The
Pharmaceutical Journal Vol 266 No 7130 p52-55January 13, 2001
The
Pharmaceutical Journal Vol 266 No 7130 p52-55
January 13, 2001
From Professor P. S. J. Spencer, FRPharmS
SIR,—As the profession starts a new year, we should not be too surprised
that the Medicines Control Agency is recommending still more medicines for addition
to the general sale list, or that sooner rather than later a national newspaper
has accused community pharmacists of selling the “morning after pill” to under-age
girls (see p40).
What has given me most concern so far was a single sentence in Alan Cochrane’s
“Notebook” column in the Daily Telegraph of January 4. The columnist
needed to obtain a prescription medicine for his daughter, and the offending
phrase read, “With no pharmacies open within a 20-mile radius during the New
Year holiday . . .”. The paragraph closed with an account of how the medicine
was subsequently obtained. I looked at this sentence in three separate ways,
and each has given me much cause for concern.
First, the writer may have done a thorough trawl of his neighbourhood pharmacies
and found them all closed or he may live in a very isolated area where there
are very few pharmacies anyway, but he makes no mention of doctor dispensing.
If true as written, this sentence meant that an area of more than 1,200 square
miles was devoid of a community pharmaceutical service over the holiday period.
You do not believe it?
Second, the writer may have been simply badly informed. He tried a few pharmacies,
they were closed, and he jumped to conclusions. In actuality, several pharmacies
were open and would have been accessible to him, had he known. I remain concerned
because it appears the profession had failed properly to identify its available
services in such a way that any reasonable person could find the information.
Or, third, the writer’s statement may have been largely fabricated, the statement
about closed pharmacies a useful throwaway remark as an introduction to other
points he wanted to make in his column - but the remark is still of great concern,
because he has written what he roundly believes to be true, that pharmacies
are closed at holiday times.
Most importantly and perhaps why I raise these issues here is the newspaper’s
ability to influence national public opinion massively. The Daily Telegraph
is a widely respected broadsheet, not a sensationalist tabloid, which sells
over a million copies every day. It has perhaps a readership in excess of three
million - compare this to The Pharmaceutical Journal which reaches just
40,000 pharmacists each week. Much complimentary material has been written in
The Journal in recent months about the way in which the profession is
progressively and effectively widening its service roles, but the impression
of the profession to outsiders remains one of profound inaccessibility.
Newspaper headlines in recent days have been grabbed by the intention of a number
of secondary schools in the home counties to open only four days a week because
of a chronic shortage of teachers. Is there a parallel here for pharmacy? I
remain convinced that the newspaper column requires careful analysis, the truth
of the matter needs verification, and at the very least a letter from an Officer
of the Society to the newspaper, setting the record straight. Five hundred words
in the Daily Telegraph could be invaluable to the profession in its attempt
to widen its role.
Paul Spencer
Cardiff
From Mr T. J. Veal, MRPharmS
SIR,—I am neither an inveterate opponent of all that this Government
proposes nor a reactionary ultra-moral freak from the Victorian era. I voted
New Labour and am a product of the “swinging sixties”. However, the latest saga
of the “morning after pill” legislation appears to be yet another illustration
of this Government’s arrogant and contemptuous attitude towards Parliament and
the electorate. It seems to be a government with a totally inverted list of
priorities.
This initiative is seriously flawed even in its objective of reducing the number
of unwanted teenage pregnancies. It is yet another attempt to apply a quick
fix to deep-seated social and educational issues. Where is the “tough on the
causes of . . .” philosophy now, towards either crime or social problems? There
is much evidence to support the view that many “unwanted” pregnancies are due
neither to ignorance nor to accident. In most cases it seems the only escape
for thousands of young girls with social deprivation, no educational achievements
and uncaring parent(s) is simply to copy the behaviour of their role models
in families and communities. No, the customers for EHC will generally be women
who have had unprotected sex as a preference. The net result will not be a reduction
in teenage pregnancies but encouragement of further casual unprotected sex,
with consequent surges in sexually transmitted diseases.
