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Noel Baumber is a pharmacist from Grantham, Lincolnshire
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The Broad spectrum feature is
open to any reader.
Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor,
or e-mailed to graeme.smith@pharmj.org.uk for
consideration |
It is not just the Royal Pharmaceutical Society whose existence
is causing consternation. Current consultations, plans and wish lists
for pharmacy’s future, I contend, are all based on the wrong strategy.
The
real problem is that we are still building an infrastructure for the “oil
age” and not for what comes after.
It was significant that talk of global recession shot through the stock
exchanges of the world as economic growth faltered and the Dow Jones
industrial average dropped 10 per cent in the first two weeks of January.
The US Federal Reserve System’s response was to try to stimulate
the US economy and put $150bn in the hands of people who would spend
it, namely, the poor.
Primary concerns in the US economy have centred on the record national
debt of $59.1 trillion, which amounts to $516,348 per US household (on
top of $112,043 personal debt). To discharge it, each householder would
have to pay $31,000 per year for 75 years. This illustrates why a high
gross domestic product and sustainable growth are important.
It seems that we have all forgotten that energy underpins our standard
of living. The bad news is that we know sustainable growth is impossible.
By the end of December 2007 we had used just over half of the world’s
2.013 trillion barrels of oil. We are now on the down slope of the Bell
curve and supply is diminishing by 5 per cent per annum. Oil wells run
dry over 10 to 15 years and eventually oil becomes either too expensive
to extract, or is left as a strategic reserve.
In his book ‘Oil apocalypse’, Vernon Coleman predicts that
the effects signalling the end of the oil age will be felt when oil becomes
scarce and prices start an inexorable rise in 2012, only four years from
now. Politicians appear to be ignoring the issue, but our whole way of
life depends upon oil.
Coal is not an alternative, as David Strahan points
out in New Scientist (“Coal: bleak outlook for the black
stuff”,
19 January 2008). Oil powers our lighting, heating, communications and
transport. It provides us with the basic building blocks for plastics,
pharmaceuticals and for industrial processes.
How can we redirect resources to build the kind of pharmaceutical infrastructure
that will help to sustain our world at a far lower standard of living?
The global race for economic growth is at odds with the need to slow
down and make the best use of the oil that remains. All governments need
to plan to reduce consumption since that buys us time.
Pharmacy’s institutions, including academia and the pharmaceutical
industry, need to research what can be done. We need sustainable technologies,
minimal bureaucracy, and to jettison everything that will not work in
a darkened world. The projected professional body for pharmacy will have
work to do that it did not anticipate, but it should also be structured
to take that responsibility on board and deliver rapid results.
We have to start questioning what constitutes a sustainable way of life.
Cost benefit analyses will have to take into account the energy consumption
of alternative proposals. For instance, is more energy consumed in the
envisaged “paperless” electronic prescription service than
in the life of the FP10’s traditional paper chain? As electricity
becomes more expensive and power supplies become interrupted and intermittent
should we abandon the idea of the N3 distribution of prescription information
for the sake of reliability?
What is the power consumption of a pharmacy? Are there optimal sizes
of pharmacy?
Diesel oil is a significant part of the consumer pound, so distance is
a new factor in the chain of manufacture and supply that already engages
supermarkets in cost comparisons and may put an end to out-of-season
fruit. This will surely affect the frequency of wholesale services. It
could also impact on home deliveries, although a pharmacy van can save
100 to 200 patients’ car journeys per day reducing congestion and
pollution.
For access we shall certainly need relatively local pharmacies
and medical facilities, not just a smattering of centralised hospitals.
Trams and trains can run on electricity, but not if the infrastructure
is missing, and that would be a priority for commuters, managers and
locums.
Can the NHS retrench and remain affordable, or will rising energy costs
finally put an end to the presumption that treatment will be free at
the point of need? The state may remain the only provider of the means
to larger facilities through taxation, but later on there may come a
point where barter and the exchange of services takes over from a collapsing
currency.
This will be an impossible situation for corporate pharmacy
saddled with the failure of globalisation to make the transition back
to a village economy. Values will change.
What will people need and how can we adjust to help them? Pharmacies
have the advantage that they are part funded by income from sales of
over-the-counter medicines. They may be called on to maximise that income
and rely less on NHS funding and learn how to charge. Doctors may once
again have to re-examine their role and earn their living in private
practice the way that veterinary surgeons and dentists do.
Investigation will dig deeper. What products can the pharmaceutical industry
no longer continue to make? Will counterfeit products fill the gap? Will
all medicines be re-evaluated by the National Institute for Health and
Clinical Excellence to derive a tighter national formulary as a result?
The 20th century revolution in packaging and presentation that fills
my two waste skips each week may be forced by circumstance into bulk
supply and dispensing in reusable glass containers.
The Royal Pharmaceutical Society has managed to unwind the small print
while retaining the essentials of ethics, but most of the restraints
and demands upon pharmacies are enshrined in law. Much of that legislation
could become irrelevant or inappropriate, but end up unrepealed.
What are the security issues for our homes and places of work when an
economy dies?
Society will become more desperate and lawless. If they do not already
have them, pharmacies may need external shutters. Small communities will
be far more stable than cities and more likely to develop the local infrastructure
that will be needed.
Nuclear, solar, wave and wind power remain as essential alternatives
and we shall need them to produce a central core of electricity. What
lies ahead is a political nightmare. A world population of 6.6 billion
is unsustainable without oil and coal and the consequences of starting
late to consider the decline will be calamitous.
Urgency demands a complete
overhaul of the Government’s political mentality and, here, pharmacy
could lead the way. |
The
Pharmaceutical Journal