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What is the Indian Pharmacopoeia Commission?

Published on by Andrew Marshall7 Comments

Introduction

Indian Pharmacopoeia Commission (IPC) is an autonomous institution of the Ministry of Health and Family Welfare which sets standards for all drugs that are manufactured, sold and consumed in India.

Outline

The set of standards are published under the title Indian Pharmacopoeia (IP) which has been modelled on and historically follows from the British Pharmacopoeia. The standards that are in effect since 01 December 2010, are the Indian Pharmacopoeia 2010 (IP 2010). The Pharmacopoeia 2014 was released by Health Minister Ghulam Nabi Azad on 04 November 2013. The Pharmacopoeia 2018 was released by Secretary, Ministry of Health & Family Welfare, Government of India.

IP, the abbreviation of ‘Indian Pharmacopoeia’ is familiar to the consumers in the Indian sub-continent as a mandatory drug name suffix. Drugs manufactured in India have to be labelled with the mandatory non-proprietary drug name with the suffix IP. This is similar to the BP suffix for British Pharmacopoeia and the USP suffix for the United States Pharmacopeia.

The IPC was formed according to the Indian Drugs and Cosmetics Act of 1940 and established by executive orders of the Government of India in 1956.

History of Publication

The actual process of publishing the first Pharmacopoeia started in the year 1944 under the chairmanship of Colonel R.N. Chopra. The IP list was first published in the year 1946 and was put forth for approval. The titles are suffixed with the respective years of publication, e.g. IP 1996. The following table describes the publication history of the Indian Pharmacopoeia.

  • 1st Edition 1955:
    • Supplement 1960
  • 2nd Edition 1966:
    • Supplement 1975
  • 3rd Edition 1985:
    • 2 volumes.
    • Addendum 1989.
    • Addendum 1991.
  • 4th Edition 1996:
    • 2 volumes.
    • Addendum 2000.
    • Vet Supplement 2000.
    • Addendum 2002.
    • Addendum 2005.
  • 5th Edition 2007:
    • 3 volumes.
    • Addendum 2008.
  • 6th Edition 2010:
    • 3 volumes.
    • Addendum 2012.
  • 7th Edition 2014:
    • 4 volumes.
    • Addendum 2015.
    • Addendum 2016.
  • 8th Edition 2018:
    • 4 volumes.
    • Addendum 2019.
    • Addendum 2021.

Refer to The International Pharmacopoeia, British Pharmacopoeia, European Pharmacopoeia, United States Pharmacopoeia, Indian Pharmacopoeia Commission, Japanese Pharmacopoeia, and Pharmacopoeia of the People’s Republic of China.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Indian_Pharmacopoeia_Commission >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the United States Pharmacopoeia?

Published on by Andrew Marshall8 Comments

Introduction

The United States Pharmacopeia (USP) is a pharmacopeia (compendium of drug information) for the United States published annually by the United States Pharmacopeial Convention (usually also called the USP), a non-profit organisation that owns the trademark and also owns the copyright on the pharmacopeia itself.

The USP is published in a combined volume with the National Formulary (a formulary) as the USP-NF. If a drug ingredient or drug product has an applicable USP quality standard (in the form of a USP-NF monograph), it must conform in order to use the designation “USP” or “NF”. Drugs subject to USP standards include both human drugs (prescription, over-the-counter, or otherwise) and animal drugs. USP-NF standards also have a role in US federal law; a drug or drug ingredient with a name recognized in USP-NF is considered adulterated if it does not satisfy compendial standards for strength, quality or purity. USP also sets standards for dietary supplements and food ingredients (as part of the Food Chemicals Codex). USP has no role in enforcing its standards; enforcement is the responsibility of the US Food and Drug Administration (FDA) and other government authorities in the United States.

Product Quality: Standards and Verification

USP establishes written (documentary) and physical (reference) standards for medicines, food ingredients, dietary supplement products, and ingredients. These standards are used by regulatory agencies and manufacturers to help to ensure that these products are of the appropriate identity, as well as strength, quality, purity, and consistency. USP 800 is an example of a publication created by the United States Pharmacopeia.

Prescription and over-the-counter medicines available in the United States must, by federal law, meet USP-NF public standards, where such standards exist. Many other countries use the USP-NF instead of issuing their own pharmacopeia, or to supplement their government pharmacopeia.

USP’s standards for food ingredients can be found in its Food Chemicals Codex (FCC). The FCC is a compendium of standards used internationally for the quality and purity of food ingredients like preservatives, flavourings, colourings and nutrients. While the FCC is recognised in law in countries like Australia, Canada and New Zealand, it currently does not have statutory recognition in the United States, although FCC standards are incorporated by reference in over 200 FDA food regulations. USP obtained the FCC from the Institute of Medicine in 2006. The IOM had published the first five editions of the FCC.

USP also conducts verification programs for dietary supplement products and ingredients. These are testing and audit programmes. Products that meet the requirements of the programme can display the USP Verified Dietary Supplement Mark on their labels. This is different from seeing the letters “USP” alone on a dietary supplement label, which means that the manufacturer is claiming to adhere to USP standards. USP does not test such products as it does with USP Verified products.

Healthcare Information

In the past, Congress authorised the Secretary of HHS to request USP to develop a drug classification system that Medicare Prescription Drug Benefit plans may use to develop their formularies, and to revise such classification from time to time to reflect changes in therapeutic uses covered by Part D drugs and the addition of new covered Part D drugs. USP has developed six versions of the Model Guidelines, the last issued early in 2014 for the 2015-2017 benefit years.

Promoting the Quality of Medicines Programme

Since 1992, USP has worked cooperatively with the United States Agency for International Development (USAID) to help developing countries address critical issues related to poor quality medicines. This partnership operated as the Drug Quality and Information (DQI) programme until 2009, when, to better meet growing global needs, USAID awarded USP a five-year, $35 million cooperative agreement to establish a new, expanded programme: Promoting the Quality of Medicines (PQM). In 2013 USAID extended the PQM programme for five years (through September 2019), increased its funding to $110 million, and expanded the geographical reach of the programme.

PQM serves as a primary mechanism to help USAID-supported countries strengthen their quality assurance and quality control systems to better ensure the quality of medicines that reach patients. PQM has four key objectives:[9]

  • Strengthen quality assurance (QA) and quality control (QC) systems.
  • Increase the supply of quality assured medicines.
  • Combat the availability of substandard and counterfeit medicines.
  • Provide technical leadership and global advocacy.

USP-USAID collaborative efforts have helped communities improve drug quality in more than 35 countries. PQM currently works in Africa, Asia, Europe/Eurasia, and the Caribbean/Latin America.

International Agreements and Offices

USP works internationally, largely through agreements with other pharmacopeias, as well as regulatory bodies, manufacturer associations and others. In recent years, USP signed a series of Memoranda of Understanding (MOU) with groups including the Pharmacopeia of the People’s Republic of China Chinese Pharmacopeia Commission, nine countries belonging to the Association of Southeast Asian Nations (ASEAN), and the Federal Service on Surveillance in Healthcare and Social Development of the Russian Federation (Roszdravnadzor). USP also operates an international office in Switzerland and offices and laboratories in Brazil, India, and China.

Refer to The International Pharmacopoeia, British Pharmacopoeia, European Pharmacopoeia, United States Pharmacopoeia, Indian Pharmacopoeia Commission, Japanese Pharmacopoeia, and Pharmacopoeia of the People’s Republic of China.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/United_States_Pharmacopeia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the European Pharmacopoeia?

Published on by Andrew Marshall7 Comments

Introduction

The European Pharmacopoeia (Pharmacopoeia Europaea, Ph. Eur.) is a major regional pharmacopoeia which provides common quality standards throughout the pharmaceutical industry in Europe to control the quality of medicines, and the substances used to manufacture them. It is a published collection of monographs which describe both the individual and general quality standards for ingredients, dosage forms, and methods of analysis for medicines. These standards apply to medicines for both human and veterinary use.

Legal Basis

The European Pharmacopoeia has a legally binding character. It is used as an official reference to serve public health, and is part of the regulatory requirements for obtaining a Marketing Authorisation (MA) for a medicinal (human or veterinary) product. The quality standards of the European Pharmacopoeia apply throughout the entire life-cycle of a product, and become legally binding and mandatory on the same date in all thirty-nine (39) signatory states, which include all European Union member states.

Several legal texts make the European Pharmacopoeia mandatory in Europe. The Convention on the Elaboration of a European Pharmacopoeia (ETS No. 50) which was adopted by the Council of Europe in 1964, laid the groundwork for the development of the European Pharmacopoeia. In 1994, a Protocol (ETS No. 134) was adopted, amending the convention to prepare for the accession of the European Union (EU), and defining the respective powers of the European Union and its member states within the European Pharmacopoeia Commission.

European Union Directive 2001/82/EC and Directive 2001/83/EC, (as amended) state the legally binding character of European Pharmacopoeia texts for Marketing Authorisation Applications (MAA). All manufacturers of medicines or substances for pharmaceutical use therefore must apply the European Pharmacopoeia quality standards in order to be able to market and use these products in Europe.

As of February 2020, thirty-nine (39) member states and the European Union are signatories to the Convention on the Elaboration of a European Pharmacopoeia. There are 30 observers in all: five European countries, 23 non-European countries, the World Health Organisation (WHO) and the Taiwan Food and Drug Administration (TFDA) of the Ministry of Health and Welfare.

The European Pharmacopoeia Commission

While the European Directorate for the Quality of Medicines & HealthCare (EDQM), a directorate of the Council of Europe, provides scientific and administrative support for the European Pharmacopoeia, the governing body is the European Pharmacopoeia Commission. The European Pharmacopoeia Commission determines the general principles applicable to the elaboration of the European Pharmacopoeia. It also decides the work programme, sets up and appoints experts to the specialised groups responsible for preparing monographs, adopts these monographs, and recommends dates for the implementation of its decisions within the territories of the contracting parties.

This Commission meets in Strasbourg, France, three times a year, to adopt texts proposed by its groups of experts, and to decide on its programme of work and general policies. Items are added to the work programme in response to requests received by the European Directorate for the Quality of Medicines & HealthCare from the member states and their national authorities, industry or experts from around the world, based on current scientific and health issues. Each national delegation has one vote. In all technical questions, the decisions of the commission are taken by a unanimous vote of the national delegations that cast a vote. Member states’ representatives mostly come from health authorities, national pharmacopoeia authorities and universities; and are appointed by the national authorities on the basis of their expertise. Representatives of the thirty (30) observers are invited to attend the sessions, but cannot vote.

The term of the chair of the commission is three years, and runs in parallel with other members of the commission’s Presidium.

