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Terry Maguire is a community pharmacist in Belfast
and formerly vice-chair and director of PharmacyHealthLink
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It was heresy, pure and simple. In medieval days I might have been cast
from the meeting and burnt at the stake with the good citizens of London
as witnesses, lest others were infected by such dangerous thoughts.
Debating — thankfully — is
less risky these days, but my disloyalty was no less contemptible when
I seconded the motion “This house believes that pharmacy cannot
provide a public health service in a commercial environment” and
did so with force and passion. At one point — when a woman in the
audience suggested I resign forthwith, given my extreme views — I
felt I had played the role of devil’s advocate too well and was
on the verge of losing my faith.
Staging a debate was an interesting and entertaining way for PharmacyHealthLink
to celebrate its 21st birthday when the big day arrived last month (PJ,
24 November 2007, p599). Given my passion for greater pharmacy involvement
in public health, to second the motion seemed irregular if not a complete
disregard for my views. When I protested I was told no one else would
do it so it had to be me. Suitably flattered, I accepted and, as a bonus — since
I was by far the “oldest” member of the committee (I think
they meant the longest serving) — I could also deliver a brief
verbal history of the organisation.
At first I found it difficult to make a case in support of the motion.
After all, I had a reputation to think of and people might fail to see
the fun side, suspect a Pauline conversion and exclude me from future
discussions. Now less enthusiastic, I set about writing my brief history;
more Monty Python (“Life of Brian”) than Simon Sharma (“The
History of Britain”).
The Pharmacy Healthcare Scheme (PHS), as it was known in the mid-1980s,
came into being after a successful sexual health campaign undertaken
by the Royal Pharmaceutical Society and the Family Planning Association
(FPA). The campaign involved sending 40 fact-laden leaflets and a shiny
display unit to the UK’s 13,500
pharmacies.
The campaign was less successful in Northern Ireland, where some pharmacists
were so incensed they threw their display unit and leaflets into the
bin upon receipt.
People in the rest of the UK mistakenly believe that the two communities
in Northern Ireland agree on nothing. This is untrue. There is generally
strong agreement that any discussion or promotion of things sexual — no
matter how well intentioned — can only be corrupting. Tempers flared
at a meeting of the Council of the Pharmaceutical Society of Northern
Ireland (PNSI) and, as the only one who stood up for the scheme and its
ideals, I was appointed as PNSI representative.
At this time the then directors of PharmacyHealthLink’s predecessor,
PHS, visited the cigar-smoking (later to become chairman of British American
Tobacco) minister of health, Kenneth Clarke. They were seeking £50,000
to put the scheme on a firm footing. They got £250,000 going up
to £350,000 over three years.
PHS had arrived and we produced about eight leaflet campaigns each year
in the early 1990s. By the late 1990s, after the change of government,
health education leaflets were out and a greater commitment to real public
health, particularly
reducing social inequalities, was in. PHS changed to Pharmacy-HealthLink
at this time, signifying a greater emphasis on supporting public health
and doing this through the UK pharmacy
network.
These were interesting times, and provided opportunities for the odd
blunder. For example, I was put in charge of a coronary heart disease
(CHD) leaflet campaign and published the wrong telephone number. Within
24 hours of the 44,000 CHD leaflets arriving in UK pharmacies an old
peoples’ home in Essex run by a normally meek religious order got
over 5,000 telephone calls seeking advice. During this crisis they were
far from meek.
Public health proved sometimes challenging. At one visit by the now defunct
Health Promotion Agency, we were told that because research in the US
had shown that mineral oils dissolved condoms and in view of the government
policy to ensure that condoms were recommended in safe sex, pharmacists
must tell everyone buying a bottle of baby oil that they must not use
it as a sexual lubricant. That was not really feasible where I worked
then, and even now.
There were also some dangers. Roger Odd, the scheme’s chairman,
visited Belfast and wanted to see a model counselling area I was building
on to my pharmacy. It was after closing time when we exited the building
into a rainy dark night. Agnes, a local street-living alcoholic, seeing
the lights greeted us by asking me for money. When I refused to cough
up she turned her attention to Roger, who misunderstood her and wished
her a “very good evening madam” in his usual polite manner.
Hearing an English accent on the Falls Road she could not control her
Irish nationalist yearnings and struck out at him wildly, flinging at
his person the wet fish supper someone had given her. He was quickly
ushered into my car and we sped off.
The history bit done, I got back to the difficult bit, my support of
the motion. Yet, as I thought about it, writing suddenly became easy.
I remembered the supermarket pharmacy chain in England that thought supply
of emergency hormonal contraception in an NHS scheme might upset its
blue-rinse customers, so it dropped the scheme, and this in a country
with the highest teenage pregnancy rate in Europe.
And I remembered some pharmacies in North Wales that decided that addicts
in need of a methadone substitute service might appear threatening to
their horsey headscarf and green wellington wearing patrons and, therefore,
withdrew the service.
Then I considered the products and commercial activities that can damage
public health: sugar-based confectionery, aggressive promotion and sales
of infant formula, low factor sun protection oils and creams, diet pills
without evidence of efficacy, and cheap sunglasses that potentially cause
eye damage. Profit, it seems, still dictates a lot of what we do.
Finally, I considered the uproar in the profession when the Medicines
and Healthcare products Regulatory Agency announced regulations that
would restrict supply of over-the-counter medicines containing pseudoephedrine
and ephedrine. The profession’s hard-fought two-year moratorium
on these products becoming prescription-only medicines will be won at
what cost if methylamphetamine addiction gets a grip in the UK, I thought.
Writing and delivering my short speech was a disarming and personally
threatening experience and, for a time, I felt that I was becoming too
convincing. But thankfully not that convincing.
Of course, we lost the debate that day, but my fellow proposer and I
did make a case that pharmacy must consider carefully the true meaning
of public health when considering its marketing mix. Moreover, if we
want to really play the public health game, in the future we may need
to make commercial choices in our pharmacies that will not be in the
short-term interests of owners and shareholders.
I did not lose my religion but for a short time my faith in pharmacy’s
ability to deliver on public health was challenged. |
The
Pharmaceutical Journal