The
Pharmaceutical Journal Vol 266 No 7131 p80-83January 20, 2001
The
Pharmaceutical Journal Vol 266 No 7131 p80-83
January 20, 2001
From Mr R. Blyth, FRPharmS
SIR,—I agree with all your recent correspondents complaining of the closure
of The Industrial Pharmacist. Industrial pharmacy may be a small branch
of the pharmaceutical profession, but its importance is in inverse proportion
to its size. The proposal to stop publishing the IP may have been made
by some person or persons ignorant or oblivious of the complexity of pharmacy.
Was it the same people who advertised for a non-pharmacist editor of The
Pharmaceutical Journal? The same people who, after the Royal Pharmaceutical
Society’s Council had vouchsafed editorial freedom, then usurped the editor’s
freedom to appoint his own editorial board?
Where was the Council when those decisions were taken? Were they each in turn
presented to the Council as un fait accompli?
As an outsider, I get the impression that the Council is failing in its duty
to monitor decisions made on its behalf. Rightly or wrongly, I place the blame
for that on the new methods of conducting Council business in the wake of the
Banks report of 1998.
The situation is alarming and it seems to me that the Council needs to think
the unthinkable, ditch the present system and return to the status quo ante
when we had procedures that may not have been perfect but which worked and certainly
avoided the kind of mistakes we have seen recently.
Let us not forget that the reason behind the closure of the IP (and,
I understand, possibly The Pharmacy Assistant and The Agricultural
and Veterinary Pharmacist also) is lack of finance.
Last August, the Society’s finances were described by Dr John Evans (a Privy
Council nominee member of our Council) as verging upon quite serious disarray.
Dr Evans was supported by a previous Treasurer of the Society (Dr Gordon Appelbe)
who said that the Council seemed hell-bent on doing things it could not afford
(PJ, August 12, 2000, pp227-8).
In a democratic Society, we should welcome the public spiritedness shown by
those two members of Council in rejecting the hush hush mentality and alerting
pharmacists to an unsatisfactory situation. Such financial disarray is perhaps
a further indictment of the present system.
Robert Blyth
Milton Keynes, Buckinghamshire
From Mr P. J. Bloor, MRPharmS
SIR,—It is now clear that the Royal Pharmaceutical Society no longer
has any interest in acknowledging or supporting its industrial members - apart
from collecting their annual subscriptions.
Failing any conciliatory moves from the Council, I wonder if it is now time
for our Industrial Pharmacists Group committee to start looking for a more receptive,
analogous professional body to join or become associated with?
Phil Bloor
Sherborne, Dorset
From Mr A. G. M. Madge, FRPharmS
SIR,—Anthony Cox’s virile and robust letter (PJ, January 6, p14) quite rightly draws attention to the financial problems of the Royal Pharmaceutical Society. However, our forebears, when founding the Society, were alive to such an eventuality and created the position of Honorary Auditors to safeguard the members of the Society. They have has been actively engaged over the years and are a valuable asset. It must be remembered that Honorary Auditors are democratically elected by the membership and thus, figuratively speaking, every member has “a toe in the door” at Lambeth. I can assure Mr Cox that, with the other Honorary Auditors, I am very conscious of our responsibilities and I trust he will support the continuation of this important office.
Mervyn Madge
Plymouth, Devon
From Mr J. A. Tweed, MRPharmS
SIR,—I wish to add my protest about the curtailment of The Industrial Pharmacist. I hope many others will register their concern. Apathy serves for him who waits.
Jack Tweed
Nottingham
From Dr W. E. Lindup, MRPharmS
SIR,—I should like to add my support to the plea by Professor Houghton
(PJ, January 13, p55)
that The Pharmaceutical Journal should include chemical structures. Inclusion
of the structure is particularly important for a new drug but structures can
also enhance all the other articles where structure-activity or structure-toxicity
relationships have been established.
