Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand
Issued Date
2022-01-01
Resource Type
ISSN
17441692
eISSN
17441706
Scopus ID
2-s2.0-85127181341
Pubmed ID
35282798
Journal Title
Global Public Health
Volume
17
Issue
12
Start Page
3931
End Page
3943
Rights Holder(s)
SCOPUS
Bibliographic Citation
Global Public Health Vol.17 No.12 (2022) , 3931-3943
Suggested Citation
Poompruek P. Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand. Global Public Health Vol.17 No.12 (2022) , 3931-3943. 3943. doi:10.1080/17441692.2022.2049843 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/87429
Title
Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Thailand’s antimicrobial stewardship strategy has focussed on promoting ‘rational drug use’ in the public sector, to reduce the threat of drug resistance and control healthcare expenditure. The strategy’s next ambition is to attend to the private sector, where antibiotics are widely available over the counter without prescription. Using ethnographic and survey data, this paper follows antibiotics through community pharmacies, to explore drug distribution and access, and identify potential challenges for stewardship. We extend the analytical frame beyond ‘irrational’ dispenser-customer transactions, to explore the logics of practice of a multiplicity of actors in the context of a highly competitive pharmaceutical market. Highlighting the role of the pharmaceutical industry in mystifying medicines, we show how antibiotics are collapsed into a category of ‘strong medicines’ and requested by customers using ‘prescriptions by proxy’. We further examine how Thailand’s drug regulation and classificatory systems, historically orientated around access to medicines, enable the proliferation of antibiotics in the context of contemporary efforts to control distribution. Recognising the negotiations involved in dispensing antibiotics in a pluralistic health system, we attempt to reconfigure allocations of responsibility, advocating for stewardship approaches that take into account local ecologies of care, as well as implications for access, equity, and accountability.