Appalling bias
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2880 (Published 28 May 2010) Cite this as: BMJ 2010;340:c2880All rapid responses
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Mr. Martin's letter is rather revealing.
Of course a business like a pharmacy is, by design, a profit-making
enterprise.
What we, if we were living in a less imperfect world, would be
entitled to object to is that there is such a thing as the Sickness
Industry which includes anyone employed in the field, be it Big Pharma,
Community Pharmacia or the Covered Wagon Screeners.
All working people are deserving of a wage and no one would begrudge
them that.
The point overlooked or unknown to Mr. Martin is that there ought to
be no conflict-of-interest-driven profit extracted from the downtrodden
and the sick, something that is shaming us all as human beings.
Geographically, this varies in severity of course, to this writer it
looks as if the UK has come very close to the USA now.
Competing interests:
None declared
Competing interests: No competing interests
Dr Willis makes some valid points about the methods deployed by some pharmacists purely for commercial gain. As for "supplying patients with generic tablets from different manufacturers in different packs every month causing confusion and making errors more likely", it is an interesting and rather worrying issue. I wonder whether the pharmacists have a professional and/or legal obligation to forewarn patients about such 'change of packs' to avoid likely errors? If this issue has not already reached the medico-legal arena, then I assume it will not be too long before we hear of such issues.Perhaps, some conscientious pharmacists and dispensing GPs already forewarn their patients accordingly.
Competing interests:
None declared
Competing interests: No competing interests
Of course pharmacists are not unique in earning a living form the
nhs.
However i often come across examples of pharmacies making money out of
patients by selling them medication which is not in their best interests
ie cough medicines or sedating antihistamines for hay fever, or promoting
the use of medication such as tamsulosin or terbinafine without mentioning
the drawbacks.
Other frustrating profit motivated examples are, ordering unneeded
medication on 'repeat' on behalf of patients causing massive waste, and
supplying patients with generic tablets from different manufacturers in
different packs every month causing confusion and making errors more
likely, presumably to squeeze every last bit of profit from a
prescription.
Pharmacists may be unfairly blamed for the excessively profit motivated
actions of Pharmacies - but there is a case to be answered, and Mr
Martin's angry response suggests that a nerve has been touched.
Competing interests:
None declared
Competing interests: No competing interests
A diversion from the core issues
I am no apologist for the pharmacy profession and certainly no
apologist for the actions of corporate pharmacy chains (our work was cited
in Richardson and Pollock’s original article:
http://www.bmj.com/cgi/content/full/340/may11_1/c2298) but I feel the need
to correct some of the incorrect assertions/misunderstandings made by
previous correspondents.
Mr Martin’s letter was easy to deconstruct and refute. Where I will
agree with the ‘responders’ is that the letter does suggest that
Richardson and Pollock’s article ‘touched a nerve’. However, such a
response was not unique to Mr Martin. The Pharmaceutical Services
Negotiating Committee (pharmacy’s representative in negotiations with the
Department of Health) issued a press release
(http://www.psnc.org.uk/data/files/PSNC_press_releases/
2010/May_2010/psnc_responds_to_bmj_article.pdf)
full of vituperative that failed to address the central thrust of
Richardson and Pollock’s article – namely the lack of data about patient-
focused services and how the provision of these has been influenced by
policy changes and changes within the pharmacy sector.
Picking up on this
press release, Chemist and Druggist magazine published an article with the
headline “‘Biased’ BMJ paper queries professionalism”
(http://www.chemistanddruggist.co.uk/c/portal/layout?
p_l_id=259751&CMPI_SHARED_articleId=4053711&CMPI_SHARED_
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4053711&CMPI_SHARED_ToolsArticleId=4053711&CMPI_SHARED
_CommentArticleId=4053711&articleTitle=%EF%BF%BDBiased
%EF%BF%BD%20BMJ%20paper%20queries%20professionalism)
in which the Royal Pharmaceutical Society of Great Britain’s (RPSGB) Head
of Corporate Communications made the assertion that “the decisions
pharmacists make around services are driven by the needs and wants of
patients”. While I am happy to agree that this is the case in a number of
instances, I am yet to see any evidence that this is the case across the
board.
Dr Willis, in his response to Mr Martin, is heavy on anecdote but
light on evidence. If he has genuinely “come across examples of
pharmacists making money out of patients by selling them medication which
is not in their best interests” then I would strongly recommend that he
draws the attention of the pharmacy regulator (the RPSGB but soon to be
the General Pharmaceutical Council) to such practices as they would appear
to be in breach of principles 2.1 and 2.2 of the Code of Ethics for
Pharmacists and Pharmacy Technicians
(http://www.rpsgb.org/pdfs/coeppt.pdf) which place a duty on pharmacists
to “consider and act in the best interests of individual patients and the
public” and “make sure that your professional judgement is not impaired by
personal or commercial interests, incentives, targets or similar
measures”.
Similarly, I fail to comprehend the logic of a general practitioner
with prescribing rights criticising pharmacists (presumably without
prescribing rights) for “causing massive waste” of medications. The
prescriber is fully at liberty to decline a request for repeat medication
should he/she deem it to be unnecessary and, additionally, he/she should
bear in mind that these requests are often made by individual patients
themselves as opposed to some nefarious plot by the pharmacist to generate
profit – a profit incidentally that, considering the corporatised nature
of the pharmacy sector, is unlikely to result in financial gain for the
pharmacist at the ‘coal face’.
Dr Willis – and before him, Mr Martin – appear to resort to inter-professional squabbles that are an unnecessary diversion from the core
issues of the original article. What is needed now – some would say
urgently in light of the NHS White Paper – is reliable and robust data on
service provision through community pharmacy. We need to know which
services are effective and value for money but we also need to know how
such provision is influenced (or not) by patient need, pharmacy ownership
and policy changes.
Competing interests:
Pharmacist and Lecturer in Pharmacy Practice at Aston University
Competing interests: No competing interests