FELLOW professionals often say to me that it is the pharmacist who is the expert in drugs and their delivery.
I agree, because I think as a pharmacist the absorption, distribution, metabolism and excretion of drugs is our primary focus when caring for patients. We will take a holistic view of how the chemistry of compounds may have positive or negative effects on the patient. The ultimate goal here is to keep the patient safe, and make sure the drug has the desired effect.
Also, I’m a pharmacist, so therefore I am perhaps biased.
If we consider community pharmacists as legitimate drug dealers s/he basically wants the medicines they sell to have the desired effect with little or no side effects so that the customers return.
I have always thought that this rather simplistic commercial model has been a core aspect to the evolution of the ‘chemist’s’ trusted reputation. The thought being that pharmacists will immediately supply something useful to ease the ailment and difficult evidence-based decisions are sometimes glossed over in favour of making the sale to a loyal customer. The long term management of the patient’s conditions cannot properly be considered at the till without access to patient records.
You will notice that in the commercial model I refer to the customer, and not the patient. It does however come at a price…credibility!
Or does it? It depends…
Perhaps there is room for some non-evidence based treatment, as long as we can professionally justify our decisions.
Is it ethically right, for example, to sell a cough bottle that you know will probably not do much good, if the result is a saved GP appointment?
Perhaps, if it’s late in the day you might even prevent the prescribing of an unnecessary antibiotic.
You might notice a patient repeatedly buying cough remedies over the counter and refer them to their GP. If the cough has been around for more than six weeks the patient might need a chest x-Ray.
An asthmatic patient repeatedly buying cough bottles may need their inhaler therapy tweaked, or their inhaler technique checked to regain control.
These three scenarios demonstrate the value of supplying non evidence-based medicines for the greater good.
My own view, is that as pharmacists we should put the patient at the centre of everything we do. The days of paternal care models are all but gone. Is it not up to us to sift the evidence of the products we sell or prescribe, and inform the patients properly so that the patient can make sound decisions about their own care?
My view is that honesty is the best policy, and therefore practicing evidence-based medicine directed by consensus guidelines is the best way to go. Best for patients that is.
The profession has already made a stand against homeopathy due to a lack of evidence of efficacy.
Perhaps it’s time to consider the overall evidence based benefit vs potential harms of the remainder of the over the counter remedies.
Why stop at homeopathy? I would propose that this could be painful commercially in the short term, but will serve our patients and our profession better in the long run.
Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in based in Aberdeen.
Follow Johnathan @JohnathanLaird