Would you talk to your GP, or a pharmacist, if you were ill?

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.”.

And

“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.

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11 thoughts on “Would you talk to your GP, or a pharmacist, if you were ill?

  1. Hi Ron,
    I am violently allergic to yellow jacket wasps stings. Here’s my story. It was a quick thinking pharmacist attending a kid’s ballgame, who called the ambulance and saved my life, while parents stood about exchanging home remedies for wasp stings. After I got out of intensive care and was released from hospital I was allergy tested, then I went through 3 years of desensitizing shots. Now have an expanded 20 minute survival time, a window of opportunity to use my Epipen (epinephrine).

    “And, the bottom line, is a pharmacist actually qualified to diagnose/suspect cancer or any other serious condition? Or not so serious?”

    Of course they aren’t, but are they completely lacking in useful knowledge?
    And, should we put our fingers in our ears when they share that knowledge with us?

    I make my own medical care decisions, Ron. Yes, I speak to my general practitioner, my pharmacist, and to my alternative medicine health care providers, whom I trust. Do I think they all have a role to play as consultants when it comes to informing me so I can make my own health care decisions? You bet I do. I keep my fingers out of my ears and I listen up when any of them speak up. Maybe that’s because I have close friends,. who are in all of those professions, though I’m not a patient of theirs.

    I’m busy living my life to the fullest and being grateful that (1) I have experts to consult and (2) I have a high enough IQ to analyze incoming information and make informed health care decisions.

  2. Hi Ron,
    since my Pharmacist looks just like the Medicine Man from the Apaches in a cowboy film I would be inclined to trust her diagnosis! She has on more than one occasion challenged prescriptions given to me by Locum GP’s (MY GP knows and reads the notes before he prescribes). In that respect I trust her, and my GP 100% but as soon as one or the other is away I studiously avoid any new medications!
    On another note we have, at last, got a bit of real winter here on the south coast, but all the local schools closing today, for 4 to 6 cm of snow? WTF? Oh well, it’s just my age, I’m told…

  3. Pingback: Would you talk to your GP, or a pharmacist, if you were ill? | Welfare, Disability, Politics and People's Right's | Scoop.it

  4. i for one would refuse such a pill. like you Ron, have read a lot of damning reports about statins. and as ive said before i am allergic to aspirin. and one of the other two caused swollen ankles ,feet and legs even while on bed-rest. (neither of which i take now as they are not needed after seeing a dr that knows what shes doing and like me feels that if there is proof that someone did not have a heart attack after being suspected of having one (no chest pain. just a small pain in my neck that made me feel rather weird.) then they should not be taking any of those tablets.time enough when they have no choice,if that time comes.)
    hope your feeling much better now.

    • Still much the same, unfortunately – I just couldn’t let this nonsense slip by without comment. Stopped vomiting (just one night, like before). Whatever the cause, it’s brought back my IBS with a vengeance.

      • Sorry to hear you still in trouble with those things. as if you aint got enough to contend with eh? wishing you all the best for a recovery from that malady at least very soon.

  5. Nice to see you back and at your cynical best Ron; I do agree the idea of a 1 size serves all combi pill terrifies me – had enough trouble with those as contraceptives!! x

  6. In general, I would trust a pharmacist to tell me about the content of my medication, its purpose, side-effects and interactions with other medication etc. I would not want to be diagnosed by one. A GP studies for years to become skilled in the science (art?) of diagnosis and they are still fallible. Every pharmacist I’ve seen has been pushed for time and I’ve overheard other people’s consultations as the ‘private room’ was little more than a converted store cupboard in the shop.
    A pharmacist once suggested that I have a medicine review and then told me I should immediately stop taking high dose calcium, as it was very dangerous to me and could cause death in my condition. As it had been prescribed by my oncologist, who has many more years of study and experience under his belt, and access to my bone scans and blood tests, I ignored her suggestion and carried on taking it. Three weeks later she rang me to say she had been wrong, and I should start taking them again as they were actually very important. Meh.
    And exactly why do we need “a culture where there’s an effective, safe, relatively low cost polypill for everyone”? Good grief. What kind of dystopia would that be?

    • The kind of dystopia in which sedatives and mind-altering drugs could be used for control of the populace. And if that hasn’t already occurred to Cameron he deserves to have his Rabid Psychopath badge taken away!

  7. My pharmacist is very friendly and useful for sore throats, coughs and sniffles, but I wouldn’t go much beyond that.
    As for statins, I am terrified that one day I will be forced on to them. And a polypill? Not sure if that’s more Harry Potter or Brave New World…
    Take care in this cold weather, Ron

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