Made to order: compounding pharmacist Sarah Abdullah on individualizing medicine
“Every patient is unique.” For compounding pharmacist Sarah Abdullah, tailoring medicines to a person’s needs is nothing new after years of working in the clean rooms of Putrajaya Hospital. Now managing her own enterprise, the also-council member of the Malaysian Community Pharmacy Guild (MCPG) spoke to MIMS Pharmacist about her experiences in the field to date.
What is it like working as a (private) compounding pharmacist? How directly involved are you with patients?
Compounding pharmacy is a service where you make medicine to order based on a prescription, dispensing directly to specific patients. I’m pretty well placed; my business model is in such a way that we’re close partners with a clinic. Our premises are side-by-side in the same building.
With this setting, when the patients come to the clinic, I get to meet and interact with them quite a lot. The doctor is always proud to introduce me. “This is the compounding pharmacist, she’s the one who compounds your medicines for you.” I’ll speak to them and get them to tell me whether the medicine is working or not, or they can ask me questions.
What patient demographics do you usually see?
It really does depend on which service you want to specialize in. The demography that comes to you will be based on that. It happens that [our pharmacy] specializes in hormone modulation, so the patients that come to us are those in need of hormones.
I would say that 50% of our patients are aged 40 and above; women who are coming for menopausal symptoms, and men who come for andropause symptoms as well. There are those in their 30s to 40s who come for fertility problems. And then you also have children who are having all sorts of hormonal issues.
Is there any special training required to become a compounding pharmacist?
There are two aspects to the business of compounding; the technical aspect, and the business aspect. I would say that the most important is the technical. We learn the techniques in our basic pharmacy degree, but somehow or other when we leave school, they sometimes get muddled with all the other clinical services emphasized on once we become provisionally registered pharmacists (PRP).
If there are any students out there interested in going into compounding pharmacy, please make sure you master your sterile preparation skills [during PRP]. Total parenteral nutrition services (TPN), cytotoxic drug reconstitution (CDR), aseptic preparations. Learn them inside and out. Not just the techniques, but the overall quality assurance (QA) systems of sterile preparation. Once you understand them, doing them for non-sterile preparations is a cinch.
In Malaysia, there is actually no legal requirement for extra training. As long as you are a fully registered pharmacist (FRP), you can become a compounding pharmacist. But if you want to set up your business with a certain standard of quality, you might want to enrol yourself in a [program] outside the country. I myself am trained and accredited in Australia.
Could you give examples of other compounding specialties?
Most of the pharmacies in Malaysia, to my knowledge, all focus on hormone modulation. Some of them might dabble in nutrition—meaning they will do vitamins, protein supplements as well.
In Australia you can find different specializations. For example, pain management, paediatric treatments, dental compounded products, aesthetic products… I know a compounding pharmacy whose business is for hair serum. [laughs] The Australians are also very much into their pets, so you also have those specialized in veterinary compounding.
What is it like working with the doctors who bring patients to you?
I happen to be lucky enough to be partnering with a doctor, so we hold training seminars for doctors on hormone modulation. [Our pharmacy] is a full-service compounding pharmacy, so we also offer lab testing outside the ones you usually get from your local lab. When the reports come, we offer clinical support in interpreting them.
I get queries from doctors almost every day. “Sarah, how is this? Sarah, how is that?” It’s a very nice symbiotic relationship. That’s why I love working in this line. Because the thing about community pharmacy—and I don’t mean it in any negative way at all—sometimes you feel like you are at loggerheads with the practitioners, whereas we should be able to work together synergistically for the benefit of the patient.
In terms of what sort of doctors usually come for our services, generally they are GPs. They are more open-minded, being not specialized in any field, and they are the ones who see their patients and know their ins and outs, their history. When something happens to the patient, all they want is an answer, a treatment that works.
Why did you go into this line?
Funny story. [laughs] I’m not sure whether I chose it per se, but I think—and I thank God for this—my career has been set in such a way that it prepared me for this line.
After I finished my PRP [in Putrajaya Hospital], my bosses simply told me “I think you can do total parenteral nutrition.” I was like “are you sure?” And they said “yes, I am. I think you can do it.” So I became number two in that department, making TPN for the paediatric patients in the NICU. It was a lot of fun but also had a lot of technical things to consider, because you’re giving to babies who basically have no immune system. Sometimes the room breaks down—and then what is your contingency plan?
About a year and a half after that, my boss told me “I think you can be in charge of cytotoxic drug reconstitution.” This is like my second year after PRP. [laughs] Again, “are you sure?” “Yes, I think you can do it.” “If you think I can, I’ll do it.”
I found the work was easier. Of course, you’re still compounding products for immunocompromised patients, but [CDR]’s a lot easier, not as much manipulation as TPN. The challenge that I faced was how to keep the environment aseptic. Because the room was just so often not working! It was continuously breaking down. There was a lot of back and forth going between me and the contractors and the Ministry of Health people involved.
Those experiences solidified my resolve to make compounded products of good quality. Because you can just imagine—I know I’m currently involved with non-sterile products, but just imagine if somehow these products get into the hands of an immunocompromised patient. If it got into the hands of your mother…
It came to a point where I was joining the Pharmaceutical Services Division’s headquarters in Petaling Jaya, and they made me in charge of clean room pharmacy for the whole country, government and private institutions alike. I got to authorize the plans for clean room pharmacies, inspect them, and issue approvals as to whether the rooms were up to quality or not.
It felt like I had come to the pinnacle of my career. But I knew if I stayed on in the government… once you are specialized in something, they will make you do that thing probably until retirement. And I simply couldn’t see myself doing this for the next 30 years.
So I decided one day, “let’s just see what other jobs I can do.” I was browsing on Jobstreet and I happened to chance upon an ad that said, “we’re looking for non-sterile compounding pharmacists.” And I’m like “yeah, well, I can do that.” [laughs] I went to an interview, met with the doctor, had a very good conversation, and the rest as they say is history.
Do you have any words for others interested in this line?
My message is that if you are interested in compounding pharmacy, I would say go for it. Just dispensing products might be taken over by technology somewhere along the line. I foresee the future of medicine is in personalized treatment, and personalized treatment will need personalized medicine. And that’s where we can use our skills to be able to compound medicine and make medicine from scratch, which is the basis of pharmacy.
So please, hone your skills. As a pharmacist, you must always have the patients in mind, and the medicines that we compound must be of efficacy and quality. So, go out there, do it, take the training that you need, anywhere in the world.