I can foresee a situation where, because of their lifestyle, the same women
will return time after time. I have witnessed this with “patients” on National
Health Service prescriptions for EHC. So we have a potential medical time bomb
waiting to explode as steroids are sold without control to girls and women of
all ages. How, as a busy community pharmacist, can I check their medical history
or age? What is there to prevent an over-16 purchasing the drug for an under-age
girl? The Society’s guidelines on supply of EHC would be hilarious if they were
not intended as serious proposals! We are supposed to obtain information and
render advice and counselling in more than 20 areas in a totally private section
of the pharmacy to ensure complete confidentiality for clients who may be under-age
girls with parents who are regular customers of the pharmacy!
So who is the winner from this ill-thought-through initiative? The commercial
benefit to the pharmacist? Are we really prepared to compromise our professional
reputations for a before tax profit of £5? As usual, the drug companies
are the driving force in their quest for profit at any cost, aided and abetted
by petty civil servants at the Department of Health intent on making minuscule
savings from the transfer of costs from the NHS to the patient (sorry, customer!).
The move also frees doctors from any possible litigation. I wonder if our wise
leaders in Lambeth or the drug companies have thought that one through.
I have been invited (as have all other community pharmacists) to a seminar on
EHC. Apart from enjoying any role-play involving potentially pregnant women,
I intend to use the occasion locally to express my severe reservations on the
subject. Any pharmacists who share my concerns can contact me at my e-mail address,
tveal@schoolhouse32.fsnet.co.uk.
Trevor Veal
Barthomley,
Cheshire
From Dr M. E. Brown, MRPharmS
SIR,—I was disappointed to read that the Royal Pharmaceutical Society’s
informative journal, The Industrial Pharmacist, may no longer be published
for financial reasons. While I appreciate the importance of the commercial bottom
line, I wonder if the Council has thought through the message that it is sending
- that industrial practice is not an important branch of pharmacy. I suggest
that industrial pharmacy is important.
Pharmacists claim, fairly, to be the experts on medicines. The unique knowledge
that pharmacy as a profession possesses includes practical experience about
medicines in the community, hospital and industry. During an individual pharmacist’s
career, practice in all three branches is possible. Pharmacists are involved
through the complete chain including fundamental research, expert report writing,
manufacturing, prescribing, dispensing, counselling and postmarketing surveillance.
However, today there is so much emphasis on the clinical aspects of medicines
that manufacturing aspects seem almost sidelined. Clinical service is of real
value - but so is expertise in making medicines. Today’s message for future
pharmacist recruits seems to be that pharmacy is mainly clinical; there is little
emphasis on making medicines. One consequence is that recruits with primarily
clinical interests will be attracted whereas recruits with industrial interests
will not; industrial interest among pharmacists will wane further. Without a
body of industrial knowledge, applied by pharmacists in actual practice, pharmacists’
claim to be experts on medicines will be significantly weakened.
Further evidence of the disinterest of the Council in industrial pharmacy includes
the fact that the Society’s website omits a list detailing those pharmacists
eligible to be nominated as qualified persons (QPs), who are able legally to
certify the release of batches of medicine on to the market. Compare that omission
with the website of the Royal Society of Chemistry: it does include a list of
chemists eligible to be QPs. That comparison may suggest that chemists consider
the manufacture of medicines more important than do pharmacists.
Professions have jostled for market share of activities over history, as the
sociologist Abbott details.1 Such jostling is
unlikely to cease in this third millennium. It would be a pity if, in a generation,
pharmacists were not the experts in medicines because the practical reality
had become that so few pharmacists worked in industry (and so few pharmacists
dispensed extemporaneously) that pharmacists had forgotten how to make medicines.
I urge the Council to reconsider the longer-term implications of its decision.
Malcolm E. Brown
Beccles, Suffolk
From Ms P. Lyons
SIR,—It is difficult to know where to begin to comment on Stephen Smith’s
letter (PJ, December 16, 2000, p896)
to which you gave so much space. Words should not be distorted to try to make
a point. And if he is quoting Greek he should be accurate.
Smith has confused ethos with ethnos. Also he misuses “euthanasia”
because he does not seem to know it means neither more nor less than “a good
death”. To begin with he thinks it equates with physician-assisted suicide.
Then he states that “euthanasia is objectively wrong”. If that were remotely
true, no so-called pharmacist could dispense any opioid analgesic, because a
pain-free death is the least that could be understood as euthanasia in the mind
of the relevant clinician. Smith is typical of the many who think that the word
“euthanasia” is a verb. It is not. It is a noun, referring to a process.