Publication

The first edition of the European Pharmacopoeia was published in 1969, and consisted of 120 texts. The 10th edition, currently applicable, was published in July 2019. The Ph. Eur. is applicable in 39 European countries and used in over 100 countries worldwide. Nowadays it contains over 3000 texts (the monographs), covering all therapeutic areas and consisting of:

  • Individual texts describing legally-binding quality standards for substances used in the manufacture of medicines or medicine ingredients (including active pharmaceutical ingredients, excipients, herbals, etc.);
  • Individual texts describing legally-binding quality standards for finished products;
  • General monographs describing legally-binding quality standards for classes of substances (such as fermentation products or substances for pharmaceutical use) or for the dosage forms that medicines can take (tablets, capsules, injections, etc.); and
  • General methods of analysis of substances used in the manufacture of medicines, which are not legally binding and may also be used for substances and medicines not described in the Ph. Eur.

Ph. Eur. texts contain detailed analytical methods to identify the substance or product and control its quality and quantitative strength.

Ph. Eur. texts also address the issue of impurities in medicinal products, which do not offer any therapeutic benefit for the patient and sometimes are potentially toxic. Impurities are present at every stage of the manufacture of medicines: in starting materials, active pharmaceutical ingredients (APIs), reagents, intermediates, excipients and primary packaging materials. But Ph. Eur. texts’ section on impurities is perhaps the most essential part of a quality standard of an active substance.

A new edition of the European Pharmacopoeia is published every three years: in both English and French, by the Council of Europe. It is made available in print and electronic (online and downloadable) versions; the online version is also accessible from smartphones and tablet computers.

Translations into other languages are published by the member states themselves. For example, a German version is jointly published by Austria, Germany and Switzerland.

Refer to The International Pharmacopoeia, British Pharmacopoeia, European Pharmacopoeia, United States Pharmacopoeia, Indian Pharmacopoeia Commission, Japanese Pharmacopoeia, and Pharmacopoeia of the People’s Republic of China.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/European_Pharmacopoeia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the International Pharmacopoeia?

Published on by Andrew Marshall7 Comments

Introduction

The International Pharmacopoeia (Pharmacopoeia Internationalis, Ph. Int.) is a pharmacopoeia issued by the World Health Organisation (WHO) as a recommendation, with the aim to provide international quality specifications for pharmaceutical substances (active ingredients and excipients) and dosage forms, together with supporting general methods of analysis, for global use. Its texts can be used or adapted by any WHO member state wishing to establish legal pharmaceutical requirements.

The Ph.Int. is based primarily on medicines included in the current WHO Model List of Essential Medicines (EML) and medicines included in the current invitations to manufacturers to submit an expression of interest (EOI) to the WHO Prequalification Team – Medicines (PQT) and those of interest to other UN organisations. In recent years, priority has been given to medicines of importance in low and middle income countries, which may not appear in any other pharmacopoeias, including child-friendly dosage forms.

The Ph.Int. is designed to serve all Member States, especially their national and regional regulatory authorities, organisations in the United Nations system, and regional and interregional harmonisation efforts, and they underpin important public health initiatives, including the prequalification and procurement of quality medicines through major international entities, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNICEF.

The monographs published in the Ph.Int. are established in an independent manner via a consultative procedure and based on international experience. Monographs on radiopharmaceuticals developed with the International Atomic Energy Agency.

Refer to The International Pharmacopoeia, British Pharmacopoeia, European Pharmacopoeia, United States Pharmacopoeia, Indian Pharmacopoeia Commission, Japanese Pharmacopoeia, and Pharmacopoeia of the People’s Republic of China.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/The_International_Pharmacopoeia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the British Pharmacopoeia?

Published on by Andrew Marshall7 Comments

Introduction

The British Pharmacopoeia (BP) is the national pharmacopoeia of the United Kingdom (UK). It is an annually published collection of quality standards for medicinal substances in the UK, which is used by individuals and organisations involved in pharmaceutical research, development, manufacture and testing.

Pharmacopoeial standards are publicly available and legally enforceable standards of quality for medicinal products and their constituents. The British Pharmacopoeia is an important statutory component in the control of medicines, which complements and assists the licensing and inspection processes of the UK’s Medicines and Healthcare products Regulatory Agency (MHRA). Together with the British National Formulary (BNF), the British Pharmacopoeia defines the UK’s pharmaceutical standards.

Pharmacopoeial standards are compliance requirements; that is, they provide the means for an independent judgement as to the overall quality of an article, and apply throughout the shelf-life of a product. Inclusion of a substance in a pharmacopoeia does not indicate that it is either safe or effective for the treatment of any disease.

Legal Basis

The British Pharmacopoeia is published on behalf of the Health Ministers of the United Kingdom; on the recommendation of the Commission on Human Medicines, in accordance with section 99(6) of the Medicines Act 1968, and notified in draft to the European Commission (EC) in accordance with Directive 98/34/EEC.

The monographs of the European Pharmacopoeia (as amended by Supplements published by the Council of Europe) are reproduced either in the British Pharmacopoeia, or in the associated edition of the British Pharmacopoeia (Veterinary).

In the pharmacopoeia, certain drugs and preparations are included regardless of the existence of actual or potential patent rights. Where substances are protected by letters patent, their inclusion in the pharmacopoeia neither conveys, nor implies, licence to manufacture.

Brief History

The regulation of medicinal products by officials in the United Kingdom dates back to the reign of King Henry VIII (1491-1547). The Royal College of Physicians of London had the power to inspect apothecaries’ products in the London area, and to destroy defective stock. The first list of approved drugs, with information on how they should be prepared, was the London Pharmacopoeia, published in 1618. The first edition of what is now known as the British Pharmacopoeia was published in 1864, and was one of the first attempts to harmonise pharmaceutical standards, through the merger of the London, Edinburgh and Dublin Pharmacopoeias. The New Latin name that had some currency at the time was Pharmacopoeia Britannica (Ph. Br.).

In 1844, concern about the dangers of unregulated manufacture and use led William Flockhart – who had provided chloroform to Doctor (later Sir) James Young Simpson for his experiment on anaesthesia – to recommend the creation of a ‘Universal Phamacopoeia for Great Britain’ in his inaugural speech as president of the Northern British branch of the Pharmaceutical Society.

A commission was first appointed by the General Medical Council (GMC), when the body was made statutorily responsible under the Medical Act 1858 for producing a British pharmacopoeia on a national basis. In 1907, the British Pharmacopoeia was supplemented by the British Pharmaceutical Codex, which gave information on drugs and other pharmaceutical substances not included in the BP, and provided standards for these.

The Medicines Act 1968 established the legal status of the British Pharmacopoeia Commission, and of the British Pharmacopoeia, as the UK standard for medicinal products under section 4 of the Act. The British Pharmacopoeia Commission continues the work of the earlier Commissions appointed by the GMC, and is responsible for preparing new editions of the British Pharmacopoeia and the British Pharmacopoeia (Veterinary), and for keeping them up to date. Under Section 100 of the Medicines Act, the Commission is also responsible for selecting and devising British Approved Names.

Since its first publication in 1864, the distribution of the British Pharmacopoeia has grown throughout the world and it is now used in over 100 countries. Australia and Canada are two of the countries that have adopted the BP as their national standard; in other countries, such as South Korea, the BP is recognised as an acceptable reference standard.

Content

The current edition of the British Pharmacopoeia comprises six volumes, which contain nearly 3,000 monographs for drug substances, excipients, and formulated preparation, together with supporting general notices, appendices (test methods, reagents etc.), and reference spectra, used in the practice of medicine, all comprehensively indexed and cross-referenced for easy reference. Items used exclusively in veterinary medicine in the UK are included in the BP (Veterinary).

  • Volumes I and II:
    • Medicinal Substances.
  • Volume III:
    • Formulated Preparations.
    • Blood related Preparations.
    • Immunological Products.
    • Radiopharmaceutical Preparations.
    • Surgical Materials.
    • Homeopathic Preparations.
  • Volume IV:
    • Appendices.
    • Infrared Reference Spectra.
    • Index.
  • Volume V:
    • British Pharmacopoeia (Veterinary).
  • Volume VI: (CD-ROM version):

The British Pharmacopoeia is available as a printed volume and electronically in both on-line and CD-ROM versions; the electronic products use sophisticated search techniques to locate information quickly. For example, pharmacists referring to a monograph can immediately link to other related substances and appendices referenced in the content by using 130,000+ hypertext links within the text.

Production

The British Pharmacopoeia is prepared by the Pharmacopoeial Secretariat, working in collaboration with the British Pharmacopoeia Laboratory, the British Pharmacopoeia Commission (BPC), and its Expert Advisory Groups (EAG) and Advisory Panels. The development of pharmacopoeial standards receives input from relevant industries, hospitals, academia, professional bodies and governmental sources, both within and outside the UK.

The British Pharmacopoeia Laboratory provides analytical and technical support to the British Pharmacopoeia. Its major functions are:

  • Development of new pharmacopoeial monographs: the laboratory undertakes the development and validation of qualitative and quantitative test methods for new BP monograph specifications, and refines and revalidates test methods for existing British Pharmacopoeia monographs.
  • British Pharmacopoeia Chemical Reference Substances (BPCRS): the laboratory is responsible for the procurement, establishment, maintenance and sale of BPCRS. The catalogue currently contains nearly 500 BPCRS, which are needed as standards for monograph tests in both the British Pharmacopoeia and the British Pharmacopoeia (Veterinary).

The current edition of the British Pharmacopoeia is available from The Stationery Office Bookshop.

Guidance

Detailed information and guidance on various aspects of current pharmacopoeial policy and practice is provided in supplementary chapters of the British Pharmacopoeia. This includes explanation of the basis of pharmacopoeial specifications, and information on the development of monographs including guidance to manufacturers.

British Approved Names

Refer to British Approved Name.

British Approved Names (BANs) are devised or selected by the British Pharmacopoeia Commission (BPC), and published by the Health Ministers, on the recommendation of the Commission on Human Medicines, to provide a list of names of substances or articles referred to in Section 100 of the Medicines Act 1968. BANs are short, distinctive names for substances, where the systematic chemical or other scientific names are too complex for convenient general use.

As a consequence of Directive 2001/83/EC, as amended, the British Approved Names, since 2002, may be assumed to be the recommended International Non-proprietary Name (rINN), except where otherwise stated. A World Health Organisation (WHO) INN identifies a pharmaceutical substance or active pharmaceutical ingredient by a unique name that is globally recognised, and in which no party can claim any proprietary rights. A non-proprietary name is also known as a generic name.

