By Tengku Nurfarhana Nadirah Tengku Hamzah and Rumana Saifi
Many Malaysians worry about the safety of the medicines they receive in public hospitals. Many patients and their families continue to believe that prescribed medicines may harm the kidneys, weaken the body, or cause more side effects than traditional remedies. These fears often originate from family stories, cultural practices, and unverified claims on social media platforms.
The consequence of these perceptions is significant: patients may skip doses, stop treatment halfway, or refuse to start treatment at all. The Malaysia Medication Adherence Assessment Tool (MyMAAT), developed in 2017 by local researchers, found that negative beliefs and lack of trust are among the strongest reasons why patients do not follow their prescribed treatments.
This issue reflects a wider global trend in which mistrust towards modern medicine contributes to poor adherence. The central question therefore remains: are the fears justified, or are medicines in public hospitals safe for everyone? How do we know that medicines in public hospitals are safe? The truth is, every medicine goes through many layers of testing and monitoring before it ever reaches patients, and strict systems are in place in Malaysia to protect the public.
Testing and approval of medicines
Before any medicine reaches the shelves of a hospital pharmacy, it goes through a long and highly regulated process. The National Pharmaceutical Regulatory Agency (NPRA) evaluates every new medicine before approval, assessing its safety, effectiveness, and quality. Even after approval, NPRA continues to monitor medicines for side effects once they are in real-world use.
The journey from the laboratory to the patient can take many years, and only a fraction of compounds investigated ever make it into clinical use. It begins with laboratory and animal testing that explore how a drug behaves and whether it causes harm. Although this stage raises ethical questions, it is required internationally to protect humans.
In order to address the ethical concerns, researchers follow the “Three Rs”: replace animal use where possible, reduce the number of animals needed, and refine methods to limit suffering. Only after a drug shows acceptable safety it can move into human clinical trials.
Clinical trials, which are a crucial part of the medicine approval process, unfold in four distinct phases. Phase 1 trials are conducted with small groups of healthy volunteers to determine initial safety, identify side effects, and establish the appropriate dosage range. Following this,
Phase 2 involves patients with the specific condition targeted by the medicine, aiming to test its effectiveness and further assess its safety. The third phase, Phase 3, consists of large trials with hundreds or even thousands of participants, where the new treatment is compared to existing standards of care; the results from this phase are critical for obtaining regulatory approval.
Finally, Phase 4 involves post-marketing surveillance once the medicine is already in hospitals, allowing for the monitoring of rare or long-term side effects. obtaining regulatory approval.
By the time a drug is approved and prescribed in public hospitals, it has passed through years of rigorous evaluation designed to minimise risks and maximise benefits.
Safety safeguards in Malaysia
Malaysia has built a robust framework for ensuring medicine safety within its public hospitals. Clinical Investigation Centres (CICs), located in major hospitals, play a central role in conducting clinical trials and ensuring medicines meet international standards. These centres ensure that all clinical trials are carried out under strict ethical and scientific guidelines.
Before a trial can begin, CICs secure approval from independent ethics committees and ensure that participants provide informed consent after being fully briefed about potential benefits and risks. CICs also have robust systems for reporting any adverse effects promptly, which helps protect participants during experimental treatments and contributes to global safety data.
Malaysia adheres to Good Clinical Practice (GCP), a globally recognized set of ethical and scientific standards. Compliance with GCP ensures that patients are not exposed to unnecessary risks and that the data generated from clinical trials are reliable, transparent, and internationally valid. Regular audits and inspections ensure that all CICs maintain these standards without compromise.
Every clinical trial protocol is thoroughly reviewed by independent ethics committees before it is approved. These committees, consisting of medical experts, ethicists, and lay representatives, scrutinize the study design to confirm that patient rights, dignity, and safety are prioritized. This safeguard minimizes the risk of exploitation and ensures that research aligns with both national regulations and international ethical expectations.
The National Pharmaceutical Regulatory Agency (NPRA) plays a vital role beyond approving medicines for use. This oversight ensures that medicines in public hospitals remain safe and effective throughout their lifecycle.
Within hospitals, doctors and pharmacists act as the frontline protectors of medicine safety. They do more than dispense drugs—they tailor prescriptions to each patient by considering individual factors such as age, body weight, existing medical conditions, and potential drug interactions. Pharmacists also play a critical role in counselling patients, explaining how medicines should be taken, and monitoring for side effects. This patient-centred approach helps reduce errors, prevent harmful interactions, and build trust in the healthcare system.
In addition, Malaysia’s hospitals increasingly use electronic medical records and digital prescribing systems, which help reduce human error and flag potential drug interactions before medicines are dispensed. These technological safeguards complement the vigilance of healthcare professionals and create an added layer of safety.
The evidence from Malaysia’s regulatory and clinical systems clearly shows that medicines in public hospitals are safe. They are the product of decades of research, layers of testing, and continuous oversight by regulatory authorities.
While side effects can occur with any medicine, the monitoring systems in place ensure that risks are minimised and managed appropriately. At the same time, trust and fairness are equally critical. Patients who believe in the safety of their treatment are more likely to follow it consistently, leading to better health outcomes. Public hospitals are not a ‘second tier’ option; rather, they are at the frontline of ensuring medicines are used safely, responsibly, and equitably.
So, are medicines in public hospitals safe for everyone? The evidence says yes. From laboratories to hospital pharmacies, and from ethics committees to regulators, many checks are in place. Of course, no system is flawless, and safety is not only about science but also about fairness, trust, and responsibility.
Public hospitals are not second best. They are at the frontline of ensuring medicines remain safe, effective, and used responsibly, protecting patients through science and ethical care.
Dr Tengku Nurfarhana Nadirah Tengku Hamzah is a Lecturer at the Faculty of Dentistry, Universiti Malaya and a Postgraduate student in the MOHRE programme and can be reached at tengkunurfarhana@um.edu.my. Dr Rumana Saifi is a Senior lecturer at the Faculty of Medicine, Universiti Malaya