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.
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.
Still worshiped by native Chinese drug guilds as their patron god, Shennong conceivably examined many herbs, barks, and roots brought in from the fields, swamps, and woods that are still recognized in Pharmacy today. The "Pa Kua" is a mathematical design symbolizing creation and life. Medicinal plants include podophyllum, rhubarb, ginseng, stramonium, cinnamon bark, and, ma huang, or Ephedra.
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.
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.
The course of instruction leading to a bachelor of science in pharmacy (BPharm) 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.
Reforms made to provide an individualized, state-of-the-art learning environment that facilitates the development of students' knowledge, skills, attitudes and behaviors needed by the pharmacy profession and society at-large, so they provide high quality pharmaceutical care:
Competency based education with an emphasis on patient-oriented practice and accountability are the current and future trends in pharmacy education. Reforms have been made to promote state-of the-art pharmaceutical sciences in curricula when at the same time there is a shift from product-oriented to patient-oriented pharmacy education and practice. There has seen a radical change in curriculum and organisational structure focussing on problem-oriented and student centred educational methods, in order to optimally prepare future practitioners and scientists.
There are five specialties of traditional Chinese pharmacy and 38 programs in China. These specialties have training targets, core courses and job orientations. All specialties have two common characteristics in their core courses: (i) the basic theories of traditional Chinese medicine, traditional Chinese pharmacy and preparations of traditional Chinese materia medica; and (ii) attention to teaching basic knowledge of modern science that includes advanced mathematics, computer application, mathematical statistics, physics, physical chemistry and analytical chemistry.
Other pharmaceutical universities and colleges (departments) are also taking steps to establish a specialty of clinical pharmacy, adding correspondence courses, beginning postgraduate classes in clinical pharmacy, and opening short courses for advanced study to help pharmacists working in hospitals who have been engaged in clinical application of drugs for many years. This has promoted the development of clinical pharmacy in China.
Since the foundation of the People's Republic of China considerable work has been done by grouping and summarizing previous experiences. The progress made in this field includes:
The chemical structures of the active ingredients of hundreds of herbs have been made clear. Now some of the active ingredients can be synthesized or modified in chemical structure. Not only have new drugs been researched but also the therapeutic mechanism of traditional Chinese medicinal herbs have been clarified, which promotes the combination of traditional Chinese pharmacy with Western pharmacy.
2. The research of the compound preparations of traditional Chinese medicinal herbs.
The compound preparations of traditional Chinese medicinal herbs are the most popular recipes used by doctors of traditional Chinese medicine. There are 12,000 recipes in Ben Cao Gangmu (the "Compendium of Materia Medica"). The composition of these recipes has a characteristic regularity and makes the ingredients in every recipe effective as a whole. This corresponds not only to symptoms but also the syndromes of the whole body. The modern study of the compound preparations of traditional Chinese materia medica is an important content of the modernization of traditional Chinese medicine and one of the prerequisites of the combination of traditional Chinese pharmacy with Western pharmacy. The selection of the ingredients and forms of preparations, production procedures (including the form modification), quality control, clinical and pharmacological experiments have been studied systematically. A number of new drugs and their new forms and giving scientific explanation to the regularity in recipe composition have been developed. Some diseases, whose scientific indexes have been known in their treatment by Western medicine, have been treated and reportedly cured by using traditional Chinese medicine. The therapeutic effects of the compound preparations of some traditional Chinese materia medica can be compared clinically with those of Western medicines and are expressed in modern scientific indexes. This provides the material foundation of the compound preparations of traditional Chinese materia medica and the modernization of the expression of their therapeutic activities.
There have been continuing efforts to combine traditional Chinese pharmacy with Western pharmacy. In order to train the personnel who are able to engage in the combination of traditional Chinese pharmacy and Western pharmacy, educational opportunities have been developed to teach and research the traditional Chinese pharmacy and Western pharmacy in combination. The students are trained to have a foundation and experimental skills in both traditional Chinese pharmacy and Western pharmacy (including the knowledge and skills of clinical medicine). There are two approaches for this training: (i) a six-year system of the specialty of combining traditional Chinese pharmacy and Western pharmacy granting Master's Degree; and (ii) a two-year system of the postbaccalaureate degree class offering Bachelor's Degree pharmaceutical graduates another Bachelor's Degree in traditional Chinese pharmacy.
Because of the launching of the socialist market economy the students with narrow specific knowledge trained by the semester system could not meet the demands of the personnel with broad specific knowledge needed by the market economy. Further, the number of the university students in China has been insufficient to meet the pharmacy manpower needs. Some areas and units refuse to employ graduates assigned by the Chinese government because the specialties of these graduates do not meet their specific requirements. The employing units need the students who are expert in their specialty and have good adaptability to various jobs. Students are encouraged to elect more optional courses and to learn what is needed by the employer market on their own initiative.
The system of courses has become more comprehensive. The world, including that of pharmacy, is faced with the great challenge of highly-developed and -complex technology. As a result, complex cross-disciplinary sciences have appeared. The number of hours, however, is limited. Therefore, new required subjects of semester system length have been added to the curriculum making it less possible to increase the elective subjects with new content.
