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.
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KEN STAFFORD