Our chemists need a cure

Our pharmacists are highly trained medical professionals but the service they offer is woefully limited – and it's not entirely their fault, writes CONOR POPE

NOT LONG AGO PriceWatch was less than delighted to see skin peeling from a finger in a most unattractive fashion. Not the biggest complaint in the world, admittedly, but mildly annoying nonetheless.

It went on for days, before eventually, we got round to going to a chemist.

There, a pleasant pharmacist diagnosed contact dermatitis – a more clinical name for an allergic reaction – and suggested a range of branded creams, mostly containing tea-tree oil, which he said would clear it up.

Then, almost as an afterthought, he offered to make up his own potion from scratch. Such an old-school notion appealed to us so the pharmacist set about making it up. He’s not the first Irish pharmacist to make and sell his own cream. Sudocrem was developed in the 1930s by Thomas Smith, a Dublin-based pharmacist and it went on to become the leading baby cream in the UK and Ireland.

In three minutes it was done. At €4, it cost a third of the price of the fancier-looking products on the shelf and within 48 hours, the peeling had stopped. By any measure the diagnosis and treatment represented great value for money. Had we gone to a doctor, it would have cost at least €60 for the consultation and a further €12 for the cream.

Generally speaking however, do the State’s pharmacists provide such good value for money? No, is the short answer. But this is not really their fault.

As anyone with even the most passing acquaintance with our university points system will know, competition for places on pharmacy courses is intense and the points are sky high.

Those lucky enough to make the grade spend four years studying, at considerable cost to themselves and the State. But then, because of regulations and policies beyond their control, when they qualify they end up dispensing pills and selling fake tan and Old Spice – things that could be done by someone with considerably less training.

While our pharmacists are at the frontline of medical services – and often the first medical professionals to see the sick – there are many things they are not permitted to do. The range of medications they can offer to patients without a doctor’s prescription is extremely limited due, mainly, to legislative restrictions that the Irish Medicines Board has no choice but to enforce.

Nor can chemists swap cheaper generic drugs for branded products even if the products are almost identical and a patient asks for it. They cannot alter dosages or administer vaccines even though many are fully qualified to do so. Their counterparts all over Europe are given the leeway to intervene in patient care in a more proactive manner.

The restrictions infuriate Darragh O’Loughlin, a pharmacist in Tuam and president of the Irish Pharmacy Union (IPU), which represents over 1,500 members across the State. “We spend four years training and the training is subsidised by the State. Then we qualify, start work and many of our skills are not being used. So on a purely economic level the State is not getting the best value for money.

“Across the EU, every pharmacist trains to the same standards and yet in other countries they have far greater authority to offer medical advice and to intervene. There are pharmacists giving vaccines across the EU yet in this country we are only talking about it,” he says.

O’Loughlin gives a simple example to illustrate his point. Impetigo is one of the most common ailments which young children can get. It is easy to diagnose and to treat with an antibiotic cream.

“Parents come in and we can diagnose it and tell them what they need. But then when they ask for the cream, we have to send them to their GP. We say they need to go immediately or the condition will worsen and then they will need an orally-administered antibiotic as well, but as often as not they don’t act fast enough and are back in two or three days with two prescriptions. It is a crazy waste of resources,” OLoughlin says.

It is different in the UK where the Medical and Health Authority – their equivalent of the IMB – has a proactive approach to deregulating medicines. It routinely has public consultations inviting consumers to suggest drugs which should be deregulated and then makes changes quickly as the sector matures.

In this State, however, the only drug to have been deregulated in recent times by the IMB was the morning after pill which became available over the counter earlier this year. One of the reasons the IMB acted was because Boots started making it available over the counter independently of any such move. It could do this because it employed a UK doctor to oversee the processes associated with it being dispensed.

Another area where pharmacists’ skills are being used better in the UK is in connection with blood pressure management. An Irish patient diagnosed with high blood pressure gets a prescription for a certain dosage of a drug to keep it under control. All pharmacists here can do is dispense the drug in that exact dosage. In the UK, however, they can check a patient’s blood pressure in the pharmacy and then moderate the dosage on an ongoing basis to ensure its effectiveness.

“I definitely hope there will be change but I think it is too early to be confident there will be,” O’Loughlin says. “There is no reason why pharmacists couldn’t be vaccinating against the flu in time for the coming winter if the Government moved now,” he says. Only 55 per cent of people in at-risk groups were vaccinated last year. In Portugal, where pharmacists and doctors give the vaccine, 75 per cent were vaccinated.”

Kate O’Flaherty is the spokeswoman for the Pharmaceutical Society of Ireland, the body which has regulated the sector since 2007. It has worked hard to update the rules under which pharmacists operate to allow them to do more. She says that prior to the regulator being set up, the sector was working under guidelines which were written in 1875, back when hacksaw surgery and leeches were all the rage.

“When it was suggested that pharmacists be given more responsibility it was said that we did not have the modern regulatory framework in place to protect the public, but that argument is gone now,” she says. “A lot of the pieces of the jigsaw are in place. As a regulator we need to find out how to facilitate the pharmacists in doing what pharmacists in other countries are allowed to do.

“They are the experts in medicine management and those skills are not being properly exploited. As patients and as a health service we could be getting better value for money as well as enhancing their role,” she believes.

Things are changing and a growing number of pharmacies offer low level health screenings and can test cholesterol, blood pressure and PSA (the test for the early detection of prostate cancer).

Of course it is one thing popping in to a chemist and showing them a weird rash on your finger, it is an entirely different ball game if the rash is somewhere less accessible or if you would rather not discuss it on the shop floor in front of your neighbour buying Old Spice for their son.

Again, things are changing and under legislation introduced late last year, pharmacies must now have dedicated consultation rooms, where patients can discuss their medicines in private.

McCabes Pharmacy will run a cholesterol level check for around €25, while a glucose level check costs €10. It also offers health screenings for between €65 and €100.

Unicare Pharmacy offers body mass index (BMI) testing and in certain branches has orthotics clinics for people suffering from foot problems. Boots meanwhile offers a “healthy heart” consultation, which involves discussing your risk factors with a pharmacist and getting your BMI, blood pressure, heart rate and cholesterol tested for €40, a lot less than it might otherwise cost.

The range of medications they can offer to patients without a doctor’s prescription is extremely limited due, mainly, to legislative restrictions