The growing number of reports of toxicity and drug-drug interactions with herbal
medicines highlights the fact that we ignore the chemical composition of a medicine
at our peril. Structure drawing programs are now much easier to use and are
even free off the internet, eg, www.dli.co.uk/cgi/dynamic/
welcome. html, where ISIS Draw is available.
Edward Lindup
Senior Lecturer,
Department of Pharmacology and Therapeutics,
University of Liverpool
From Mr I. C. Strachan, MRPharmS
SIR,—Like most pharmacists, I have been a passive observer of the debate
to support or condemn the possibility of a non-pharmacist editor of The Pharmaceutical
Journal. My view is clear. The most important criterion for selection of
applicants must be an ability to enhance the aspirations and interests of the
profession. This will demand qualities of imagination, courage and ability to
articulate their views in a persuasive manner.
If such credentials are best served through a non-pharmacist editor then so
be it. The Royal Pharmaceutical Society was absolutely correct not to exclude
applications from non-pharmacy candidates. It is their potential to contribute
fully to the advancement of our profession that matters.
Over the years I have heard some fairly inspirational non-pharmacists extol
the virtues of our members and I believe the only question should be to ensure
that the right candidate is selected.
Ian Strachan
Bury, Lancashire
From Dr C. Anderson, MRPharmS
SIR,—I feel that my reported remarks about No Smoking Day (PJ,
December 9, 2000, p850)
have been taken out of the context of my complete talk at the Pro-Change launch.
I was discussing the fact that most non-smoking interventions are aimed at people
in action (ie, ready to quit) and that many people are actually not ready to
quit and need other messages. I never meant to deride No Smoking Day and I am
an avid supporter of most, if not all, anti-smoking initiatives.
I was insulted that Doreen McIntyre (PJ, January 13, p54),
a fellow health professional in the smoking cessation lobby, would seek to associate
me with Nottingham university’s business school, which has accepted money from
BAT. The pharmacy school has already stated that it deeply regrets the vice-chancellor’s
decision to accept the money and stated that the funding will not be associated
with and will be geographically remote from all health-related activities in
the university.
Claire Anderson
Director of Pharmacy Practice and Social Pharmacy,
Pharmacy School,
University of Nottingham
From Dr L. Goodyer, MRPharmS
SIR,—I would like to thank Norma Chapman (PJ, January 13, p53)
for pointing out that rabies is indeed present in Canada, contrary to the statement
that I had made in error in my article covering travel vaccinations (PJ,
November 25, 2000, p797).
This was particularly bought home to me by the recent death of a nine-year-old
boy bitten by a bat carrying the disease, which was the first human case in
Canada since 1985.
In answer to the question concerning why in particular those travelling to high
risk areas for longer than a month should consider vaccination, it is simply
a case of the longer one is in the area, the greater the chance of encountering
a bite from a rabid animal. The same argument is given to the advice regarding
hepatitis B, ie, the longer a traveller is away the more chance that at some
point hospital treatment will be required. Also, rabies in travellers is a very
rare evident, being headline news when it does occur. This must also be viewed
in the light of local conditions. For instance, if one is travelling to a more
remote area with a known problem concerning infected stray dogs and a poor supply
of treatment, it may be advisable to have the vaccine even if one is away for
a relatively short period.
Larry Goodyer
Department of Pharmacy,
King’s College London
From Mr M. E. Allen, MRPharmS
SIR,—I refer to the article on travel vaccinations (PJ, November
25, 2000, p792). Something
I have always found useful for traveller information is the fax-back service
provided by the Hospital for Tropical Diseases. This provides recommendations
for vaccination and other means to stay free from disease. What is particularly
attractive about the service is that advice about several countries can be combined
in a single, personalised and brief format. It is my opinion that travel agents
should be legally obliged to provide such information before taking a booking,
but it seems unlikely this will be so. The pharmacist, therefore, might take
the opportunity to advise customers before they become patients.
The system provides a fax-back within minutes of a request. This has the advantage
that the traveller then has written details and is less likely to neglect the
precautions.
