UPSELLING DRUGS. PART ONE.

I caught a virus and a touch of pneumonia. Nothing serious. Nothing to worry about. My doctor prescribed antibiotics and off I went to the pharmacist feeling confident I was being well cared for. After the usual wait the pharmacist gave me a little bottle of antibiotics for $3.00. But at the same time he produced another bottle of pills called Probiotcs, saying, “I always advise patients to take these too because antibiotics kill the good as well as the bad bacteria.” These pills were over $30.00  

I was lost for words for a moment. I didn’t have extra money on me. But that was not my major concern. Whenever I have sought advice from pharmacists I have found them unfailingly helpful, but this was a first; unsolicited advice inconsistent with advice given by my doctor. I found the experience disturbing. How would a person who is hard-up as well as sick respond to this dilemma? The feeling of unease stayed with me.  How much was this a commercial intrusion into the world of medicine? I set out to find out.

First stop: The practice manager of the medical centre I attend. I sent the  following (abbreviated) email entitled "Ethical Issue."

“1. I  did not go to the pharmacist for advice. 
2. The advice he gave me made me question the value of the advice given by the doctor.
3. I have never experienced this kind of unsolicited advice from a chemist before when asked simply to provide prescribed  medicine.
4. I think this indicates that the chemist is abusing the special relationship with your practice for commercial gain. I found the man friendly. Perhaps he was unaware of the ethical issue here. You may not agree. I would appreciate your opinion.” Back came the reply:

“You are correct in pointing out that the situation you experienced raises a number of issues which need to be clarified.”  

So, the matter was now between the pharmacy owner and the practice manager.  But getting a response from the owner of the pharmacy proved difficult partly because the practice manager went on leave and there was some miscommunication. Weeks dragged on until I decided to phone the pharmacy.

I raised my concerns with the manager. She repeated what the pharmacist had said: Antibiotics attack good and bad bacteria and it was common practice to sell Probiotic. "We sell a lot." She was polite but could not see my point of view about the practice being unethical. And so I wrote to the Pharmacy Council of New Zealand. They  replied: 

“The product that you were offered when collecting your prescription for an antibiotic is a service offered by many pharmacists to counter harmful side effects of antibiotics.  The pharmacist is within his/her rights to offer or recommend such a product as long as the patient is given the choice to decline the purchase.”

I wrote to Pharmac and got this reply: “It sounds like your pharmacist was offering you some probiotics.  These are an optional extra to, as your pharmacist explained, keep up the healthy flora in your stomach to reduce the likelihood of stomach upsets as a result of the antibiotics.”

“You can either consider this to be 'upselling' or the pharmacist 'doing his best for his patient' by offering you this option, albeit unsubsidised. Either way, it is allowed for your pharmacist to offer you additional products if they feel they may help your situation.  And you have the right to decline them if you wish.”

 All this was  fine  but  none of it  answered the issue (or the word) I was concerned about. I had asked for a judgement on ethical practice and I was still looking for an answer.