The credit system has solved some of the problems in the semester system. The foundation has been emphasized and specialty de-emphasized, as follows:
1. Students who major in different fields of pharmacy have taken common basic courses such as mathematics, chemistry, biology and computer sciences. The lecture hours and requirements of these courses have been arranged in a unified way. This has given a broad and solid foundation of basic theories from these courses to all pharmacy students. The curricula based on the credit system is stipulated to include less than 70 percent of required courses and increase the proportion of optional courses which account for 20-30 percent of all the courses offered. This gives the students the freedom to choose what interests them and what they need in their future jobs.
2. According to the different programs the specific subjects were divided into modules. For example, students who learn analysis and the assay of drugs may elect spectroanalysis, pharmaceutical analysis and other courses. The students who learn hospital pharmacy may elect hospital pharmaceutical preparations, clinical pharmacology and other related topics. Students can choose the subjects in the modules according to the requirements of the country's construction. the needs of social development and their individual interest. The bright students have been allowed to choose more subjects and finish the study earlier than those who are academically challenged or those who take part-time study.
By carrying out the credit system the Chinese higher pharmaceutical education have trained more students who are expert in their specialty and have multiple skills by the combination of liberal and professional education.
In order to promote scientific research and the training of highly qualified researchers, mobile research stations have been approved by the government. Thus far in China, there have been six such stations where postdoctoral students are carrying on their research in five pharmaceutical specialties. These stations play an important role in stimulating academic exchange, training high-level professional personnel and attracting the overseas-trained students to come back.
Although the postgraduate education of pharmaceutical sciences has developed quickly, the number of the postgraduates is still limited. The proportion of postgraduates to undergraduates is 0.05:1. Many fields, such as pharmaceutical research, pharmaceutical industry and commerce, inspection and clinical application of drugs, pharmaceutical education and management, need graduates with advanced degrees, but these specialties have produced relatively few graduates for several years.
New training approaches have been tried, such as establishing a six-year-system for the higher pharmaceutical education, enrolling middle-school graduates and granting them a Master-Degree after graduation. The characteristics of this system are as follows: (i) it shortens the length of study period (less than one year); (ii) continuous study avoids the repetition of some courses, strengthens the foundation and broadens the knowledge range; (iii) this basic training approach is course/subject oriented, so that the advantages of the skills of teachers and the academic departments are fully taken; and (iv) in the first 4.5-5 years the students finish the courses of under-/post-grad study, then write their thesis under the direction of advisors in the following 1-1.5 years.
There are 51 pharmaceutical institutions of higher learning (including universities and colleges) in China according to the statistics made by the end of 1995. Within these 51 institutions there are 95 programs which have enrolled 3,968 state-planned undergraduate students. In 1995 more students were enrolled in some specialties than in 1990 because of the rapid development of the health and medical economies in China which need more personnel in the fields of pharmacy. The number of the students studying various specialties increased greatly, e.g., pharmaceutical analysis by 64. 5 percent, microbial pharmacy by 122 percent, pharmacology of traditional Chinese pharmacy by 200 percent, management of medical and pharmaceutical enterprises by 300 percent and pharmaceutics of traditional Chinese materia medica by 64. 2 percent.
Hong Kong & Macau:
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:
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.
The results of research in pharmacy are usually published in such journals as the:
Asian Journal of Pharmaceutical Sciences was founded jointly by Shenyang Pharmaceutical University and China Medicine Technical International Development Association. The journal is published 6 issues per year by Hong Kong Asiamed Publishing House in English for international distribution. There is no page charge, but cost of translation and English may be levied when necessary.
There are also other societies in which history, teaching, and the military aspects of pharmacy are given special emphasis.
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.
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.
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. 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.
Pharmaceutical expenditures can exceed 30% of total health expenditures in some poorer areas; so greater scrutiny and control over drugs are evident lately. Pharmacoeconomic research, either used when health providers examine different treatments to make cost-effective decisions, or when regulatory institutions estimate the greater value of a new product to set a reimbursement level, marks the horizon for the world's pharmaceutical markets.
Pharmacoeconomics as a science has begun to advance with methodological guidelines as it is increasingly applied in many countries.
China today must confront significant cost-containment in health care, as seen in every developing nation of the world. Pharmacoeconomic research thus will likely find favor to facilitate the evaluation of resource utilization for greater efficiency and better health outcomes in its population; however, pharmacoeconomics currently is stagnating in China due to the lack of adequate academic research centers, pharmaceutical industry investment, and government coordination.
It is predicted that China will, out of necessity, end this lag as its health care system overcomes its limitation on pharmacoeconomic knowledge and lessens influences from the old pharmaceutical pricing and reimbursement system. The upsurge import of more Western drugs now with the World Trade Organization (WTO) entry is another force leading to China's eventual progress in this area.
Current applications within a few industrialized countries can serve as a prelude to describing lessons for and reforms taking place in China. There are encouraging, although not yet significant, steps being taken to embed more pharmacoeconomics into the Chinese health care system.
Fudan Center for Pharmacoeconomic Research and Evaluation (CPRE) of Fudan University in Shanghai.
Pharmacoeconomics China or Chinese PharmacoEconomics Guidelines Project - Chinese Medical Doctor Association is the executive center of this project, and the center specializes in Chinese PharmacoEconomics Guidelines to improve the development of PharmacoEconomic assessment and clinical rational drug usage in China