Pharmacists wishing to access this service should telephone 0839 33 77 33
and follow instructions to obtain the list of countries covered. Another number
is then called and the country code(s) keyed in in the order they are to be
visited, to obtain information tailored for the specific tour.
The cost of the service is covered by use of premium-rate telephone lines. I
strongly recommend that pharmacists promote and benefit from this very useful
service.
Michael Allen
London SW15
From Mr B. I. Stroh, MRPharmS
SIR,—I have been a regular user of metered dose inhalers (MDIs) for many years and I have found that I can achieve much better total co-ordination in their use when I use the inhaler with two hands:
Because this action is much smoother and less jerky than when using only one
hand, the total co-ordination needed to trigger the aerosol just after the inspiration
has begun becomes easier and more controlled.
I should like to suggest to manufacturers that they add a small ridged flange
on each side of the base of the plastic casing to afford the thumb tips a larger
and better grip.
Brian Stroh
London NW11
From Ms M. Bi, MRPharmS
SIR,—I am writing in reference to the deregulation of Levonelle-2. Although
I appreciate the Royal Pharmaceutical Society wanting to extend the pharmacist’s
role, I do not think this is the right way of doing it.
I can understand there is a need for such a product in certain circumstances
but that need is being adequately met under present legislation. The objective
behind this deregulation and, therefore, making the product more readily available
is, I think, to reduce teenage pregnancies and unwanted pregnancies. I cannot
understand how the first of these objectives is going to be met if the product
is going to cost £19.99. Where are teenagers going to get this sort of
money? And if they are sick within the first three hours of taking the product
they will have to pay another £19.99 for a second supply.
Then there is the question of age: what proof will we need to see to validate
the client’s age and who will be held liable if a woman comes in who is pregnant
and overdue and wants to do a do-it-yourself abortion job at home with unknown
consequences?
Teenage pregnancies should be tackled through education of the whole family
starting from parents who should be taught to instill good morals in their children.
This should be continued through the school life of the child where these teachings
should be complemented with sensible and appropriate sex education, which should
put the onus on family life and marriage.
The most serious concern I have with the announcement that Levonelle-2 was to
be deregulated was that it was made to the public before the profession was
made aware of it. Also, it gave the public the view that it would be available
from all pharmacies, which I do not think will be the case if pharmacists object
to selling the product on religious or moral grounds. Pharmacists have not been
consulted about whether they would like to see this deregulation and it would
have made a lot more sense to have a vote for it by those pharmacists who are
going to be in the front line of the supply chain.
I will be unable to sell this product from my pharmacy for all the reasons above
and because it does not have a designated consulting area/room. Making this
product available under patient group directions would be the best route of
supply, since there would be designated pharmacies for this purpose.
Masrat Bi
Birmingham
From Mr B. P. Patel, MRPharms, and Mr A. Kohli, MRPharmS
SIR,—It appears that yet again the Royal Pharmaceutical Society has failed
us as a profession. Though the news that emergency hormonal contraception is
to become available from pharmacies is to be welcomed, it is regrettable that
the Society has allowed it to be deregulated to a P classification.
If this was to be the first step towards expanding the pharmacist’s role and
to show the full potential of the knowledge and experience we have, we have
failed already. It does not allow us to supply to all persons requiring it,
especially to those under 16 years of age and to those who cannot afford £20.
We have not been entrusted to supply the service via the National Health Service
and consequentially the NHS decreases its workload at the expense of ours with
little remuneration. People may argue that the high sale mark-up of the drug
will be sufficient remuneration, but with the current battle against resale
price maintenance how long will this last? Also, such an arrangement will be
looked upon as a money-making scheme by pharmacists and will again put a black
mark against the profession’s intentions. Health providers or money-makers?
It amazes us that over the past year The Journal has reported the successes
of pilot schemes for supply of emergency hormonal contraception under patient
group directions on several occasions yet the Society has not pushed for such
contracts to be put forward nation-wide. These schemes ensured the safe and
appropriate use of EHC and created links with other health care professionals.