Related Publications

Refer to The International Pharmacopoeia, British Pharmacopoeia, European Pharmacopoeia, United States Pharmacopoeia, Indian Pharmacopoeia Commission, Japanese Pharmacopoeia, and Pharmacopoeia of the People’s Republic of China.

The British National Formulary (BNF) and its related publications contain information on prescribing, indications, side effects and costs of all medication available on the National Health Service.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/British_Pharmacopoeia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is a Pharmacist?

Published on by Andrew Marshall2 Comments

Introduction

Pharmacists – also known as chemists (Commonwealth English) or druggists (North American and, archaically, Commonwealth English) – are health professionals who control, formulate, preserve and dispense medications and provide advice and counselling on how medicines should be used to achieve maximum benefit, minimal side effects and to avoid drug interactions.

They also serve as primary care providers in the community. Pharmacists undergo university or graduate-level education to understand the biochemical mechanisms and actions of drugs, drug uses, therapeutic roles, side effects, potential drug interactions, and monitoring parameters. This is mated to anatomy, physiology, and pathophysiology. Pharmacists interpret and communicate this specialised knowledge to patients, physicians, and other health care providers.

Among other licensing requirements, different countries require pharmacists to hold either a Bachelor of Pharmacy, Master of Pharmacy, or Doctor of Pharmacy degree.

The most common pharmacist positions are that of a community pharmacist (also referred to as a retail pharmacist, first-line pharmacist or dispensing chemist), or a hospital pharmacist, where they instruct and counsel on the proper use and adverse effects of medically prescribed drugs and medicines. In most countries, the profession is subject to professional regulation. Depending on the legal scope of practice, pharmacists may contribute to prescribing (also referred to as “pharmacist prescriber”) and administering certain medications (e.g. immunisations) in some jurisdictions. Pharmacists may also practice in a variety of other settings, including industry, wholesaling, research, academia, formulary management, military, and government.

Nature of Work

Historically, the fundamental role of pharmacists as a healthcare practitioner was to check and distribute drugs to doctors for medication that had been prescribed to patients. In more modern times, pharmacists advise patients and health care providers on the selection, dosages, interactions, and side effects of medications, and act as a learned intermediary between a prescriber and a patient. Pharmacists monitor the health and progress of patients to ensure the safe and effective use of medication. Pharmacists may practice compounding; however, many medicines are now produced by pharmaceutical companies in a standard dosage and drug delivery form. In some jurisdictions, pharmacists have prescriptive authority to either independently prescribe under their own authority or in collaboration with a primary care physician through an agreed upon protocol called a collaborative practice agreement.

Increased numbers of drug therapies, aging but more knowledgeable and demanding populations, and deficiencies in other areas of the health care system seem to be driving increased demand for the clinical counselling skills of the pharmacist. One of the most important roles that pharmacists are currently taking on is one of pharmaceutical care. Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and management of each to improve outcomes. Pharmaceutical care has many benefits that may include but are not limited to: decreased medication errors; increased patient compliance in medication regimen; better chronic disease state management, including hypertension and other cardiovascular disease risk factors; strong pharmacist–patient relationship; and decreased long-term costs of medical care.

Pharmacists are often the first point-of-contact for patients with health inquiries. Thus pharmacists have a significant role in assessing medication management in patients, and in referring patients to physicians. These roles may include, but are not limited to:

  • Clinical medication management, including reviewing and monitoring of medication regimens.
  • Assessment of patients with undiagnosed or diagnosed conditions, and ascertaining clinical medication management needs.
  • Specialised monitoring of disease states, such as dosing drugs in kidney and liver failure.
  • Compounding medicines.
  • Providing pharmaceutical information.
  • Providing patients with health monitoring and advice, including advice and treatment of common ailments and disease states.
  • Supervising pharmacy technicians and other staff.
  • Oversight of dispensing medicines on prescription.
  • Provision of and counselling about non-prescription or over-the-counter drugs.
  • Education and counselling for patients and other health care providers on optimal use of medicines (e.g. proper use, avoidance of overmedication).
  • Referrals to other health professionals if necessary.
  • Pharmacokinetic evaluation.
  • Promoting public health by administering immunisations.
  • Constructing drug formularies.
  • Designing clinical trials for drug development.
  • Working with federal, state, or local regulatory agencies to develop safe drug policies.
  • Ensuring correctness of all medication labels including auxiliary labels.
  • Member of inter-professional care team for critical care patients.
  • Symptom assessment leading to medication provision and lifestyle advice for community-based health concerns (e.g. head colds, or smoking cessation).
  • satged dosing supply (e.g. opioid substitution therapy).

Education and Credentialing

The role of pharmacy education, pharmacist licensing, and continuing education vary from country to country and between regions/localities within countries. In most countries, pharmacists must obtain a university degree at a pharmacy school or related institution, and/or satisfy other national/local credentialing requirements. In many contexts, students must first complete pre-professional (undergraduate) coursework, followed by about four years of professional academic studies to obtain a degree in pharmacy (such as Doctorate of Pharmacy). In the European Union, pharmacists are required to hold a Masters of Pharmacy, which allows them to practice in any other EU country, pending professional examinations and language tests in the country in which they want to practice. Pharmacists are educated in pharmacology, pharmacognosy, chemistry, organic chemistry, biochemistry, pharmaceutical chemistry, microbiology, pharmacy practice (including drug interactions, medicine monitoring, medication management), pharmaceutics, pharmacy law, pathophysiology, physiology, anatomy, pharmacokinetics, pharmacodynamics, drug delivery, pharmaceutical care, nephrology, hepatology, and compounding of medications. Additional curriculum may cover diagnosis with emphasis on laboratory tests, disease state management, therapeutics and prescribing (selecting the most appropriate medication for a given patient).

Upon graduation, pharmacists are licensed, either nationally or regionally, to dispense medication of various types in the areas they have trained for.

Some may undergo further specialised training, such as in cardiology or oncology. Specialties include:

  • Academic pharmacist.
  • Clinical pharmacy specialist.
  • Community pharmacist.
  • Compounding pharmacist.
  • Consultant pharmacist.
  • Drug information pharmacist.
  • Home health pharmacist.
  • Hospital pharmacist.
  • Industrial pharmacist.
  • Informatics pharmacist.
  • Managed care pharmacist.
  • Military pharmacist.
  • Nuclear pharmacist.
  • Oncology pharmacist.
  • Regulatory-affairs pharmacist.
  • Veterinary pharmacist.
  • Pharmacist clinical pathologist.
  • Pharmacist clinical.

Training and Practice by Country

Armenia

The Ministry of Education and Ministry of Health oversee pharmacy school accreditation in Armenia. Pharmacists are expected to have competency in the WHO Model List of Essential Medicines (EML), the use of Standard Treatment Guidelines, drug information, clinical pharmacy, and medicine supply management. There are currently no laws requiring pharmacists to be registered, but all pharmacies must have a license to conduct business. According to a World Health Organisation (WHO) report from 2010, there are 0.53 licensed pharmacists and 7.82 licensed pharmacies per 10,000 people in Armenia. Pharmacists are able to substitute for generic equivalents at point of dispensing.

Australia

The Australian Pharmacy Council is the independent accreditation agency for Australian pharmacists. The accreditation standards for Australian pharmacy degrees include compulsory clinical placements, with an emphasis on encouraging rural experiences to develop a rural workforce. It conducts examinations on behalf of the Pharmacy Board of Australia towards eligibility for registration. The Australian College of Pharmacy provides continuing education programmes for pharmacists. The number of full-time equivalent pharmacists working in Australia over the past decade has remained stable. Pharmacy practice is described by the practice standards and guidelines including those from the Pharmaceutical Society of Australia.

Wages for pharmacists in Australia appear to have stagnated, and even gone backwards. As of 2007, the award wages for a pharmacist is $812 a week. Pharmacist graduates are the lowest paid university graduates most years. Most pharmacists do earn above the award wage; the average male pharmacist earns $65,000, a female pharmacist averages $56,500. Contract and casual work is becoming more common. A contract pharmacist is self-employed and often called a locum; these pharmacists may be hired for one shift or for a longer period of time. There are accounts of underemployment and unemployment emerging recently.

Canada

The Canadian Pharmacists Association (CPhA) is the national professional organisation for pharmacists in Canada. Specific requirements for practice vary across provinces, but generally include a bachelor’s (BSc Pharm) or Doctor of Pharmacy (PharmD) degree from one of 10 Canadian universities offering a pharmacy programme, successful completion of a national board examination through the Pharmacy Examining Board of Canada (PEBC) (Quebec being the exception), practical experience through an apprenticeship/internship programme, and fluency in French or English. International pharmacy graduates can begin their journey of becoming licensed to practice in Canada by enrolling with the National Association of Pharmacy Regulatory Authorities (NAPRA) Pharmacists’ Gateway Canada. The vast majority (~70%) of Canada’s licensed pharmacists work in community pharmacies, another 15% work in hospital, and the remainder work in other settings such as industry, government, or universities. Pharmacists’ scope of practice varies widely among the 13 provinces and territories and continues to evolve with time. As a result of pharmacists’ expanding scope and knowledge application, there has been a purposeful effort to transition the professional programs in Canadian pharmacy schools to offer doctors of pharmacy over baccalaureate curriculums to ensure graduates have the most up to date level of training to match the increasing practice requirements.

Germany

In Germany, the education and training is divided into three sections, each ending with a state examination:

  • University: Basic studies (at least four semesters).
  • University: Main studies (at least four semesters).
  • Community Pharmacy / Hospital Pharmacy / Industry: Practical training (12 months; 6 months in a Community Pharmacy).

After the third state examination a person must become licensed as an RPh (“registered pharmacist”) for a licence to practice pharmacy. Today, many pharmacists work as employees in public pharmacies. They will be paid according to the labour agreement of Adexa and employer associations.

Japan

Brief History

In ancient Japan, the men who fulfilled roles similar to pharmacists were respected. The place of pharmacists in society was settled in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organisational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists – and even pharmacist assistants – were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.

Contemporary

As of 1997, 46 universities of pharmacy in Japan graduated about 8000 students annually. Contemporary practice of clinical pharmacists in Japan (as evaluated in September 2000) focuses on dispensing of drugs, consultation with patients, supplying drug information, advising on prescription changes and amending prescriptions. These practices have been linked to decreases in the average number of drugs in prescriptions, drug costs and incidence of adverse drug events.

