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Which? report
Have our colleagues been fairly judged?
From Ms M. A. King, MRPharmS
Does the involvement of three pharmacists in the development of the
Which? scenarios (PJ, 21 February, p214) automatically give validity
to them? Perhaps the profession should decide. To facilitate this, I
have used the first scenario as an example.In it, pharmacy staff were
expected to spot the potential interaction of St John’s wort with
the contraceptive pill.
Was the Which? survey1 measuring what it should have been measuring?
Stress and inability to sleep properly, the presenting symptoms of the
undercover agent, are more likely to be associated with anxiety disorders
than mild to moderate depression. Indeed feeling “down in the dumps” is
more likely to be associated with depression than these symptoms.2 The
indication for St John’s wort is mild to moderate depression.3 Can this scenario measure the appropriateness of pharmacists’ responses
when perhaps the most appropriate response was completely outside the
scenario outlined in Which?’s “What should happen” section?1
Were the measures used accurate measures of what they were supposed to
be measuring? The interaction with oral contraceptives can be found in
many places including the e-BNF and the Medicines and Healthcare products
Regulatory Agency website.4
Which? states “there’s no evidence that the herb’s
[sic] addictive but that, if it’s taken for a while, it should
be stopped gradually”.1 Is there “evidence” to support
this last statement? There is evidence for an opposing view: an article
in JAMA suggests that St John’s wort should be ceased five days
before surgery5 and makes no mention of gradual withdrawal.
Martindale lists fatigue as a side effect in third place after gastrointestinal
symptoms and allergic reactions but there is no sign of drowsiness in
the listed side effects. The Martindale entries on photosensitivity identify
isolated cases, while an article in the BMJ notes that although there
have been cases of phototoxicity in animals, the equivalent of 30 to
50 times the therapeutic dose was consumed.6 There was no evidence of
photosensitivity in several controlled trials.2 Although tiredness and
photosensitivity were mentioned in a PJ article on St John’s wort,7 should the pharmacists in the Which? study have been criticised for not
telling the undercover agent about drowsiness and photosensitivity? The
medical model states that common side effects, serious side effects and
side effects that the patient would want to know about should be included
in information given to patients.
Given these criteria have our colleagues been fairly judged?
Michelle King
Aberdeen
References
1. Can your pharmacist cope? Which? 2004;(February):10–13.
2. Kumar P, Clarke M. Clinical Medicine 5th ed, Edinburgh: WB Saunders;
2002.
3. Gaster B, Holroyd J. St John’s wort for depression: a systematic
review. Archives of Internal Medicine 2000;160:152–6.
4. Reminder: St John’s Wort (Hypericum perforatum) interactions.
Current Problems in Pharmacovigilance 2000;26:6–7 (PDF 60K)
5. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care.
JAMA 2001;286:208–16.
6. Linde K, Ramirez G, Mulrow, Pauls, Weinhammer W, Melchart D. St John’s
wort for depression: an overview and meta-analysis. BMJ 1996;313:253–8.
7. Barnes J. Herbal therapeutics: depression. The Pharmaceutical Journal 2002;268:
908–10. |
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