Professor Sir Nicholas Wald, director at the Wolfson Institute of Preventative Medicine, has come up with the – let’s say excessively unrealistic – idea that pharmacies should have a role in prescribing for patients, particularly in cardiovascular disease.
He also claims that “a combination pill containing statins, ACE inhibitors and aspirin amongst other ingredients, could be given to healthy patients aged 55 years in pharmacies to help tackle cardiovascular disease.”.
“We need a culture where there’s an effective, safe, relatively low cost polypill for everyone. I think that’s achievable at about £1 a day.”
Which is where, I feel, he is excessively unrealistic. Anyone involved in medicine must surely be aware that there is no such thing as a drug – or combination of drugs – that’s safe for everybody. So why should a polypill be any different? And call me picky, but “think” is a universe away from “I have evidence to show”. A polypill will be a novel combination, and probably patentable, which means Big Pharma can charge what they like for it, and probably will. On the other hand, if by “polypill” they really mean a handful of tablets, then it might be doable.
A polypill might be expected to contain a statin, ACE inhibitor, aspirin, and a calcium-channel blocker. Perhaps a diuretic, too. There are several combinations being trialled.
Personally, I don’t trust statins. Increasingly, they’re being proven dangerous, either alone or in conjunction with other drugs. My one experience with a statin ended after 48 hours when I had excruciating muscle pain (probably the onset of rhabdomyolysis, not unknown with some statins). Went back to my GP, told him what had happened, that I wasn’t taking any more and, based on what I’d read, wasn’t interested in taking such a problematic drug on a just in case basis. He wasn’t happy, as statins, at the time were widely touted as the saviours of humanity!
This study shows that there is little or no benefit in prescribing statins on a just in case basis for people with no history of heart disease.
And if a patient does experience problems with a polypill, how the hell can anyone tell which component, or combination thereof, is the cause?
In addition, I have serious problems with pharmacists prescribing pretty much anything, not just polypills, as they don’t have access to patient records and could easily prescribe drugs to a which patient has a severe intolerance.
Related to the above, Professor Richard Parish, chief executive of the Royal Society of Public Health. has suggested that because pharmacists see so many people (mine hasn’t seen me in years**), they are ideally placed to refer patients suspected of having cancer. Huh?
**And when I was mobile, he saw me often but very rarely interacted with me, thus gleaning no useful information about me at all.
Parish’s logic is that men are reluctant to confide in their GPs, but would probably have no problems doing so to a pharmacist, who could refer them for tests if they have symptoms of cancer.
But what evidence is there for this? Why should a patient open up to a pharmacist but not their GP? It makes no sense.
And what of the referral process? GP referrals are monitored, and sometimes killed off or given a lower priority. Wouldn’t this tend to happen rather more to pharmacists? Or would pharmacy referrals bypass the GP monitoring system?
And, the bottom line, is a pharmacist actually qualified to diagnose/suspect cancer or any other serious condition? Or not so serious?
I ask because, some years ago, I was stung on the throat by a wasp. I went to the pharmacy to get something for the pain (bloody big queen wasp had snuggled under my scarf on a frosty morning), and was firmly told that I had to go and see my GP immediately, as a matter of urgency, as it was a risky place to be stung. So I did as I was told. My GP, though, was furious that I was wasting his time, I reacted angrily, told him if he had a problem to take it up with the pharmacy, and left. Never did get anything for the pain, which lingered for days. So that’s probably one GP who won’t be thrilled at pharmacist intrusion into his area of expertise (he’s not that keen on mine either!).
And if I were really cynical (ha!), I might well feel that this whole prescribing/referring thing was intended to weaken the power of GPs, who are currently at war with the government on several fronts.
Source: Pulse magazine, except for the statins study link. Membership might be required to read this page.