Change of attitude needed on antibiotics
Hong Kong prides itself on having a world-class public health system. It has its problems - notably the need to contain spiralling costs while keeping up with increasingly expensive advances in medical technology. But one particularly pressing challenge is the threat to public health posed by the resistance of bacteria to antibiotics. This is the subject of a three-part series in this newspaper that concludes today.
The development of bacterial drug resistance raises the spectre of a plague of superbugs that do not respond to treatment. That is not the futuristic scenario it may seem to generations who grew up in a world made safer by the wonder drug penicillin. Asked by the World Health Organisation to rate the 10 most important diseases of the next decade, eminent public health authorities bracketed 'diseases due to antibacterial resistance' at the top of the list, along with a flu pandemic.
Our series reveals that we are all affected by the looming crisis - from the government to doctors, health professionals and administrators, pharmacists and, above all, patients. It abounds with examples of improper use of antibiotics. They range from prescriptions for healthy patients and for viral conditions that do not respond to antibiotics, courses of treatment that are not long enough to be effective, illegal over-the-counter sales without prescriptions and self-medication. Medical experts warn that all these practices contribute to the development of drug-resistant superbugs.
Everyone, from the government down to an individual with a common cold, has a role to play in heading off a crisis.
The government should seriously consider whether the robust entrepreneurial spirit for which Hong Kong is well known is appropriate where the supply of drugs is concerned - especially where it leads to an illicit trade in antibiotics and other drugs, including strong painkillers which in other parts of the world require a doctor's prescription.
The Health Department should crack down on illegal over-the-counter sales of prescription drugs. Indeed, pharmacies - both in the community and within doctors' practices - seem to be part of the problem. Unlike many countries, including the United States, Britain and Canada, where community pharmacies must be owned by a professional pharmacist, anyone with the money can run one in Hong Kong. All too often the pharmacist is an employee powerless to stop malpractice-for-profit by the owner. Some pharmacies do not even have computerised records.
The practice of doctors prescribing through in-house pharmacies, with no separate records that can be accessed without invading patient privacy, does nothing to allay concerns about the overuse of antibiotics, not to mention the appearance of potential conflict of interest.
The government would be sensible to consider urgent measures to separate the prescription and dispensing of drugs. It should promote a professional, effectively regulated community pharmacy sector accountable to the health authorities for all drugs dispensed outside hospitals. The sector should be a key public-health player in its own right. It is not a reform that can be achieved overnight, but the longer a start on it is delayed, the more urgent it is likely to become.
This week the health authorities are launching a campaign to fight the rising problem of superbugs. But the Centre for Health Protection admits that effective surveillance of the misuse of antibiotics by private doctors and patients will be difficult because of a lack of information.
This illustrates the key to the success of a community-wide approach - patient education. Many patients need to be convinced that antibiotics can no longer be taken for granted as wonder drugs that the doctor should prescribe as a matter of course. If this is achieved, we will have taken a small step towards heeding a warning issued years ago by the WHO: the rise of drug-resistant diseases threatens to turn the clock back to the dark days before penicillin.
