Strange how mud can be slung over and over again. But as always an argument has more than one side, and in the debate of branded medicine shortages in the UK, the two main camps are the pharmaceutical industry and the community pharmacist. There are other players but for the sake of this blog I will stick with the two aforementioned. Big Pharma has made many press statements, either by their own PR gurus or through their common voice, The Association of the British Pharmaceutical Industry (ABPI). Many impartial reports have seen the light such as the latest by Emma Weinbren from the Chemist and Druggist. Alas I have not seen any substantial response from the community pharmacist’s perspective.
Big pharma’s argument is based on placing blame squarely on the shoulders on the community pharmacists who, it is alleged, are exporting the branded medicines to the rest of the European Community, thereby depriving the UK patients of said medicines. This is a very sensitive issue that illicit various responses, some of which I intend to explore further, but I would like to point out at this point of the blog, that I am unaware of any acknowledgement by the Industry that some blame might lie with them.
So lets look at this export accusation. European laws allow full trade of pharmaceuticals across the borders of the EU, provided that local laws are adhered to. The latter requires only that the exporter be registered with the MHRA as a wholesaler of pharmaceuticals. The main catalyst that made the export of medicines to the EU viable was the weakness of the British Pound against the Euro. As the Pound approached parity with the Euro, the prospect of exporting became impossible to resist. It was further fuelled by the introduction of the so called Category M medicines classification whereby the Department of Health cut large proportions off the remuneration of pharmacies. So medicines started flooding across the Channel.
The then regulator, the Royal Pharmaceutical Society of Great Britain, as the current regulator, the General Pharmaceutical Council, warned that all pharmacists have a duty of care towards our patients, and that stern action would be taken against any who jeapardise the supply route.
The reaction from the Pharmaceutical Industry was swift. Many branded products were withdrawn from the supply chain, and special distribution arrangements put in place, apparently to protect the supply for British only consumption. And the mud slinging game commenced.
I would at this point ask of you to allow me to paint you a picture of the daily difficulties that virtually all pharmacists experience. The branded products in question may only be obtained through either of two processes:
1. From designated wholesalers that have to adhere to a quota system that allows pharmacies to order freely each month until they ‘hit’ their quota. Thereafter no further supplies may be made.
2. Directly from the manufacturer. This route must be followed once a pharmacy has ‘hit’ their quota, or as in some cases, it is the only route whereby some products may be obtained. These ‘requests’, more often than not, must be accompanied with a facsimile ‘proof’ of issue in the form of a prescription, which in turn sparked an almighty furore around data protection, etc. More mud was slung, and this specific issue is still unresolved.
So who are these so called mercenary exporters that leave this path of mayhem in their wake? Yes, there are pharmacists that do the unthinkable, probably about 1 or 2% at best. Lilly has asserted that they do have the names of these pharmacists, and in June this year threatened to reveal this list to the DoH. In spite of the Department begging for this list, Lilly has yet not delivered. One wonders why? But then there are also hospital trusts that do this at a much larger scale in order to boost their failing budgets!
So, because of the very few maverick pharmacists and hospital trusts, all pharmacies are being treated with the same brush, and indirectly all the UK patients that use these medicines.
But let us look a little bit closer to why it is that the big pharma in the UK are so concerned about the export of their medicines. I mean, surely the more they have to make and sell in order to meet the demand, the more it will be to their financial benefit? But alas, as always with these big companies, things are not always as straight forward as one might think. The reason why, for argument sake Lilly, do not want the British Cymbalta (which costs less due to the influence of the NHS) to flood the streets of say Germany, is because they make far less profit if the cheaper British product is sold rather than the more expensive German one. So the truth is out, they do not want the export of British products purely because they want to protect their profits, not because they want to protect the UK patients! During the heyday of the strong Pound against a weaker Euro, they were too happy to allow us to import European stock, because that suited their pockets then.
But dear reader, you know what, as you should by now have guessed, I care not one bit either way. My concern is for the patients that I, and the vast majority of my colleagues, are unable to serve. Today alone, I have had the misfortune of not being able to supply my patients with the following medicines: Cipralex, Cymbalta, Evista, Prograf and Myfortic. I had the misfortune of the transplant patient bursting out in tears for fear that if I am unable to obtain the medicines in time, she runs the risk of the transplant being rejected and having to rejoin the waiting list for a new organ. As always, we pharmacists are at the coal face and are the ones that have to face the patients, not the desk jockeys at Novartis. Our patients are human, and sometimes do leave renewing their medicines to the last minute, in spite of years of training. Not being allowed to even carry one box of Myfortic on my shelves, have caused great distress to my patient today. Novartis on the other hand joyfully commit to have the product in my hands within three working days!
Ladies and gentleman we are so morally wrong to play this game at the expense of our patients. We call ourselves ‘professional’ and drop the baton around every corner. When are we going to accept our calling as being one of serving our patients and not one of stuffing our pockets to bursting? When will we have enriched ourselves enough? Are we truly such devastating parasites, that we will gorge ourselves at the cost of our patient’s very lives? Shame on the lot of us! There are days that I am ashamed of being called a pharmacist. At least my patient did get a tissue to wipe her tears, for that was all I was able to give.