Nigeria

Training to become a registered pharmacist in Nigeria involves a five-year course after six years of secondary/high school or four years after eight years of secondary/high school (i.e. after two (2) years of Advanced-level studies in accredited Universities). The degree awarded by most pharmacy schools is a Bachelor of Pharmacy Degree (B.Pharm.) However, in the near future, all schools will offer a 6-year first Degree course leading to the award of a Pharm.D (Doctor of Pharmacy Degree). The University of Benin has started the Pharm.D programme with other pharmacy schools planning to start soon. The Pharmacy Degree in Nigeria is unclassified i.e. awarded without first class, second class upper, etc., however graduates could be awarded Pass with Distinctions in specific fields such as Pharmaceutics, Pharmacology, medicinal chemistry etc. Pharmacy Graduates are required to undergo one (1) year of Tutelage under the supervision of an already Registered Pharmacist(a preceptor) in a recognised and designated Institution before they can become Registered Pharmacists. The Profession is Regulated by a Government Statutory body called the Pharmacists Council of Nigeria. The West African Post Graduate College of Pharmacy runs post-registration courses on advanced-level practice in various fields of pharmacy. It is a college jointly funded by a number of Countries in the West Africa sub-region. There are thousands of Nigerian-trained pharmacists registered and practicing in countries such as the US, the UK, Canada etc., due to the relatively poor public sector salaries in Nigeria.

Pakistan

In Pakistan, the Pharm.D. (Doctor of Pharmacy) degree is a graduate-level professional doctorate degree. Twenty-one universities are registered with the Pharmacy Council of Pakistan for imparting Pharmacy courses. In 2004 the Higher Education Commission of Pakistan and the Pharmacy Council of Pakistan revised the syllabus and changed the 4-year B.Pharmacy (Bachelor of Pharmacy) Programme to a 5-year Pharm.D. (Doctor of Pharmacy) programme. All 21 universities have started the 5-year Pharm.D Programme. In 2011 the Pharmacy Council of Pakistan approved the awarding of a Doctor of Pharmacy degree, a five-year programme at the Department of Pharmacy, University of Peshawar.

Poland

Polish pharmacists have to complete a 5+1⁄2-year Master of Pharmacy Programme at medical university and obtain the right to practice as a pharmacist in Poland from District Pharmaceutical Council. The Programme includes 6 months of pharmacy training. The Polish name for the Master of Pharmacy Degree (M.Pharm.) is magister farmacji (mgr farm). Not only pharmacists, but also pharmaceutical technicians are allowed to dispense prescription medicines, except for narcotics, psychotropics and very potent medicines. Pharmacists approve prescriptions fulfilled by pharmaceutical technicians subsequently. Pharmaceutical technicians have to complete 2 years of post-secondary occupational school and 2 years of pharmacy training afterwards. Pharmacists are eligible to prescribe medicines in exceptional circumstances. All Polish pharmacies are obliged to produce compound medicines. Most pharmacists in Poland are pharmacy managers and are responsible for pharmacy marketing in addition to traditional activities. To become a pharmacy manager in Poland, a pharmacist is expected to have at least 5 years of professional experience. All pharmacists in Poland have to maintain an adequate knowledge level by participating in various university- and industry-based courses and arrangements or by undergoing postgraduate specialisation.

Sweden

In Sweden, the national board of health and welfare regulates the practice of all legislated health care professionals, and is also responsible for registration of pharmacists in the country. The education to become a licensed pharmacist is regulated by the European Union, and states that minimum educational requirements are five years of university studies in a pharmacy programme, of which six months must be a pharmacy internship. To be admitted to pharmacy studies, students must complete a minimum of three years of gymnasium, similar to high school (school for about 15 to 20-year-old students) program in natural science after elementary school (6 to 16-year-olds). Only three universities in the whole of Sweden offer a pharmacy education, Uppsala University, where the Faculty of Pharmacy is located, the University of Gothenburg, and Umeå University. In Sweden, pharmacists are called Apotekare. At pharmacies in Sweden, pharmacists work together with another class of legislated health care professionals called Receptarier, in English so-called prescriptionists, who have completed studies equal to a Bachelor of Science in pharmacy, i.e. three years of university. Prescriptionists also have dispensing rights in Sweden, Norway, Finland and Iceland. The majority of the staff in a pharmacy are Apotekstekniker or “pharmacy technicians” with a three -semester education at a vocational college. Pharmacy technicians do not have dispensing rights in Sweden but are allowed to advise on and sell over-the-counter medicines.

Switzerland

In Switzerland, the federal office of public health regulates pharmacy practice. Four Swiss universities offer a major in pharmaceutical studies, the University of Basel, the University of Geneva, the University of Lausanne and the ETH Zurich. To major in pharmaceutical studies takes at least five years. Students spend their last year as interns in a pharmacy combined with courses at the university, with focus on the validation of prescriptions and the manufacturing of pharmaceutical formulations. Since all public health professions are regulated by the government it is also necessary to acquire a federal diploma in order to work in a pharmacy. It is not unusual for pharmaceutical studies majors to work in other fields such as the pharmaceutical industry or in hospitals. Pharmacists work alongside pharma assistants, an apprenticeship that takes three years to complete. Pharmacists can further specialise in various fields; this is organised by PharmaSuisse, the pharmacists’ association of Switzerland.

Tanzania

In Tanzania, pharmacy practice is regulated by the national Pharmacy Board, which is also responsible for registration of pharmacists in the country. By international standards, the density of pharmacists is very low, with a mean of 0.18 per 10,000 population. The majority of pharmacists are found in urban areas, with some underserved regions having only 2 pharmacists per region. According to 2007-2009 data, the largest group of pharmacists was employed in the public sector (44%). Those working in private retail pharmacies were 23%, and the rest were mostly working for private wholesalers, pharmaceutical manufacturers, in academia/teaching, or with faith-based or non-governmental facilities. The salaries of pharmacists varied significantly depending on the place of work. Those who worked in the academia were the highest paid followed by those who worked in the multilateral non-governmental organisations. The public sector including public retail pharmacies and faith based organisations paid much less. The Ministry of Health salary scale for medical doctors was considerably higher than that of pharmacists despite having a difference of only one year of training.

Trinidad and Tobago

In Trinidad and Tobago, pharmacy practice is regulated by the Pharmacy Board of Trinidad and Tobago, which is responsible for the registration of pharmacists in the twin islands. The University of the West Indies in St. Augustine offers a 4-year Bachelor of Science in Pharmacy as the sole practicing degree of pharmacy. Graduates undertake a 6-month internship, known as pre-registration, under the supervision of a registered pharmacist, at a pharmacy of their choosing, whether community or institutional. After completion of the required pre-registration period, the graduate can then apply to the Pharmacy Board to become a registered pharmacist. After working one (1) calendar year as a registered pharmacist, the individual can become a registered, responsible pharmacist. Being a registered, responsible pharmacist allows the individual to license a pharmacy and be a pharmacist-in-charge.

United Kingdom

In British English (and to some extent Australian English), the professional title known as “pharmacist” is also known as “dispensing chemist” or, more commonly, “chemist”. A dispensing chemist usually operates from a pharmacy or chemist’s shop, and is allowed to fulfil medical prescriptions and sell over-the-counter drugs and other health-related goods. Pharmacists can undertake additional training to allow them to prescribe medicines for specific conditions.

Practices

In the United Kingdom, most pharmacists working in the National Health Service practice in hospital pharmacy or community pharmacy. The Royal Commission on the National Health Service in 1979 reported that there were nearly 3,000 pharmacists employed in the hospital and community health service in the UK at that time. They were enthusiastic about the idea that pharmacists might develop their role of giving advice to the public.

The new professional role for pharmacist as prescriber has been recognised in the UK since May 2006, called the “Pharmacist Independent Prescriber”. Once qualified, a pharmacist independent prescriber can prescribe any licensed medicine for any medical condition within their competence. This includes controlled drugs except schedule 1 and prescribing certain drugs for the treatment of addiction (cocaine, diamorphine and dipipanone).

Education and Registration

Pharmacists, pharmacy technicians and pharmacy premises in the United Kingdom are regulated by the General Pharmaceutical Council (GPhC) for England, Scotland and Wales and by the Pharmaceutical Society of Northern Ireland for Northern Ireland. The role of regulatory and professional body on the mainland was previously carried out by the Royal Pharmaceutical Society of Great Britain, which remained as a professional body after handing over the regulatory role to the GPhC in 2010.

The following criteria must be met for qualification as a pharmacist in the United Kingdom (the Northern Irish body and the GPhC operate separately but have broadly similar registration requirements):

  • Successful completion of a 4-year Master of Pharmacy degree at a GPhC accredited university. Pharmacists holding degrees in Pharmacy from overseas institutions are able to fulfil this stage by undertaking the Overseas Pharmacist Assessment Programme (OSPAP), which is a one-year postgraduate diploma. On completion of the OSPAP, the candidate would proceed with the other stages of the registration process in the same manner as a UK student.
  • Completion of a 52-week preregistration training period. This is a period of paid or unpaid employment, in an approved hospital or community pharmacy under the supervision of a pharmacist tutor. During this time the student must collect evidence of having met certain competency standards set by the GPhC.
  • A pass mark in the GPhC registration assessment (formally an exam). This includes a closed-book paper and an open-book/mental calculations paper (using the British National Formulary and the GPhC’s “Standards of Conduct, Ethics and Performance” document as reference sources). The student must achieve an overall mark of 70%, which must include at least 70% in the calculations section of the open-book paper. From June 2016, the assessment will involve two papers, as before but the use of a calculator will now be allowed. However, reference sources will no longer be allowed in the assessment. Instead, relevant extracts of the British National Formulary will be provided within the assessment paper.
  • Satisfactorily meeting the GPhC’s Fitness to Practice Standards.

United States

In 2014 the United States Bureau of Labour Statistics revealed that there were 297,100 American pharmacist jobs. By 2024 that number is projected to grow by 3%. The majority (65%) of those pharmacists work in retail settings, mostly as salaried employees but some as self-employed owners. About 22% work in hospitals, and the rest mainly in mail-order or Internet pharmacies, pharmaceutical wholesalers, practices of physicians, and the Federal Government.

All graduating pharmacists must now obtain the Doctor of Pharmacy (Pharm.D.) degree before they are eligible to sit for the North American Pharmacist Licensure Examination (NAPLEX) to enter into pharmacy practice. In addition, pharmacists are subject to state-level jurisprudence exams in order to practice from state to state.

