We need to support the development of a SIGN guideline for over the counter sales of medicines

Johnathan Laird

ONE of the really important stances that I am proud to say the Pharmaceutical Society stand for is the fact that as a profession pharmacy practice should be rooted in scientific evidence. We are a profession of scientists.

How can it be that we allow the sale of over the counter medicinal products (OTC) with thin or no evidence base from registered pharmacies in this country?

I’m well aware that in most small community pharmacies up to 50% of sales can come from healthcare so I should declare that I don’t make £1000’s or 10’s of £1000’s per year on these sales so it is perhaps easier for me to have this view. Apologies if you don’t agree but I really think that to recapture that mantle of high calibre at the heart of the community we need to continue with rigour and follow the evidence in terms of the products we sell.

Otherwise to be frank we are just a shop.

In Scotland there has been recent leadership and resultant delivery of grass roots community pharmacy research. I applaud this and indeed actively supported by taking part.

I feel like as a pharmacist I exist in two worlds. One is the evidence based, guidance driven work I do in general practice. I am currently being supervised to learn how to run ‘on the day’ clinics and also have an established post exacerbation clinic. In this role I follow the evidence and guidance unless there are compelling and justifiable reasons not to. For example the evidence tells me that pulmonary rehabilitation, smoking cessation, inhaler technique checks and advising the patient to get the flu jab are all high return interventions that I can make for that patient. I have yet to recommend a cough bottle to a COPD patient with a cough because the evidence simply does not support it. I’m attempting to take a balanced scientific approach to this area of practice.

You must then see my confusion and disconnect with the system when a patient can walk into a community pharmacy and buy a cough bottle without question.

I have wrestled with this and sometimes think I am seeking utopia but I recognise that things will never be perfect and actually it is fine to sell things that do no harm. Perhaps we should market the fact that we are a profession that actively champions the ‘placebo effect’, which there is some evidence for by the way.

Just because it does no harm does not in my view make it professionally justifiable. If we want to be highly regarded knowledgeable professionals then I’m not sure we can go on without at least making an effort to assess the evidence base of the various products we sell. In some quarters pharmacist are selling themselves as the ‘experts in medicines’. Well surely having a firm grasp of the evidence base underpinning the medicinal products we supply is a critical aspect of this claim. It is a question of credibility.

I would like to encourage the emerging grass roots community pharmacy research, supported by the Royal Pharmaceutical Society, to look at this very topic. It would be fascinating to view a SIGN guideline for the supply of OTC products. We have traffic light markings on food products now to indicate sugar or fat content. I would like to see this approach applied to the evidence underpinning the efficacy of OTC products. Perhaps evidence could be categorised as strong, moderate, weak or nonexistent. Perhaps again this is a utopian aspiration however in our emerging data driven world this information will eventually in my view make its way to the consumer anyway.

Better to be on the front foot and start work now.

A SIGN guideline supporting the supply of over the counter medicines would be something that may cause financial pain in the short term (or maybe not) and would show the collective commitment of the community sector to an evidence based scientific approach to practice.

Johnathan is a member of the RPS Scottish Pharmacy Board but is writing in his personal capacity here.