There
appears to be a worrying lack of British legal controls.
Drugs like Xenical and Reductil, under the terms of their British
licence, can only be prescribed for patients who have have succeeded
in losing a proportion of their body fat prior to commencing a course.
Doctors have to supervise a patient's treatment and discontinue
it, if the patient does not show progress.
However, one website selling these products, states "Amazing
results can be achieved quickly", and "Start your slimming
program today".
All this without a prescription or a doctor visit.
Now,
most of the above would be completely alien to the overwhelming
majority of Australian pharmacists, but with the speed of the
Internet, and the ability to generate a high profile quickly,
it only takes one rogue operator to bring the entire profession
into disrepute.
Of
course, the operators of these British sites are not necessarily
pharmacists, due to the open ownership laws in Britain. Even though
there are laws in place (similar to Australia) preventing the
advertising or dispensing of drugs without a prescription, not
one website appears to have been forced to close.
The only successful action to date seems to be one initiated by
the General Medical Council, which in January 2002 suspended a
doctor from practising for three months. He had been ben working
for www.ukyes.com, giving blanket approvals for their checklists,
and was found guilty of unprofessional conduct.
The website is still running.
One
of the difficulties in investigating these illegal sites is that
they generally operate out of sub-domains, and it becomes almost
impossible to identify the owners or the individuals operating
the site.
Policing of this activity appears to be divided among a number
of government agencies, with no particular agency having the sole
responsibility.
Thus none of the agencies assume any responsibility, with the
result that no investigations can be launched leading to a successful
prosecution.
Because
e-pharmacy is an integral component of the British (and Australian)
NHS plan, it is obvious that more attention will have to be given
to regulatory affairs and their mode of operation, perhaps leading
to the establishment of a single agency to oversight all policing.
Doctors will soon be given the green light to e-mail prescriptions
to pharmacies, where patients will be able to collect the dispensed
medications, or have them delivered to their homes.
Patients will also be able to direct their prescriptions to established
Internet pharmacies, after obtaining the cheapest comparison prices.
Those
British Internet pharmacies that are operating legally and ethically,
are very worried that the "shonky" operators (who seem
to have moved their deceptive practices up a notch), are operating
under domain names that are very similar to the legitimate pharmacy.
Some have taken steps to retain lawyers to investigate all such
practices and make recommendations to the various regulatory agencies.
What has emerged is that existing legislation, formulated between
1960 and 1968, is totally inadequate to control the Internet Pharmacy
with a 2000+ vintage.
To this date, except for the doctor noted above, no Internet pharmacy
operator has been prosecuted.
The
lessons from Britain need to be noted and steps taken to ensure
that Australian Internet pharmacies present a more a uniform ethical
approach to the Australian community.
Differentiation of sites can be made through marketing technique
and strategy, but ethicality should be common to all.
There also needs to be a review of existing official pharmacy
thinking, to ensure that past over-reactions directed against
pioneer Internet pharmacies, do not manifest in draconian legislation
that becomes stifling, and a disincentive to adopt new technology
and ideas.
For example, this writer fully believes that a prescription drug
requires an initial face-to-face consultation with a medical practitioner
(to establish need and generate the prescription), plus an initial
face-to-face consultation with a pharmacist (to establish appropriateness
of medication and total patient safety).
But is this necessary for the subsequent repeats dispensed by
a pharmacy (Internet or not)?
And is the pharmacy face-to-face interview required in the instance
of a new prescription that is simply a renewal of an existing
drug?
What happens when a subsequent review of the patient is required?
Should this be on a needs basis, or be a mandatory fixed interval?
This writer happens to believe that a review should occur at regular
intervals, both by doctor and pharmacist.
But should the review period be identical for the doctor and the
pharmacist?
A patient's medical review requirements are totally different
to that of a review of their medications from a pharmacist perspective.
What should trigger off a medication review...the introduction
of a new drug to the patient's regime, or a fixed period of time
irrespective of whether the patient's regime has changed or not
(so that updated drug information can be applied for patient benefit),
or both?
It
would seem to me that there would be some valid opportunities
for Internet pharmacies to ethically dispense prescriptions without
a face-to-face consultation, given sensible answers and regulation
of the instances noted above.
It would also seem to me that ownership and legal control of an
Internet pharmacy must be vested only in a qualified pharmacist,
given that a substantial number of "rogue" British Internet
pharmacies appear to be owned by non-pharmacists.
When
GPs begin to transmit prescriptions by e-mail or smartcard, will
your pharmacy have the infrastructure to satisfactorily exploit
the opportunities presented by this new technology?
Bear in mind that established Internet pharmacies already have
a significant segment of your patient/customer base and may use
the electronic prescription process to escalate their market share.
Traditional pharmacist response, has been to seek to suppress
any such threatening moves, despite the fact that the new services
may be just what customers/patients needed, and would support.
It would be refreshing to see, that if on the introduction of
the new e-health services, pharmacists developed competing structures
to maintain or improve their market share, rather than waste time,
opportunity and capital in seeking to suppress new initiatives
of their competitors, just because they were not ready, or indeed
capable, of adopting new technologies.
This effort should be diverted instead to the formation of sensible
rules and regulations which retain the essential requirements
of cognitive pharmacy in an ethical framework, but still allowing
a creative expansion of new pharmacy services, particularly in
the provision of information services.
Back
to Frontpage
Other
Articles by this writer
|
.jpg)