Pharmacy School Accreditation

The Accreditation Council for Pharmacy Education (ACPE) has operated since 1932 as the accrediting body for schools of pharmacy in the United States. The mission of ACPE is “To assure and advance excellence in education for the profession of pharmacy”. ACPE is recognised for the accreditation of professional degree programmes by the United States Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA). Since 1975, ACPE has also been the accrediting body for continuing pharmacy education. The ACPE board of directors are appointed by the American Association of Colleges of Pharmacy (AACP), the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP) (three appointments each), and the American Council on Education (one appointment). To obtain licensure in the United States, applicants for the North American Pharmacist Licensure Examination (NAPLEX) must graduate from an ACPE accredited school of pharmacy. ACPE publishes standards that schools of pharmacy must comply with to gain accreditation.

A Pharmacy school pursuing accreditation must first apply and be granted Pre-candidate status. These schools have met all the requirements for accreditation, but have not yet enrolled any students. This status indicates that the school of pharmacy has developed its programme in accordance with the ACPE standards and guidelines. Once a school has enrolled students, but has not yet had a graduating class, they may be granted Candidate status. The expectations of a Candidate programme are that they continue to mature in accordance with stated plans. The graduates of a Candidate programme are the same as those of fully accredited programmes. Full accreditation is granted to a programme once they have demonstrated they comply with the standards set forth by ACPE.

The customary review cycle for established accredited programmes is six years, whereas for programmes achieving their initial accreditation this cycle is two years. These are comprehensive on-site evaluations of the programmes. Additional evaluations may be conducted at the discretion of ACPE in the interim between comprehensive evaluations.

Education

Acceptance into a doctorate of pharmacy program depends upon completing specific prerequisites or obtaining a transferable bachelor’s degree. Pharmacy school is four years of graduate school (accelerated Pharmacy Schools go January to January and are only 3 years), which include at least one year of practical experience. Graduates receive a Doctorate of Pharmacy (PharmD) upon graduation. Most schools require students to take a Pharmacy College Admissions Test PCAT and complete 90 credit hours of university coursework in the sciences, mathematics, composition, and humanities before entry into the PharmD program. Due to the large admittance requirements and highly competitive nature of the field, most pharmacy students complete a bachelor’s degree before entry to pharmacy school.

Possible prerequisites:

  • Anatomy.
  • Physiology.
  • Biochemistry.
  • Biology.
  • Immunology.
  • Chemical engineering.
  • Economics.
  • Pathophysiology.
  • Physics.
  • Humanities.
  • Microbiology.
  • Molecular biology.
  • Organic chemistry.
  • Physical chemistry.
  • Statistics.
  • Calculus.

Besides taking classes, additional requirements before graduating may include a certain number of hours for community service, e.g. working in hospitals, clinics, and retail.

Estimated timeline: 4 years undergraduate + 4 years doctorate + 1–2 years residency + 1–3 years fellowship = 8 to 13 years.

A doctorate of pharmacy (except non-traditional, i.e. transferring a license from another country) is the only degree accepted by the National Associate of Boards of Pharmacy NABP to be eligible to “sit” for the North American Pharmacist Licensure Examination (NAPLEX). Previously the United States had a 5-year bachelor’s degree in pharmacy. For BS Pharmacy graduates currently licensed in US, there are 10 Universities offering non-traditional doctorate degree programmes via part-time, weekend or on-line programmes. These are programs fully accredited by Accreditation Council for Pharmacy Education (ACPE) but only available to current BS Pharmacy graduates with a license to practice pharmacy. Some institutions still offer 6 year accelerated PharmD programmes.

The current Pharm.D. degree curriculum is considerably different from that of the prior BS in pharmacy. It now includes extensive didactic clinical preparation, a full year of hands-on practice experience in a wider array of healthcare settings, and a greater emphasis on clinical pharmacy practice pertaining to pharmacotherapy optimisation. Legal requirements in the US to becoming a pharmacist include: graduating from an accredited PharmD programme, conducting a specified number of internship hours under a licensed pharmacist (i.e. 1,800 hours in some states), passing the NAPLEX, and passing a Multi-state Pharmacy Jurisprudence Exam MPJE. Arkansas, California, and Virginia have their own exams instead of the MPJE; in those states, pharmacists must pass the Arkansas Jurisprudence Exam, the California Jurisprudence Exam, or the Virginia Pharmacy Law Exam.

Residency is an option for post-graduates that is typically 1-2 years in length. A residency gives licensed pharmacists decades of clinical experience in an extremely condensed timeframe of only a few short years. In order for new graduates to remain competitive, employers generally favour residency trained applicants for clinical positions. The profession is moving toward resident-trained pharmacists who wish to provide direct patient care clinical services. In 1990, the American Association of Colleges of Pharmacy (AACP) required the new professional degree. Graduates from a PharmD program may also elect to do a fellowship that is geared toward research. Fellowships can varying in length but last 1-3 years depending on the programme and usually require one (1) year of residency at minimum.

Specialisation and Credentialing

American pharmacists can become certified in recognized specialty practice areas by passing an examination administered by one of several credentialing boards.

  • The Board of Pharmacy Specialties certifies pharmacists in thirteen specialties:
    • Ambulatory care pharmacy.
    • Cardiology pharmacy.
    • Compounded sterile preparations pharmacy.
    • Critical care pharmacy.
    • Geriatric pharmacy.
    • Infectious diseases pharmacy.
    • Nuclear pharmacy.
    • Nutrition support pharmacy.
    • Oncology pharmacy.
    • Paediatric pharmacy.
    • Pharmacotherapy.
    • Psychiatric pharmacy.
    • Solid organ transplant pharmacy.
  • The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.

Vaccinations

As of 2016, all 50 states and the District of Columbia permit pharmacists to provide vaccination services, but specific protocols vary between states.

California

All licensed California pharmacists can perform the following:

  • Order and interpret drug therapy related tests.
  • Furnish smoking cessation aids (such as nicotine replacement therapy).
  • Furnish oral self-administered contraception (birth control pills).
  • Furnish travel medications recommended by the CDC.
  • Administer vaccinations pursuant to the latest CDC standards for anyone ages 3+.

The passage of Assembly Bill 1535 (2014) authorises pharmacists in California to furnish naloxone without a physician’s prescription.

With the passage of Senate Bill 159 in 2019, pharmacists in California are authorised to furnish pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to patients without a physician’s prescription. In order to be eligible to dispense, a pharmacists must first “complete a training program approved by the” California State Board of Pharmacy.

California pharmacists can apply for Advanced Practice Pharmacist (APh) licenses from the California State Board of Pharmacy. Senate Bill 493, written by Senator Ed Hernandez, established a section on the Advanced Practice Pharmacist and outlines the definition, scope of practice, qualifications, and regulations of those holding this license. An APh can:

  • Perform patient assessments.
  • Refer patients to other healthcare providers.
  • Participate in the evaluation and management of diseases and health conditions in collaboration with other health care providers.
  • Initiate, adjust, or discontinue therapy pursuant to the regulations outlined in the bill.

To qualify for an advanced practice pharmacist license in California, the applicant must be in good standing with the State Board of pharmacy, have an active pharmacist license, and fulfil two of three requirements, including certification in their area clinical practice. The license must be renewed every 2 years, and the APh applying for renewal must complete 10 hours of continuing education in at least one area relevant to their clinical practice.

Vietnam

School students must take a national exam to enter a university of pharmacy or the pharmacy department of a university of medicine and pharmacy. About 5-7% of students can pass the exam. There are 3 aspects to the exam. These are on math, chemistry, and physics or biology. After being trained at the university for 5 years, successful students receive a bachelor’s degree in pharmacy. Or they are university pharmacists (university pharmacist to discriminate between college pharmacist or vocational pharmacist in some countries of the world these trainee pharmacists are called pharmacist assistants). An alternative method of obtaining a bachelor’s degree is as follows. School pupils study at a college of pharmacy or a vocational school of pharmacy. After attending the school or college they go to work in a pharmacy, and with two years of practice they could take an exam to enter university of pharmacy or the pharmacy department of a university of medicine and pharmacy. This exam is easier than the national one. Passing the exam they continue studying to gain 3-year bachelor’s degrees or 4-year bachelor’s degrees. This degree is considered equivalent to a 5-year bachelor’s degree.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Pharmacist >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 03 November [2022]

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People (Deaths)

  • 1957 – Wilhelm Reich, Ukrainian-Austrian psychotherapist and author (b. 1897).

Wilhelm Reich

Wilhelm Reich (24 March 1897 to 03 November 1957) was an Austrian doctor of medicine and a psychoanalyst, along with being a member of the second generation of analysts after Sigmund Freud. The author of several influential books, most notably The Impulsive Character (1925), The Function of the Orgasm (1927), Character Analysis (1933), and The Mass Psychology of Fascism (1933), he became known as one of the most radical figures in the history of psychiatry.

Reich’s work on character contributed to the development of Anna Freud’s The Ego and the Mechanisms of Defence (1936), and his idea of muscular armour – the expression of the personality in the way the body moves – shaped innovations such as body psychotherapy, Gestalt therapy, bioenergetic analysis and primal therapy. His writing influenced generations of intellectuals; he coined the phrase “the sexual revolution” and according to one historian acted as its midwife. During the 1968 student uprisings in Paris and Berlin, students scrawled his name on walls and threw copies of The Mass Psychology of Fascism at police.

After graduating in medicine from the public University of Vienna in 1922, Reich became deputy director of Freud’s outpatient clinic, the Vienna Ambulatorium. During the 1930s, he was part of a general trend among younger analysts and Frankfurt sociologists that tried to reconcile psychoanalysis with Marxism. He is credited for establishing the first sexual advisory clinics in Vienna, along with Marie Frischauf. He said he wanted to “attack the neurosis by its prevention rather than treatment”.

He moved to New York in 1939, after having accepted a position as Assistant Professor at the New School of Social Research. During his five years in Oslo, he had coined the term “orgone energy” – from “orgasm” and “organism” – for the notion of life energy. In 1940 he started building orgone accumulators, modified Faraday cages that he claimed were beneficial for cancer patients. He claimed that his laboratory cancer mice had had remarkable positive effects from being kept in a Faraday cage, so he built human-size versions, where one could sit inside. This led to newspaper stories about “sex boxes” that cured cancer.

From 1956 to 1960 many of his writings and his equipment were seized and destroyed by FDA officials. In the 21st century some considered this wholesale destruction to be one of the most blatant examples of censorship in US history.

Following two critical articles about him in The New Republic and Harper’s in 1947, the US Food and Drug Administration obtained an injunction against the interstate shipment of orgone accumulators and associated literature, believing they were dealing with a “fraud of the first magnitude”. Charged with contempt in 1956 for having violated the injunction, Reich was sentenced to two years imprisonment, and that summer over six tons of his publications were burned by order of the court. He died in prison of heart failure just over a year later, days before he was due to apply for parole.

What is the Eysenck Personality Questionnaire?