Reclassification of Levonelle-2 will not provide for this and since the sale
of P medicines does not occur in the manner suggested as correct in the “Medicines,
ethics and practice” guide, is such supply appropriate? We are sure that we
are not the only locums who have worked in pharmacies and have been appalled
and ashamed at the emphasis placed on the use of medicine supply protocols.
This is another opportunity that we have lost to prove our ability and to show
what a difference we can make to the NHS and the health of the nation. We have
no one to blame but ourselves. It is high time that we pulled together and made
changes happen.
Brijesh Patel
Kingston upon Thames, Surrey
Ashish Kohli
Sutton, Surrey
From Mr J. R. S. Tait, MRPharmS
SIR,—I endorse the convictions of Trevor Veal (PJ, January 13,
p52). The media have reported that the “morning-after pill” is being distributed
free-of-charge at school to girls from the age of 11, without parental consent
and without even the knowledge of the family doctor. Perhaps the next phase
in this inexorable, insidious index of desperation will be the soaking of sweets
with sex hormones! Pumping high-dose progestogen into young girls is essentially
another form of drug abuse.
For over 30 years our society has been in sexual, moral free-fall with the authorities
vainly beating the “education, education” drum while pelting pubescence with
all the mechanical, chemical and rubber contraceptive aids. The provision of
emergency hormonal contraception is in reality a confession of failure and a
short-term, pragmatic response to long-term escalating problems, such as HIV
and sexually transmitted infections, which must be addressed by every sensible
means.
Lack of access to contraception services is not the cause of teenage pregnancy.
Rather, chilling government statistics reveal that the source of the problem
is the fractured family, especially the fatherless, where there is lack of love,
attention and support for children. The Daily Telegraph reported on January
13 that girls deliberately become pregnant when their fathers vanish.
The shattered nuclear family is the main cause of illegitimate pregnancies,
behavioural problems in children, pandemic drug addiction, high school drop-outs,
young criminals, the poverty trap, homelessness, soaring crime and escalating
divorce.
Surveys confirm what all sensible people in this country know: that marriage
is by far the best way to bring up children and is at the heart of a healthy
society, and that a stable family environment is an integral pillar of our civilisation.
The heart of the matter is a matter of the heart, that is, sexual privilege
within the responsibility, security and stability of a loving long-term relationship,
namely, marriage.
EHC encourages sexual promiscuity, reinforces our depraved sexual culture and
further erodes the sanctity of marriage.
In its yearning to be recognised as part of primary health care, our Royal Pharmaceutical
Society has led us into a medical, social and moral quagmire.
John Tait
Swindon, Wiltshire
From Mr D. J. Fallon, MRPharmS
SIR,—I wish to object strongly to the leaflet insert “Medicine matters,
issue 13”, which was distributed with a recent Pharmaceutical Journal.
From the very first paragraph it is a form of brainwashing designed to make
emergency hormonal contraception, using Levonelle-2, an acceptable option. Paragraph
one states: “Since the dawn of civilisation, women and couples have resorted
to emergency contraception to avoid accidental pregnancy following unprotected
intercourse or contraceptive mishaps.” This is blatant hogwash. The truth behind
the current situation is portrayed by the cover photograph of The Journal
of December 16, 2000, which shows a pack of Levonelle-2 being exchanged for
£20. It really is a symbolic change. Relating to the “dawn of civilisation”,
there is ancient documentary evidence which indicates a similar transaction
taking place for 30 pieces of silver.
I shall not be supplying emergency hormonal contraception since I believe that
in the long run these powerful hormones can prove psychologically and physically
damaging. I am not prepared to quiz people (who may well be lying) on their
sexual history. Doctors should take full responsibility for the welfare of their
patients. I would never rest if even one of my sales resulted in a paralysing
brain stem blood clot.
