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KEN STAFFORD Consultant Pharmacist Perspective |
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The
Tail Wagging the Dog?
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Over
the past few weeks I have been very interested to watch the furore
that erupted with the "down scheduling" of ibuprofen
and nicotine patches. |
| Why
should Australia be virtually forced to fall in line with New Zealand,
a country of some 3 million people (smaller than either Sydney or
Melbourne), all in the name of cross Tasman harmonisation? Why should
we follow the lead of the only country in the world outside America
that permits direct to consumer advertising of prescription medicines
with all of the ongoing problems associated with the practice? I have no intention of continuing with the arguments for and against the easing of the restrictions, rather I would like to write about my concern of its effect on pharmacists counselling patients and carrying out medication reviews. We, as pharmacists, are all aware of the need to have a fairly complete picture of ALL medications someone is taking to effectively counsel them or to review their therapy. Increasing the range of medicines that can be easily purchased off the supermarket shelf is going to make it that much more difficult to apply our skills with a degree of certainty. This is especially true when talking to the elderly, as I have to on a regular basis, who find it difficult in some cases to recognise that OTC items can have toxic effects. Getting an accurate answer to the question "What other medicines are you taking?" may become much more difficult if this trend towards down regulation of drugs continues. Even now many older Australians do not regard aspirin or paracetamol as potent drugs because they bought them from Coles or Woolworths without having to get a prescription from the doctor! This is despite the fact that if these two drugs were only now being presented for registration, rather than many years ago, both would be rejected on the grounds of excessive toxicity. Clinical pharmacists have had to work around this problem for many years and I'm sure my colleagues all have their own ways of ensuring that OTC purchases are taken into account during counselling sessions or medication reviews. Although I accept the fact that pharmacists have in most cases been able to work around the problem, the possibility of many more potentially toxic drugs becoming readily available outside the pharmacy setting does little to set my mind at rest. Consultant pharmacy is all about the quality use of medicines to obtain optimum clinical outcomes and opening the OTC market to a wider range of therapeutically active drugs will make it just that little harder for pharmacists to operated effectively. It's interesting that people who would never think of trying to fix their broken TV often have little hesitation in trying to fix themselves, using "clinical" information gleaned from peer reviewed medical sources such as "Today Tonight" or "A Current Affair", then wonder why they wind up in hospital. Pharmacists have worked so hard to become recognised as the specialists in the use of medicines it is worrying that decisions such as the one making potent NSAIDS open sellers can be made with little or no thought about their appropriate use or safety. Another case, I suppose, of two steps forward and 1+ steps back for pharmacy in its efforts to improve the use of medicines in Australia. Not wishing to end on a negative note I am delighted to see that the younger generation of pharmacists continues to be confident that the profession will progress and that increasing numbers of them are being accredited as consultants. With this group becoming the powerhouse driving the profession forward there is little chance that pharmacy will not succeed. |