I suggest that Smith in his role as a pharmacist knows no more about God or
His image than I do. If, under his other hat, he enjoys some irrational beliefs,
they should not influence his professional conduct. It is totally irrelevant,
not to say offensive, to quote Genesis. He then presumes to call himself a scientist.
Fortunately, however, he has the humility to use the word “if” in his paragraph
beginning, “Third, if all humans are created by one God”. So all the humans
who do not believe this are exempt from the rest of his personal opinions. And
again, there is happily an “if” for his fourth notion about doctrine.
“Whose life is it anyway?” - he should be asking “Whose death is it anyway?”.
Pamela Lyons
Luton, Bedfordshire
From Mrs N. Chapman
SIR,—The article “Travel vaccinations” (PJ, November 25, 2000,
p797) stated that Canada
is free of rabies. This is not the case. Rabies is a significant problem here
in Ontario, where the ministry of natural resources is responsible for control
of rabies in wild animals.
Also, I fail to see why only travellers who are visiting rabies high-risk countries
for longer than one month should be vaccinated. Would a rabid animal have scruples
about biting a visitor who was staying in the country for only a few days?
Norma Chapman
Ontario, Canada
From Ms C. Grout, MRPharmS
SIR,—I support Mr Tanna’s sentiments in asking members of the Royal Pharmaceutical
Society’s Council to set an example by undertaking continuing professional development
(PJ, December 9, 2000, p857).
However, it is important to note that this cannot be measured in hours. Simply
recording lectures or workshops attended is not sufficient, as it does not indicate
how an individual has developed in his or her practice. CPD is a process requiring
reflective practice to identify learning needs, to plan and undertake appropriate
activities to meet these needs, and to evaluate the impact. Outcomes are measured
in practice by how individuals have improved.
Council members must already be undertaking a good deal of CPD in order to carry
out their duties - for example, preparatory work, meeting skills, and project
work undertaken for the Council - but I wonder how many of them document this
development? I would suggest that their “role model” activity should be in documenting
the CPD process, as this is what we will inevitably be monitored by.
Claire Grout
CPD pharmacist,
Oxfordshire and Berkshire Hospitals
From Mr R. Dunkley, MRPharmS
SIR,—I noticed with interest the advertisement in The Pharmaceutical
Journal of December 9, 2000 (p867) for courses in information technology
provided by ePharmsolutions Ltd. Courses are a good idea - because IT can make
pharmacists more effective in their business and professional life. My first
reaction when reading the advertisement was to hope that the company was not
charging for these courses. The Microsoft Office modules that ePharmsolutions
is offering, ie, Word 97, Excel 97 and Outlook 97/98, are way out of date and
do not integrate at all well with the current Office 2000 manifestation (soon
to be replaced by Office 10). Word in the 97 release does not have the round
trip HTML capability of Word 2000. Outlook even in the 2000 version is still
“buggy”, but the 97/98 version does not integrate at all with Outlook 2000.
The evidence for all my pronouncements comes from an Office 2000 website I discovered
called “Woody’s Office Watch” (www.woodyswatch.com),
where there is a weekly mailing that gives impartial advice on Microsoft Office
products. Pharmacists might be saying, “Well I have got Office 97 installed
- I am going to go to these courses”, but what happens when their computer turns
up its legs and they have to upgrade? Office 2000 is standard now (just as Office
97 was) and they will not find it the same.
What I say to ePharmsolutions Ltd is: Great idea, training is everything and
all power to your elbow. But, please, offer Office 2000 instead of Office 97.
Bob Dunkley
Leeds
Ms BELINDA EKUBAN (director, ePharmSolutions Ltd) replies:
I appreciate the writer’s interest in the IT courses being offered by our company.
However, I would like to clarify some of the issues raised.
It is true that the most current Microsoft Office application is Office 2000,
but you would find that most pharmacy businesses are still using Office 97 and
have not found the need to upgrade to this newer version. For this reason we
found it inappropriate to offer training on a package that is hardly being used
by the target group - pharmacists. We have, however, made provision to highlight
the changes in the Office 2000 package for those who request this. I would also
like to stress that all new programs released by Microsoft are 100 per cent
backward compatible, and I disagree totally with the writer’s statement that
“Outlook 97/98 version does not integrate at all with Outlook 2000”.