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Introduction

In psychology, the Eysenck Personality Questionnaire (EPQ) is a questionnaire to assess the personality traits of a person. It was devised by psychologists Hans Jürgen Eysenck and Sybil B.G. Eysenck.

Hans Eysenck’s theory is based primarily on physiology and genetics. Although he was a behaviourist who considered learned habits of great importance, he believed that personality differences are determined by genetic inheritance. He is, therefore, primarily interested in temperament. In devising a temperament-based theory, Eysenck did not exclude the possibility that some aspects of personality are learned, but left the consideration of these to other researchers.

Dimensions

Eysenck initially conceptualised personality as two biologically-based independent dimensions of temperament, E and N, measured on a continuum, but then extending this to include a third, P.

E – Extraversion/Introversion

  • Extraversion is characterised by being outgoing, talkative, high on positive affect (feeling good), and in need of external stimulation.
  • According to Eysenck’s arousal theory of extraversion, there is an optimal level of cortical arousal, and performance deteriorates as one becomes more or less aroused than this optimal level.
  • Arousal can be measured by skin conductance, brain waves or sweating.
  • At very low and very high levels of arousal, performance is low, but at a better mid-level of arousal, performance is maximised.
  • Extraverts, according to Eysenck’s theory, are chronically under-aroused and bored and are therefore in need of external stimulation to bring them UP to an optimal level of performance.
  • About 16% of the population tend to fall in this range.
  • Introverts, on the other hand, (also about 16 percent of the population) are chronically over-aroused and jittery and are therefore in need of peace and quietness to bring them DOWN to an optimal level of performance.
  • Most people (about 68% of the population) fall in the midrange of the extraversion/introversion continuum, an area referred to as ambiversion.

N – Neuroticism/Stability

  • Neuroticism or emotionality is characterised by high levels of negative affect such as depression and anxiety.
  • Neuroticism, according to Eysenck’s theory, is based on activation thresholds in the sympathetic nervous system or visceral brain.
  • This is the part of the brain that is responsible for the fight-or-flight response in the face of danger.
  • Activation can be measured by heart rate, blood pressure, cold hands, sweating and muscular tension (especially in the forehead).
  • Neurotic people – who have low activation thresholds, and unable to inhibit or control their emotional reactions, experience negative affect (fight-or-flight) in the face of very minor stressors – are easily nervous or upset.
  • Emotionally stable people – who have high activation thresholds and good emotional control, experience negative affect only in the face of very major stressors – are calm and collected under pressure.

The two dimensions or axes, extraversion-introversion and emotional stability-instability, define four quadrants. These are made up of:

  • Stable extraverts (sanguine qualities such as outgoing, talkative, responsive, easy going, lively, carefree, leadership).
  • Unstable extraverts (choleric qualities such as touchy, restless, excitable, changeable, impulsive, irresponsible).
  • Stable introverts (phlegmatic qualities such as calm, even-tempered, reliable, controlled, peaceful, thoughtful, careful, passive).
  • Unstable introverts (melancholic qualities such as quiet, reserved, pessimistic, sober, rigid, anxious, moody).

Further research demonstrated the need for a third category of temperament:

P – Psychoticism/Socialisation

  • Psychoticism is associated not only with the liability to have a psychotic episode (or break with reality), but also with aggression.
  • Psychotic behaviour is rooted in the characteristics of toughmindedness, non-conformity, inconsideration, recklessness, hostility, anger and impulsiveness.
  • The physiological basis suggested by Eysenck for psychoticism is testosterone, with higher levels of psychoticism associated with higher levels of testosterone.

The following table describes the traits that are associated with the three dimensions in Eysenck’s model of personality.

PsychoticismExtraversionNeuroticism
AggresiveSociableAnxious
AssertiveIrresponsibleDepressed
EgocentricDominantGuilt Feelings
UnsympatheticLack of ReflectionLow Self-Esteem
ManipulativeSensation-SeekingTense
Achievement-OrientatedImpulsiveMoody
DogmaticRisk-TakingHypochondriac
MasculineExpressiveLack of Autonomy
Tough-MindedActiveObsessive

L – Lie/Social Desirability

Although the first 3 scales were predicted upon a biologically based theory of personality, the fourth scale has not been theoretically specified to the same extent, but it was considered to be conceptually strong to the extent that it would demonstrate the same degree of measurement similarity across cultures.

Criticism

Since the re-evaluation of Eysenck’s work in the 21st century, amidst revelations of data fabrication or fraud committed by Eysenck, the Eysenck Personality Questionnaire has itself come under scrutiny as potentially biased, flawed, or based upon faulty data.

Versions

EPQ also exists in Finnish and Turkish versions.

In 1985 a revised version of EPQ was described – the EPQ-R – with a publication in the journal Personality and Individual Differences. This version has 100 yes/no questions in its full version and 48 yes/no questions in its short scale version. A different approach to personality measurement developed by Eysenck, which distinguishes between different facets of these traits, is the Eysenck Personality Profiler.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Eysenck_Personality_Questionnaire >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Culture-Bound Syndrome?

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Introduction

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognisable disease only within a specific society or culture.

There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) which also includes a list of the most common culture-bound conditions (DSM-IV: Appendix I). Counterpart within the framework of ICD-10 (Chapter V) are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.

More broadly, an endemic that can be attributed to certain behaviour patterns within a specific culture by suggestion may be referred to as a potential behavioural epidemic. As in the cases of drug use, or alcohol and smoking abuses, transmission can be determined by communal reinforcement and person-to-person interactions. On etiological grounds, it can be difficult to distinguish the causal contribution of culture upon disease from other environmental factors such as toxicity.

Identification

A culture-specific syndrome is characterised by:

  • Categorisation as a disease in the culture (i.e. not a voluntary behaviour or false claim);
  • Widespread familiarity in the culture;
  • Complete lack of familiarity or misunderstanding of the condition to people in other cultures;
  • No objectively demonstrable biochemical or tissue abnormalities (signs); and
  • The condition is usually recognised and treated by the folk medicine of the culture.

Some culture-specific syndromes involve somatic symptoms (pain or disturbed function of a body part), while others are purely behavioural. Some culture-bound syndromes appear with similar features in several cultures, but with locally specific traits, such as penis panics.

A culture-specific syndrome is not the same as a geographically localised disease with specific, identifiable, causal tissue abnormalities, such as kuru or sleeping sickness, or genetic conditions limited to certain populations. It is possible that a condition originally assumed to be a culture-bound behavioural syndrome is found to have a biological cause; from a medical perspective it would then be redefined into another nosological category.

Medical Perspectives

The American Psychiatric Association states the following:

The term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be “illnesses,” or at least afflictions, and most have local names. Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists. Anthropologists have a tendency to emphasize the relativistic and culture-specific dimensions of the syndromes, while physicians tend to emphasize the universal and neuropsychological dimensions. Guarnaccia & Rogler (1999) have argued in favour of investigating culture-bound syndromes on their own terms, and believe that the syndromes have enough cultural integrity to be treated as independent objects of research.

Guarnaccia and Rogler demonstrate the issues that occur when diagnosing cultural bound disorders using the DSM-IV. One of the key problems that arise is the “subsumption of culture bound syndromes into psychiatric categories”, which ultimately creates a medical hegemony and places the western perspective above that of other cultural and epistemological explanations of disease. The urgency for further investigation or reconsideration of the DSM-IV’s authoritative power is emphasized, as the DSM becomes an international document for research and medical systems abroad. Guarnaccia and Rogler provide two research questions that must be considered, “firstly, how much do we know about the culture-bound syndromes for us to be able to fit them into standard classification; and secondly, whether such a standard and exhaustive classification in fact exists”.

It is suggested that the problematic nature of the DSM becomes evident when we view it as definitively conclusive. Questions are raised to whether culture-bound syndromes can be treated as discrete entities, or whether their symptoms are generalised and perceived as an amalgamation of previously diagnosed illnesses. If this is the case, then the DSM may be what Bruno Latour would defined as “particular universalism”. In that the Western medical system views itself to have a privileged insight into the true intelligence of nature, in contrast to the model provided by other cultural perspectives.

Some studies suggest that culture-bound syndromes represent an acceptable way within a specific culture (and cultural context) among certain vulnerable individuals (i.e. an ataque de nervios at a funeral in Puerto Rico) to express distress in the wake of a traumatic experience. A similar manifestation of distress when displaced into a North American medical culture may lead to a very different, even adverse outcome for a given individual and his or her family. The history and etymology of some syndromes such as Brain-Fog Syndrome, have also been reattributed to 19th century Victorian Britain rather than West Africa.

In 2013, the DSM 5, dropped the term culture-bound syndrome, preferring the new name “Cultural Concepts of Distress”.

Cultural Collusion Between Medical Perspectives

Within the traditional Hmong culture, epilepsy (qaug dab peg) directly translates to “the spirit catches you and you fall down” which is said to be an evil spirit called a dab that captures your soul and makes you ill. In this culture, individuals with seizures are seen to be blessed with a gift; an access point into the spiritual realm which no one else has been given. In westernised society, epilepsy is considered a serious long-term brain condition, that can have a major impairment on an individual’s life. The way the illness is dealt with in Hmong culture is vastly different due to the high-status epilepsy has amongst the culture, compared to individuals who have the condition in westernised societies. Individuals with epilepsy within the Hmong culture are a source of pride for their family.

Another culture bound illness is neurasthenia which is a vaguely described medical ailment in Chinese culture that presents as lassitude, weariness, headaches, and irritability and is mostly linked to emotional disturbance. A report done in 1942 showed that 87% of patients diagnosed by Chinese psychiatrists as having neurasthenia could be reclassified as having major depression according to the DSM-3 criteria. Another study conducted in Hong Kong showed that most patients selectively presented their symptoms according to what they perceived as appropriate and tended to only focus on somatic suffering, rather than the emotional problems they were facing.

Globalisation

Globalisation is a process whereby information, cultures, jobs, goods, and services are spread across national borders. This has had a powerful impact on the 21st century in many ways including through enriching cultural awareness across the globe. Greater level of cultural integration is occurring due to rapid industrialisation and globalisation, with cultures absorbing more influences from each other. As cultural awareness begins to increase between countries, there is a consideration into whether cultural bound syndromes will slowly lose their geographically bound nature and become commonly known syndromes that will then become internationally recognised. Anthropologist and psychiatrist Roland Littlewood makes the observation that these diseases are likely to vanish in an increasingly homogenous global culture in the face of globalisation (and industrialisation). Depression for example, was once only accepted in western societies, however it is now recognised as a mental disorder in all parts of the world. In contrast to Eastern civilisations such as Taiwan, depression is still much more common in Western cultures like the United States. This could indicate that globalisation may have an impact on allowing disorders to be spread across borders, however these disorders may remain predominant in certain cultures.

