From Ms C. E. Heading, MRPharmS
SIR,—Reading the report of the British Pharmaceutical Conference of the
plenary session that addressed prescribing habits (PJ, October 7, p524),
alongside commentary in the national press on implications of the Human Rights
Act, reveals an issue that is underexplored.
In short, as fundholders struggle to control costs, what steps are being taken
to avoid gender bias in recommendations made by bodies such as primary care
groups or trusts and the National Institute for Clinical Excellence itself?
Without wishing to imply that any improper decisions have been made, it is clear
that bodies responsible for making recommendations, or restricting availability
of licensed products must be able to show an absence of gender bias. This may
seem an outrageous suggestion, but it should be remembered that, so far as individual
prescribers are concerned, it has been judged necessary to monitor the issue
and collect evidence.
Established research in this area tends to show that, where all things are equal,
there is little difference in prescribing patterns for male and female patients
by individual clinicians.1,2 Demonstration
of presence or absence of bias in recommendations and selections of products
available to prescribers, is a very different issue and needs to be monitored.
The type of scenario that needs to be examined can be illustrated with respect
to central nervous system disorders, where restrictions on prescribing interferons
for multiple sclerosis (prevalence about 2:1 women to men) have gained media
attention.
Moving to CNS disorders as a whole, products prescribed for the disorders are
the second most widely prescribed class of medicines. However, the net ingredient
cost per prescribed item is way below average, and third from bottom.3 In other
words the products prescribed are of low cost. The diagnosis prevalence of CNS
disorders collectively is significantly higher in women and, depending on how
it is measured, the ratio can be 2:1. Similarly, for musculoskeletal and joint
disorders, the prevalence and severity rates are high for women, but the cost
of products prescribed is below average.3 The Human Rights
Act 1998 forces the National Health Service to put patients before resources,
and availability of medicines may well be challenged sooner or later, on a gender
basis.
The purpose of this letter therefore, is not to make unsubstantiated allegations,
but is to alert those concerned of the need to be aware of potential gender
bias, and to collect evidence on which sound judgments can be made.
Christine E. Heading
President, National Association of Women Pharmacists,
Ruislip,
Middlesex
1. Sclar DA, Robinson LM, Skaer TL, Galin RS. What factors
influence prescribing of antidepressant pharmacotherapy? An assessment of national
office-based encounters. Int J Psychiatry Med 1998;284:407-19
2. Martinez M, Agusti A, Arnau JM, Vidal X, Laporte JR. Trends
of prescribing patterns for the secondary prevention of myocardial infarction
over a 13-year period. Eur J Clin Pharmacol 1998;543:203-8
3. Pharma facts and figures 2000. London: Association of
the British Pharmaceutical Industry; 2000