The writer also suggests that we should not charge for these courses because
there is information available on the internet that can be downloaded for free.
We realise that there are various ways of acquiring knowledge: one example is
by self-tuition and another is by instruction. Individuals have their different
preferences and obviously these courses are being organised for those who prefer
to learn by instruction. We would expect those who prefer self-tuition to buy
relevant literature or download programs to educate themselves. Unfortunately
there are costs associated with running courses and for that reason there is
usually an associated fee, as I am sure you will find is the case with other
privately organised courses for professionals.
From Ms T. Cameron
SIR,—I am a pharmacy technician (MTO3) working for a local primary care
group with 10 years’ experience of hospital and community pharmacy. Having read
the item “Use of dispensing nurses in pharmacies proposed” (PJ, November
11, 2000, p706),
I felt I had to respond. I was disgusted at Dr David Cousins’s opinion that
technicians “could not be left unsupervised when dispensing” and that “nurses
should be able to provide the supervision for technicians”. I do not feel that
nurses have the experience required to supervise us in any way. I am fully aware
that they deal with drugs while on the wards but the majority of them do not
have the drug knowledge required. From my experience nurses and drugs do not
mix.
I am not disputing their intelligence and I am fully aware that they have a
role to play but they need to play it in the areas that they know most about.
I would not dream of going on to a ward and attempting nurses’ work or trying
to tell them what to do and neither would any of my colleagues.
We train for two years to become technicians (I trained for three years) and
in that time we study microbiology, pharmaceutics, chemistry, pharmacology and
law and ethics to name but a few subjects. We are not just in the dispensary
to put tablets into bottles. Without the technician force hospital pharmacies
would not function. We are professionals in our own right and, in my opinion,
no lower than nurses. Pharmacists should be encouraging the technician role
and giving the more experienced of us greater responsibility, not treating us
like we do not have a clue.
Tanya Cameron
Prescribing Support and Information Management & Technology Technician,
Gloucester and South Tewkesbury PCG
From Ms D. McIntyre
SIR,—I feel I must respond to Dr Claire Anderson’s reported comment that
“people are bored with No Smoking day” (PJ, December 9, 2000, p863).
The figures speak for themselves: over half a million smokers have a go at stopping
on No Smoking day and millions more respond positively to the day’s messages
about stopping. I applaud Boots stores for their efforts in supporting quitters,
and thank the thousands of Boots staff who support No Smoking day with in-store
events and promotions.
It does our joint efforts no good when professional colleagues undermine that
work with unjustified public remarks. I hope this is not a sign that Nottingham
university’s new tobacco industry benefactors are colouring their academic colleagues’
views.
Doreen McIntyre
No Smoking Day,
London EC1
From Mr D. L. Coleman, FRPharmS
SIR,—Congratulations on your leading article (PJ, January 6, p3)
calling for the 21st century to see the end of snipping of patient packs. All
power to your elbow!
The present situation remains absurd, often unlawful, confusing to the patient
and uneconomic for good measure.
It is unlawful because pharmacists are required to provide appropriate patient
leaflets and the regulations specify information required on the pack itself,
and this is not practical in a “snipping” situation. It is confusing to the
patient because, apart from missing leaflets, odd snipped tablets get lost,
get out of turn or get wasted.
Moreover, it can hardly help instill patients’ confidence in their medicines
(or their pharmacist) to receive cut off odds and ends.
Economically, anything which might reduce patient compliance is bad, anything
which deliberately fosters waste is crazy. A patient on multiple medication
would find it difficult to understand why, when switched perhaps from citalopram
to paroxetine or from nizatidine to omeprazole, they need an increase from 28
to 30 tablets a month. What to do with the two extra?
The last point would not be solved just by allowing the dispensing of patient
packs but before we progress further, medicine management for patients must
be addressed.