DSM-IV-TR List

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes.

NameGeographical Localisation/Population(s)
Running AmokBrunei, Singapore, Malaysia, Indonesia, Philippines, Timor-Leste
Ataque de NerviosHispanophone, as well as in the Philippines where it is known as “nervous breakdown”
Bilis, CóleraLatinos
Bouffée DéliranteFrance and French-speaking countries
Brain Fag SyndromeWest African students
Dhat SyndromeIndia
Falling-Out, Blacking OutSouthern United States and Caribbean
Ghost SicknessNative American (Navajo, Muscogee/Creek)
HwabyeongKorean
KoroChinese, Malaysian and Indonesian populations in Southeast Asia; Assam; occasionally in the West
LatahMalaysia and Indonesia, as well as the Philippines (as mali-mali, particularly among Tagalogs)
LocuraLatinos in the United States and Latin America
Mal de PeleaPuerto Rico
NerviosLatin America, Latinos in the United States, Philippines
Evil EyeMediterranean; Hispanic populations and Ethiopia
PibloktoArctic and subarctic Inuit populations
Zou huo ru mo
(Qigong Psychotic Reaction)		Han Chinese
RootworkSouthern United States, Caribbean nations
Sangue DormidoPortuguese populations in Cape Verde
Shenjing ShuairuoHan Chinese
Shenkui, shen-kʼueiHan Chinese
ShinbyeongKorean
SpellAfrican American, White populations in the southern United States and Ethiopia
SustoLatinos in the United States; Mexico, Central America and South America
Taijin KyofushoJapanese
ZārEthiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies

DSM-5 List

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as cultural concepts of distress, a closely related concept.

NameGeographical Localisation/Population(s)
Ataque de NerviosHispanophone, as well as in the Philippines
Dhat SyndromeIndia
Khyâl CapCambodian
Ghost SicknessNative American
KufungisisaZimbabwe
Maladi MounHaiti
NerviosLatin America, Latinos in the US
Shenjing ShuairuoHan Chinese
SustoLatinos in the US, Mexico, Central America and South America
Taijin KyofushoJapanese

ICD-10 List

NameGeographical Localisation/Population(s)
AmokSoutheast Asian Austronesians
Dhat Syndrome (Dhātu), Shen-kʼuei, JiryanIndia and Taiwan
Koro, Suk Yeong, Jinjin BemarSoutheast Asia, India, and China
LatahMalaysia and Indonesia
Nervios, Nerfiza, Nerves, NevraEgypt; Greece; northern Europe; Mexico, Central and South America
Pa-leng (Frigophobia)Taiwan and Southeast Asia
Pibloktoq (Arctic Hysteria)Inuit living within the Arctic Circle
Susto, EspantoMexico, Central and South America
Taijin Kyofusho, Shinkeishitsu (Anthropophobia)Japan
Ufufuyane, SakaKenya, Southern Africa (among Bantu, Zulu, and affiliated groups)
UqamairineqInuit living within the Arctic Circle
Fear of WindigoIndigenous people of Northeast America

Other Examples

Though “the ethnocentric bias of Euro-American psychiatrists has led to the idea that culture-bound syndromes are confined to non-Western cultures”, a prominent example of a Western culture-bound syndrome is anorexia nervosa.

Within the contiguous US, the consumption of kaolin, a type of clay, has been proposed as a culture-bound syndrome observed in African Americans in the rural south, particularly in areas in which the mining of kaolin is common.

In South Africa, among the Xhosa people, the syndrome of amafufunyana is commonly used to describe those believed to be possessed by demons or other malevolent spirits. Traditional healers in the culture usually perform exorcisms in order to drive off these spirits. Upon investigating the phenomenon, researchers found that many of the people claimed to be affected by the syndrome exhibited the traits and characteristics of schizophrenia.

Some researchers have suggested that both premenstrual syndrome (PMS) and the more severe premenstrual dysphoric disorder (PMDD), which have currently unknown physical mechanisms, are Western culture-bound syndromes. However, this is controversial.

Tarantism is an expression of mass psychogenic illness documented in Southern Italy since the 11th century.

Morgellons is a rare self-diagnosed skin condition reported primarily in white populations in the US. It has been described by a journalist as “a socially transmitted disease over the Internet”.

Vegetative-vascular dystonia can be considered an example of somatic condition formally recognised by local medical communities in former Soviet Union countries, but not in Western classification systems. Its umbrella term nature as neurological condition also results in diagnosing neurotic patients as neurological ones, in effect substituting possible psychiatric stigma with culture-bound syndrome disguised as a neurological condition.

Refugee children in Sweden have been known to fall into coma-like states on learning their families will be deported. The condition, known in Swedish as uppgivenhetssyndrom, or resignation syndrome, is believed to only exist among the refugee population in Sweden, where it has been prevalent since the early part of the 21st century. In a 130-page report on the condition commissioned by the government and published in 2006, a team of psychologists, political scientists, and sociologists hypothesized that it was a culture-bound syndrome.

A startle disorder similar to latah, called imu (sometimes spelled imu:), is found among Ainu people, both Sakhalin Ainu and Hokkaido Ainu.

A condition similar to piblokto, called menerik (sometimes meryachenie), is found among Yakuts, Yukaghirs, and Evenks living in Siberia.

The trance-like violent behaviour of the Viking age berserkers – behaviour that disappeared with the arrival of Christianity – has been described as a culture-bound syndrome.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Culture-bound_syndrome >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Mass Psychogenic Illness?

Published on by Andrew Marshall1 Comment

Introduction

Mass psychogenic illness (MPI) – also called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria, or mass hysteria – involves the spread of illness symptoms through a population where there is no infectious agent responsible for contagion.

It is the rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss, or alteration of function, whereby physical complaints that are exhibited unconsciously have no corresponding organic causes.

Causes

MPI is distinct from other types of collective delusions by involving physical symptoms. It is not well understood and its causes are uncertain. Features of MPI outbreaks often include:

  • Symptoms that have no plausible organic basis;
  • Symptoms that are transient and benign;
  • Symptoms with rapid onset and recovery;
  • Occurrence in a segregated group;
  • The presence of extraordinary anxiety;
  • Symptoms that are spread via sight, sound or oral communication;
  • A spread that moves down the age scale, beginning with older or higher-status people;
  • A preponderance of female participants.

British psychiatrist Simon Wessely distinguishes between two forms of MPI:

  • Mass anxiety hysteria “consists of episodes of acute anxiety, occurring mainly in schoolchildren. Prior tension is absent and the rapid spread is by visual contact.”
  • Mass motor hysteria “consists of abnormalities in motor behaviour. It occurs in any age group and prior tension is present. Initial cases can be identified and the spread is gradual. … [T]he outbreak may be prolonged.”

While his definition is sometimes adhered to, others such as Ali-Gombe et al. of the University of Maiduguri, Nigeria contest Wessely’s definition and describe outbreaks with qualities of both mass motor hysteria and mass anxiety hysteria.

The DSM-IV-TR does not have specific diagnosis for this condition but the text describing conversion disorder states that “In ‘epidemic hysteria’, shared symptoms develop in a circumscribed group of people following ‘exposure’ to a common precipitant.”

Common Symptoms

Timothy F. Jones of the Tennessee Department of Health compiles the following symptoms based on their commonality in outbreaks occurring in 1980-1990:

SymptomPercent Reporting
Headache67
Dizziness or Light-Headedness46
Nausea41
Abdominal Cramps or Pain39
Cough31
Fatigue, Drowsiness or Weakness31
Sore or Burning Throat30
Hyperventilation or Difficulty Breathing19
Watery or Irritated Eyes13
Chest Tightness/Chest Pain12
Inability to Concentrate/Trouble Thinking11
Vomiting10
Tingling, Numbness or Paralysis10
Anxiety or Nervousness8
Diarrhoea7
Trouble with Vision7
Rash4
Loss of Consciousness/Syncope4
Itching3

Prevalence and Intensity

Adolescents and children are frequently affected in cases of MPI. The hypothesis that those prone to extraversion or neuroticism, or those with low IQ scores, are more likely to be affected in an outbreak of hysterical epidemic has not been consistently supported by research. Bartholomew and Wessely state that it “seems clear that there is no particular predisposition to mass sociogenic illness and it is a behavioural reaction that anyone can show in the right circumstances.”

Intense media coverage seems to exacerbate outbreaks. The illness may also recur after the initial outbreak. John Waller advises that once it is determined that the illness is psychogenic, it should not be given credence by authorities. For example, in the Singapore factory case study, calling in a medicine man to perform an exorcism seemed to perpetuate the outbreak.

Research

Besides the difficulties common to all research involving the social sciences, including a lack of opportunity for controlled experiments, mass sociogenic illness presents special difficulties to researchers in this field. Balaratnasingam and Janca report that the methods for “diagnosis of mass hysteria remain contentious.” According to Jones, the effects resulting from MPI “can be difficult to differentiate from [those of] bioterrorism, rapidly spreading infection or acute toxic exposure.”

These troubles result from the residual diagnosis of MPI. There is a lack of logic in an argument that proceeds: “There isn’t anything, so it must be MPI.” It precludes the notion that an organic factor could have been overlooked. Nevertheless, running an extensive number of tests extends the probability of false positives. Singer, of the Uniformed Schools of Medicine, has summarized the problems with such a diagnosis:

“[Y]ou find a group of people getting sick, you investigate, you measure everything you can measure … and when you still can’t find any physical reason, you say ‘well, there’s nothing else here, so let’s call it a case of MPI.'”

Brief History

Middle Ages

The earliest studied cases linked with epidemic hysteria are the dancing manias of the Middle Ages, including St. John’s dance and tarantism. These were supposed to be associated with spirit possession or the bite of the tarantula. Those with dancing mania would dance in large groups, sometimes for weeks at a time. The dancing was sometimes accompanied by stripping, howling, the making of obscene gestures, or even (reportedly) laughing or crying to the point of death. Dancing mania was widespread over Europe.

Between the 15th and 19th centuries, instances of motor hysteria were common in nunneries. The young ladies that made up these convents were sometimes forced there by family. Once accepted, they took vows of chastity and poverty. Their lives were highly regimented and often marked by strict disciplinary action. The nuns would exhibit a variety of behaviours, usually attributed to demonic possession. They would often use crude language and exhibit suggestive behaviours. One convent’s nuns would regularly meow like cats. Priests were often called in to exorcise demons.

