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Letters to the Editor
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Packaging
Patients and pharmacy staff being put at risk
From Dr C. Green, MRPharmS
I am disappointed by the reply to my previous letter from Bruce
Charlesworth (PJ, 1 April, p383). It is as patronising as it is predictable and I
doubt that there are many of my colleagues who will have failed to note
this. As a health care professional, never mind a pharmacist, I find
the suggestion that I am trivialising or dismissing the importance of
counterfeit medicines as offensive as it is inaccurate.
Dr Charlesworth likens my letter to one
published on 3 December 2005 (p686). This letter refers to the number of methotrexate tablets supplied
to patients and does not mention the appearance of packaging. The only
similarity between the two letters is the dismissive and patronising
reply from the manufacturer. Although medicines are not the same as average
consumer products, and I thank Dr Charlesworth for alerting me to that,
Walkers Crisps are a classic example of retaining a strong brand image,
while differentiating between products. However, its handling of salt
and vinegar, and cheese and onion crisps does teach us a salutary lesson
about colour coding. Pfizer is subject to the same packaging restrictions
as every other pharmaceutical company so if some manufacturers can address
these issues, why cannot all of them? Dr Charlesworth suggests it is
important to have packaging recognisable as a Pfizer product — fine,
but please, can we have it with some noticeable differences between products?
I can tell him of one patient who was prescribed amlodipine 12mg daily
due to a doctor becoming confused by the similar packaging of amlodipine
10mg and doxazosin 2mg. Because this was a rather obvious error, it was
spotted and dealt with. Had the patient been taking another Pfizer product
with a dose in multiples of 10mg, the patient might have been the subject
of a serious prescribing or medication error. Another patient was the
subject of a dispensing error, where 150mg of fluconazole was dispensed
instead of 50mg, largely because these products, with near identical
packaging, were next to each other on the shelf. I am certain that pharmacists
across Britain and, thanks to the “global brand essence”,
pharmacists all over the world can recount similar stories. As a result
of this and similar incidents, there is a trend to rearrange storage
of a number of manufacturers’ products because it is not safe to
store them in traditional order.
Dr Charlesworth describes Pfizer as an ethical company. I would ask him
how ethical it is knowingly to expose patients to these risks, day after
day, in country after country for the sake of a blue and white global
brand essence. And if that branding is not about encouraging and promoting
the use of Pfizer products and therefore profits, what is it about?
We often see letters and reports in The Pharmaceutical Journal lauding
the role of pharmacists as the custodians of the nation’s medicines,
and as the protectors of patients against the harmful effects of medicines.
It saddens me that we have known about the effects of poor packaging
for well over a decade but, as a profession, we have never stood up and
been counted when it comes to doing something about it to the point of
effecting change. I urge my fellow pharmacists to register and join the
debate at the National Patient Safety Agency website at www.saferhealthcare.org.uk and make their feelings known about packaging that puts patients’ health,
patients’ lives and, potentially, the reputation and livelihood
of pharmacy staff at risk.
Chris Green
Director of Pharmacy and Medicines Management
Countess of Chester NHS Foundation Trust
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The
Pharmaceutical Journal