The Royal Pharmaceutical Society must continue to pursue this issue with all
vigour, not just as a practice sideline but as a fundamental issue of ethics
and patient safety. At the same time the Society must be clear what legal changes
are needed to enable emergency dispensing of patient packs (often meaning a
28-day supply) and to allow, in a practical way, for monitored dose system dispensing.m
David Coleman
North Walsham, Norfolk
From Mr A. O. Bond, FRPharmS
SIR,—Why does this year’s retention fee form invite members to donate
to the Royal Pharmaceutical Society’s charitable funds without giving them the
opportunity to sign a “Gift Aid” declaration? This could add nearly 27p in the
pound to such gifts.
Is the Society’s finances so good that it can afford to ignore this handout
from the tax man or is the Council’s corporate head so firmly in the sand that
it is still unaware of last April’s budget?
Andrew Bond
Glastonbury,
Somerset
Miss ANN LEWIS (Secretary and Registrar, Royal Pharmaceutical Society) replies:
The feasibility of this is being considered and is one of a number of improvements
for the collection of fees which we hope to introduce.
From Mr S. W. F. Holloway
SIR,—The President of the Royal Pharmaceutical Society is reported (PJ, December 16, 2000, p884) as saying that the first honorary member of the Society was elected in 1868. In fact, honorary membership is as old as the presidency. Both categories are found in the original “Laws and Constitution of the Pharmaceutical Society of Great Britain”, adopted by a general meeting on June 1, 1841. When the list of the founders of the Society was published in The Pharmaceutical Journal on January 1, 1842 (PJ, 1841/2, p359-86) there were already 23 honorary members of the Society.
Sydney Holloway
Leicester
From Mr S. Whitaker, MRPharmS
SIR,—Could the Secretary and Registrar please explain the process by which the editorial advisory board will be appointed prior to the appointment of the new editor of The Pharmaceutical Journal?
Simon Whitaker
Cardiff
Miss ANN LEWIS (Secretary and Registrar, Royal Pharmaceutical Society) replies:
The board will be appointed in consultation with the new editor.
From Professor P. J. Houghton, FRPharmS
SIR,—It is still important, if not necessary, for entrants to pharmacy
degree courses to have chemistry “A”-levels or their equivalent and the Royal
Pharmaceutical Society requires several aspects of pharmaceutical chemistry
to be taught for courses to be accredited for registration. I am, therefore,
intrigued by the almost total absence of chemical structures in The Pharmaceutical
Journal. Structures convey a lot of information about any drug discussed
so I find it strange that they are omitted, especially when reporting newly
licensed products.
A picture is worth a thousand words and good articles like the recent one on
isoflavones (PJ, January 6, p16)
would have been enhanced by a simple diagram showing the chemical similarities
between the isoflavone molecule and the naturally occurring female sex hormones,
eg, estradiol.
If pharmacists consider that such information is no longer necessary, it seems
that schools of pharmacy should reconsider their teaching of pharmaceutical
chemistry.
Peter J. Houghton
Professor of Pharmacognosy,
King’s College London
From Mr D. L. Rew, MRPharmS
SIR,—May I pose a question prompted by your item headed “Pharmacists
to reduce GP workload” (PJ, December 9, 2000, p845)?
Where are all the underemployed pharmacists standing around, hands in pockets,
anxious to take on these extra duties and thus reduce the burden borne by the
poor general practitioner?
Derek Rew
Exeter, Devon
From Mr D.Hughes, MRPharmS
SIR,—I see that the authorities have decided that pharmacists should
prescribe zamanovir (Relenza) via a patient group direction (PJ, November
25, 2000, p777). I am just
wondering when they think we will have the time to go through the triage and
counselling procedure while simultaneously checking and dispensing more than
200 prescriptions per day (doubled in winter), since the supply must be performed
personally by the pharmacist.
Have they forgotten that general medical practitioners do not have interruptions
because they have an appointment system with receptionists to answer telephone
inquiries, while pharmacists are expected to be available to the public at all
times? In addition, the number of prescriptions dispensed exceeds the number
written by the doctor because of repeats, and it takes longer to dispense a
prescription than it does to print it out or sign it.
My other concern is that Relenza is a new drug, so the possibility of adverse
effects cannot be ignored.
It seems that in inventing new roles for the pharmacist, they have forgotten
our main duty, which is to safeguard the patients’ interest. No doubt, they
will say that we must change our role to safeguard the profession, but I believe
that the reverse is true, because if we neglect our primary function, technicians
will replace us.
David Hughes
Hetton Le Hole,
Tyne and Wear