18th to 21st Centuries

Factories

MPI outbreaks occurred in factories following the industrial revolution in England, France, Germany, Italy and Russia as well as the United States and Singapore.

W.H. Phoon, Ministry of Labour in Singapore, gives a case study of six outbreaks of MPI in Singapore factories between 1973 and 1978. They were characterised by:

  1. Hysterical seizures of screaming and general violence, wherein tranquilizers were ineffective;
  2. Trance states, where a worker would claim to be speaking under the influence of a spirit or jinn; and
  3. Frightened spells: some workers complained of unprecedented fear, or of being cold, numb, or dizzy. Outbreaks would subside in about a week.

Often a bomoh (medicine man) would be called in to do a ritual exorcism. This technique was not effective and sometimes seemed to exacerbate the MPI outbreak. Females and Malay people were affected disproportionately.

Especially notable is the “June Bug” outbreak: In June 1962, a peak month in factory production, 62 workers at a dressmaking factory in a textile town in the Southern US experienced symptoms including severe nausea and breaking out on the skin. Most outbreaks occurred during the first shift, where four fifths of the workers were female. Of 62 total outbreaks, 59 were women, some of whom believed they were bitten by bugs from a fabric shipment, so entomologists and others were called in to discover the pathogen, but none was found. Kerchoff coordinated the interview of affected and unaffected workers at the factory and summarizes his findings:

  • Strain – those affected were more likely to work overtime frequently and provide the majority of the family income. Many were married with children.
  • Affected persons tended to deny their difficulties. Kerchoff postulates that such were “less likely to cope successfully under conditions of strain.”
  • Results seemed consistent with a model of social contagion. Groups of affected persons tended to have strong social ties.

Kerchoff also links the rapid rate of contagion with the apparent reasonableness of the bug infestation theory and the credence given to it in accompanying news stories.

Stahl and Lebedun describe an outbreak of mass sociogenic illness in the data centre of a university town in the United States Midwest in 1974. Ten of 39 workers smelling an unconfirmed “mystery gas” were rushed to a hospital with symptoms of dizziness, fainting, nausea and vomiting. They report that most workers were young women either putting their husbands through school or supplementing the family income. Those affected were found to have high levels of job dissatisfaction. Those with strong social ties tended to have similar reactions to the supposed gas, which only one unaffected woman reported smelling. No gas was detected in subsequent tests of the data centre.

Schools

Mass hysteria affected schools in Berry, Alabama, and Miami Beach in 1974, with the former episode taking the form of recurring pruritus, and the latter initially triggering fears of poison gas (it was traced back to a popular student who happened to be sick with a virus).

Thousands were affected by the spread of a supposed illness in a province of Kosovo in March to June 1990, exclusively affecting ethnic Albanians, most of whom were young adolescents. A wide variety of symptoms were manifested, including headache, dizziness, impeded respiration, weakness/adynamia, burning sensations, cramps, retrosternal/chest pain, dry mouth and nausea. After the illness had subsided, a bipartisan Federal Commission released a document, offering the explanation of psychogenic illness. Radovanovic of the Department of Community Medicine and Behavioural Sciences Faculty of Medicine in Safat, Kuwait reports:

This document did not satisfy either of the two ethnic groups. Many Albanian doctors believed that what they had witnessed was an unusual epidemic of poisoning. The majority of their Serbian colleagues also ignored any explanation in terms of psychopathology. They suggested that the incident was faked with the intention of showing Serbs in a bad light but that it failed due to poor organization.

Rodovanovic expects that this reported instance of mass sociogenic illness was precipitated by the demonstrated volatile and culturally tense situation in the province.

The Tanganyika laughter epidemic of 1962 was an outbreak of laughing attacks rumoured to have occurred in or near the village of Kanshasa on the western coast of Lake Victoria, Tanzania, eventually affecting 14 different schools and over 1,000 people.

On the morning of Thursday 07 October 1965, at a girls’ school in Blackburn in England, several girls complained of dizziness. Some fainted. Within a couple of hours, 85 girls from the school were rushed by ambulance to a nearby hospital after fainting. Symptoms included swooning, moaning, chattering of teeth, hyperpnea, and tetany. Moss and McEvedy published their analysis of the event about one year later. Their conclusions follow. Note that their conclusion about the above-average extraversion and neuroticism of those affected is not necessarily typical of MPI:

  • Clinical and laboratory findings were essentially negative.
  • Investigations by the public health authorities did not uncover any evidence of pollution of food or air.
  • The epidemiology of the outbreak was investigated by means of questionnaires administered to the whole school population. It was established that the outbreaks began among the 14-year-olds, but that the heaviest incidence moved to the youngest age groups.
  • By using the Eysenck Personality Inventory, it was established that, in all age groups, the mean E [extraversion] and N [neuroticism] scores of the affected were higher than those of the unaffected.
  • The younger girls proved more susceptible, but disturbance was more severe and lasted longer in the older girls.
  • It was considered that the epidemic was hysterical, that a previous polio epidemic had rendered the population emotionally vulnerable, and that a three-hour parade, producing 20 faints on the day before the first outbreak, had been the specific trigger.
  • The data collected were thought to be incompatible with organic theories and with the compromise theory of an organic nucleus.

Another possible case occurred in Belgium in June 1999 when people, mainly schoolchildren, became ill after drinking Coca-Cola. In the end, scientists were divided over the scale of the outbreak, whether it fully explains the many different symptoms and the scale to which sociogenic illness affected those involved.

A possible outbreak of mass psychogenic illness occurred at Le Roy Junior-Senior High School in 2011, in upstate New York, US, in which multiple students began having symptoms similar to Tourette syndrome. Various health professionals ruled out such factors as Gardasil, drinking water contamination, illegal drugs, carbon monoxide poisoning and various other potential environmental or infectious causes, before diagnosing the students with a conversion disorder and mass psychogenic illness.

Starting around 2009, a spate of apparent poisonings at girls’ schools across Afghanistan began to be reported; symptoms included dizziness, fainting and vomiting. The United Nations, World Health Organisation and NATO’s International Security Assistance Force carried out investigations of the incidents over multiple years, but never found any evidence of toxins or poisoning in the hundreds of blood, urine and water samples they tested. The conclusion of the investigators was that the girls were experiencing a mass psychogenic illness.

In August 2019 the BBC reported that schoolgirls at the Ketereh national secondary school (SMK Ketereh) in Kelantan, Malaysia, started screaming, with some claiming to have seen ‘a face of pure evil’. Dr Simon Wessely of King’s College Hospital, London suggested it was a form of ‘collective behaviour’. Robert Bartholomew, an American medical sociologist and author, said, “It is no coincidence that Kelantan, the most religiously conservative of all Malaysian states, is also the one most prone to outbreaks.” This view is supported by Afiq Noor, an academic, who argues that the stricter implementation of Islamic law in school in states such as Kelantan is linked to the outbreaks. He suggested that the screaming outbreak was caused by the constricted environment. In Malaysian culture burial sites and trees are common settings for supernatural tales about the spirits of dead infants (toyol), vampiric ghosts (pontianak) and vengeful female spirits (penanggalan). Authorities responded to the Kelantan outbreak by cutting down trees around the school.

Outbreaks of MPI “have been reported in Catholic convents and monasteries across Mexico, Italy and France, in schools in Kosovo and even among cheerleaders in a rural North Carolina town”.

Episodes of mass hysteria has been observed in schools of Nepal frequently, even leading to closure of schools temporarily. A unique phenomenon of “recurrent epidemic of mass hysteria” was reported from a school of Pyuthan district of western Nepal in 2018. After a 9-year-old school girl developed crying and shouting episodes, quickly other children of the same school were also affected resulting in 47 affected students (37 females, 10 males) in the same day. Since 2016 similar episodes of mass psychogenic illness has been occurring in the same school every year. This is thought to be a unique case of recurrent mass hysteria.

In July 2022 reports of up to 15 girls showing unusual symptoms such as screaming, trembling, and banging their heads came up from a government school in Bageshwar, Uttarakhand. Mass psychological illness has been suggested as a possible cause.

Terrorism and Biological Warfare

Bartholomew and Wessely anticipate the “concern that after a chemical, biological or nuclear attack, public health facilities may be rapidly overwhelmed by the anxious and not just the medical and psychological casualties.” Additionally, early symptoms of those affected by MPI are difficult to differentiate from those actually exposed to the dangerous agent.

The first Iraqi missile hitting Israel during the Persian Gulf War was believed to contain chemical or biological weapons. Though this was not the case, 40% of those in the vicinity of the blast reported breathing problems.

Right after the 2001 anthrax attacks in the first two weeks of October 2001, there were over 2,300 false anthrax alarms in the US. Some reported physical symptoms of what they believed to be anthrax.

Also in 2001, a man sprayed what was later found to be a window cleaner into a subway station in Maryland. Thirty-five people were treated for nausea, headaches and sore throats.

In 2017, some employees of the US embassy in Cuba reported symptoms (nicknamed the “Havana syndrome”) attributed to “sonic attacks”. The following year, some US government employees in China reported similar symptoms. Some scientists have suggested the alleged symptoms were psychogenic in nature. However, one study using neuroimaging suggest at least some organic, non-psychogenic cause.

Children in Recent Refugee Families

Refugee children in Sweden have been reported to fall into coma-like states on learning their families will be deported. The condition, known as resignation syndrome (Swedish: uppgivenhetssyndrom), is believed to only exist among the refugee population in the Scandinavian country, where it has been prevalent since the early part of the 21st century. Commentators state “a degree of psychological contagion” is inherent to the condition, by which young friends and relatives of the affected individual can also come to have the condition.

In a 130-page report on the condition, commissioned by the government and published in 2006, a team of psychologists, political scientists and sociologists hypothesized that it was a culture-bound syndrome, a psychological illness endemic to a specific society.

This phenomenon has later been called into question, with children witnessing that they were forced, by their parents, to act in a certain way in order to increase chances of being granted residence permits. As evidenced by medical records, healthcare professionals were aware of this scam, and witnessed parents who actively refused aid for their children, but remained silent. Later, Sveriges Television, Sweden’s national public television broadcaster, were severely critiqued by investigative journalist Janne Josefsson for failing to uncover the truth.

Internet

After the rise of a popular breakthrough YouTube channel in 2019 where the presenter exhibits extensive Tourette’s-like behaviour, there was a sharp rise in young people referred to clinics specialising in tics, thought to be related to social contagion spread via the internet, and also to stress from eco-anxiety and the COVID-19 pandemic. The authors of an August 2021 report found evidence that social media was the primary vector for transmission, declaring the phenomenon the first recorded instance of “mass social media–induced illness” (MSMI).

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Mass_psychogenic_illness >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.