Part Two of Upselling Drugs

 I decided to approach one more official body, Otago & Southland District Health Boards. Here is the reply:

  

“The DHB has a contractual relationship with pharmacies and requires ethical standards to be upheld at all times. The DHB is not the correct or appropriate organisation to make judgement on a pharmacist's ethics or actions. I can however provide you my personal views as a pharmacist which hopefully you will find helpful. Your experience of being offered another product with your antibiotic prescription is common practice in New Zealand and around the world.  I ask you the question ... if it had been a different product such as a cough medicine or pain relief, then would your response have been the same?  The pharmacist was offering a product, which in their professional opinion, would have had benefit to the patient.  The product you would have been offered would have been some form of pro-biotic which does have a solid evidence basis for being beneficial when taken with antibiotics.  Ultimately you were provided advice and given a choice.”

In my view this argument still emphasised option above ethics. I remained unconvinced. However, with so much high-powered opposition my conviction was faltering. At this point the practice manager returned to work and restored my faith, at least in one corner of the medical field. 

      

The doctor given the task on behalf of the practice to take up my concerns wrote the following, “which reflect the position of the practice:”  

 

“Offering of probiotics suggests that everyone gets side effects from antibiotics, when this is clearly not the case.

 Offering of probiotics is at best confusing for patients and at worst undermines the credibility of the doctor, by suggesting that the prescribed medicine is somehow ‘bad’ for them.

There is an ethical conflict which arises from the fact that the pharmacy is making money out of selling the product being recommended.

There is a big difference between patients actively seeking pharmacist advice and being offered unsolicited advice.

There are tensions arising from the fact that pharmacists dispense both evidence based medicine and alternative treatments.”  (Though not concerned about pharmacists giving advice about alternative treatments per se, it is important that they make the distinction that it is not an evidence-based treatment).

 

The pharmacy manager’s response is summarised as follows: 

 “Providing advice to patients about the taking of medication is considered an integral part of the pharmacist’s role, including what possible side-effects to expect and in what circumstances they should go back and see their doctor.

Making recommendations about treatments with general health benefits is also part of the pharmacist’s role. This is not intended to be ‘hard sell’ and it is the patient’s decision whether they follow the advice or not.

It is never intended to undermine the advice or treatment made by prescribers.”

Nevertheless, the manager noted that she would be working with the pharmacist involved to address his understanding of how advice should be communicated to customers.

This division of opinion between front-line doctors and patients on one side and everyone else on the other side is surprising and a bit of a worry. Particularly when poor, inarticulate people front up to pharmacists with a prescription for themselves or their children. The “decision” the patient has to make is to waste money on drugs they don’t need or feel guilty for being confused and stingy.  There are clinical and ethical views here, and the real worry is that they may in time be swamped by the clout of a billion dollar industry.

    

Christopher Horan