Dennis J. Fallon
Birmingham
From Mr N. J. G. Stow, FRPharmS
SIR,—Your item “Lloyds refurbishes heritage branch” (PJ, November
11, 2000, p713) gives
the inaccurate impression that the good luck stone was recently discovered.
In fact this happened in the late 1950s. I know because I was there!
Some years ago I prepared a small booklet on the history of the pharmacy in
which I wrote: “Renovation began in 1957. The beams, which over the years had
become covered in paint or plaster, were exposed, thoroughly cleaned and treated
with a powerful in-house formulation of ammonia and peroxide to restore them
to their present natural colour. “
Apart from dealing with very minor areas of damage they have been left untouched
ever since. . . . “
During the renovation a good luck stone was found buried face down at the entrance
to the shop - superstition has it as long as the stone remained good fortune
would favour the occupants. The stone is now mounted on the wall of the ground
floor and can be seen just below the clock.”
Noel Stow
Bury St Edmunds, Suffolk
From Mr K. D. Ball, MRPharmS
SIR,—I was pleased to read the article by Clare Bellingham concerning
“Current issues in influenza’’ (PJ, January 13, p57).
In her article the use of amantadine in West Cumbria Health Care NHS trust was
mentioned. Your readers might like to know a little more about that and, if
they wish, they can contact me at the e-mail address and I will provide full
details.
In brief, myself and the director of nursing services took the view that we
needed to take some action as part of winter and millennium planning given that
our influenza vaccine uptake was around 3 per cent (not much better this year
at 16 per cent). We made five-day courses of amantadine available through the
accident and emergency department and the admissions ward and of the 74 courses
issued there was an 82 per cent success rate. The most interesting factor was
that of those who were successfully treated, most had no absence. We estimate
that we saved between 195 and 320 days’ sickness comparing the absences for
colds and other similar infections during that period. The decision to use amantadine
was taken on evidence in the literature and a pragmatic approach to winter planning.
We have treated three staff successfully so far this year and I would urge both
pharmacy and general managers to consider the use of amantadine as part of front
line planning during the ’flu season.
Ken Ball
West Cumberland Hospital, Whitehaven, Cumbria
(e-mail ball.ken@virgin.net)
From Mr J. L. Turner, MRPharmS
SIR,—As someone who first worked as a pharmacist for Burroughs in Dartford,
then Burroughs Wellcome & Co, later the Wellcome Foundation Ltd, and left all
of them long ago, I am saddened to see (PJ, January 13, p46)
that the letters “gsk” on what appears to be an egg yolk is all that is left
of the once proud, world-recognised blue unicorn.
The test will come in 30 years’ time: will anyone then write to your successor
lamenting the passing of an initialled blob? I doubt it.
John Turner
Hartley Wintney, Hampshire
From Mr D. M. Lee, MRPharmS
SIR,—May I echo your call for the Royal Pharmaceutical Society to regulate
internet pharmacies and not resist them (PJ, January 6, p3).
Pharmacy2u, the UK’s first online pharmacy, has sought to work with the Society
to set the standard for this new form of pharmacy practice. Indeed, the Society
endorsed Pharmacy2u working practices last February (PJ, February 26,
2000, p316). Since then,
we have worked with the leading doctor, patient, industry, and governmental
stakeholders to draw up a benchmark for online pharmacies. The benchmark is
similar to the recent New Zealand accreditation procedure (PJ, January
6, p3) and has received
widespread support.
The recently published Health and Social Care Bill offers the opportunity to
debate fully this draft benchmark. It builds on the Department of Health’s September,
2000, “Pharmacy in the future - implementing the NHS plan” strategy which states:
“The Government’s view is that, if proper safeguards and professional standards
are in place, there is no reason in principle why medicines should not be sold
or dispensed electronically.” We look forward to working with the Society and
the Department of Health to ensure patients are not offered incorrect medicines
or pharmacy advice from unregulated websites.
Daniel Lee
Managing Director and Superintendent Pharmacist,
Pharmacy2u