to limit the availability of CFMa Recommendations . Justification . Create a CFM reporting system Due to the fact that there is no CFM reporting system in Lebanon. Establishing one would allow pharmacists and othersb to report any suspected CFM Adopt a Code of Ethics for pharmacists There is not a recognised Code of ethics for pharmacists in Lebanon. Therefore, OPLc should establish a code of ethics that states publicly the principles that define the roles and responsibilities of pharmacists towards their patients, other healthcare professionals, community and society.29 Introduce whistleblowing Since whistleblowing is not part of the Lebanese culture, it would be essential to introduce it, to encourage pharmacists and others to act against other pharmacists or offenders who dispense or deal with CFM Reactivate the national laboratory The national laboratory was established 1952 but its work was halted during the civil war 1975–1990.60 The Laboratory can be reactivated to randomly test the quality and safety of both the imported and locally manufactured medicines that are available in the country Recommendations . Justification . Create a CFM reporting system Due to the fact that there is no CFM reporting system in Lebanon. Establishing one would allow pharmacists and othersb to report any suspected CFM Adopt a Code of Ethics for pharmacists There is not a recognised Code of ethics for pharmacists in Lebanon. Therefore, OPLc should establish a code of ethics that states publicly the principles that define the roles and responsibilities of pharmacists towards their patients, other healthcare professionals, community and society.29 Introduce whistleblowing Since whistleblowing is not part of the Lebanese culture, it would be essential to introduce it, to encourage pharmacists and others to act against other pharmacists or offenders who dispense or deal with CFM Reactivate the national laboratory The national laboratory was established 1952 but its work was halted during the civil war 1975–1990.60 The Laboratory can be reactivated to randomly test the quality and safety of both the imported and locally manufactured medicines that are available in the country aCounterfeit medicine, bCan be other healthcare professionals or members of the public, cLebanese Order of Pharmacists. Open in new tab Future studies can further explore the experiences, views and beliefs of the pharmacists/public/government/regulatory authorities regarding CFM and how they believe CFM can be limited/controlled. These studies can identify the appropriate measures required for the development of beneficial interventions. Conclusion The results of this study were in accordance with similar studies, in addition highlighted the important role that pharmacists can play in ensuring and assuring patients safe and effective medicines. The findings would suggest for future research to further assess the pharmacists' role and the implementation of the study’s recommendations. Declarations Conflict of interest The Author(s) declare(s) that they have no conflicts of interest to disclose. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors' contributions LS contributed to the concept, study design, data analyses, writing the manuscript and submission for publication. PG and AM supervised the study, reviewed and edited the manuscript. SW supervised the study and helped with the statistics. Acknowledgements The authors would like to thank the pharmacists that agreed to take part in this study and the pharmacy students at the Lebanese American University – School of Pharmacy, for their contribution to this study. Contents of this paper are part of a PhD thesis by the primary author available at the University of Brighton at: http://eprints.brighton.ac.uk/15755/. References de Matos CA , Ituassu CT, Rossi CAV. Consumer attitudes toward counterfeits: a review and extension . J Consum Mark 2007 ; 24 : 36 – 47 . Google Scholar Crossref Search ADS WorldCat Lai KKY , Zaichkowsky JL. Brand imitation: do the Chinese have different views? APJM 1999 ; 16 : 179 – 192 . 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TI - Pharmacist awareness and views towards counterfeit medicine in Lebanon
JF - International Journal of Pharmacy Practice
DO - 10.1111/ijpp.12388
DA - 2018-05-04
UR - https://www.deepdyve.com/lp/oxford-university-press/pharmacist-awareness-and-views-towards-counterfeit-medicine-in-lebanon-XT7LuVTc5a
SP - 273
EP - 280
VL - 26
IS - 3
DP - DeepDyve
ER -