With so many stories circulating it’s hard to know where to start. This week I attended the MHRA Board meeting, I shall be reporting on that in next week’s blog. I have also had the good fortune to interview Dr Ahmad Malik.
Last week I went to the pharmacy to pick up some medication for a friend. When I got there, I was told it was not in stock. I was handed the prescription back and told to trawl the area to see if any other pharmacy had it. Fortunately, I drive, so it was not overly inconvenient; however, without a car, it would have been nigh on impossible. I did as I was told (for a change) and went to the four other pharmacies within a six-mile radius, but nothing: none of them had the drug in stock. Eventually, I had to return empty-handed to my friend, only to tell her to ring her GP for an alternative.
Pharmacies in crisis
Pharmacy First was launched in Scotland initially, and is now being launched in England now. A £645 million investment was pledged to support community pharmacy services. With GPs overwhelmed, community pharmacists have become the shop window of the NHS. But is it working?
Last week, I watched an ITV documentary called Pharmacies: the new NHS frontline?. The programme focused on the health of our pharmacies as the pressure from GPs and the NHS gets piled upon them. But did anyone ask the pharmacists for the reasons before ITV took us all running through their doors in search of a ‘cure’, ‘diagnosis’ and advice? As the cameras ventured behind the scenes, the audience caught a glimpse of the pressure that many were experiencing, having to deal with so much extra workload.
Are pharmacists trained to diagnose medical conditions? The answer is clearly no; if pharmacists wanted to be doctors, they would have trained to be one. Yet it appears that diagnosing is exactly what many are expected to do. I was alarmed to hear one pharmacist tell a customer that the blemish on her face was, in his opinion, nothing to worry about and not a melanoma as the customer had feared; to go home and not worry any more. Would that have reassured you? It certainly wouldn’t have reassured me.
With increased pressures, rising costs of pharmaceuticals and a shortage of many medicines, pharmacists are feeling overwhelmed and overworked. As the costs of drugs escalates, many pharmacists are having to incur losses, as the cost exceeds the price they can claim back from the NHS. Pharmacies are paid to provide NHS services, but their income comes from dispensing medicines. Pharmacies buy medicines in at cheaper prices than the NHS, which ultimately reimburses them; however, in practice, this is not what is happening, and on many occasions the pharmacy ends up taking the financial hit. Whilst the big pharmacies such as Boots may be able to withstand losses such as these, many independent pharmacies can’t and have ended up closing as a result. In the documentary, 96% of independent pharmacies say their business is not financially viable.
What is the impact of global supply issues and how many people are struggling to get their medication due to shortages? With approximately eight British pharmacies closing down a week, supply cannot keep up with demand. The ITV Tonight programme surveyed 980 pharmacy workers from across the country and shone a spotlight on an industry in crisis.
The situation is further compounded by medicine shortages: pharmacists are constantly faced with the task of explaining to customers that they should either source the medication themselves by contacting other pharmacies or instructing them to return to their GP for an available alternative medicine. We even witnessed a patient travelling 160 miles from Plymouth to the Isle of Wight in search of her ADHD medication; that is how desperate she got.
Why are medicines in such short supply?. Are the medicines we are all familiar with being deliberately withdrawn in order to replace them with novel experimental medicines? What impact has Brexit had on supply of medicines to the UK? Are the drugs we have become so used to even still being manufactured? Are some drugs becoming too expensive to manufacture?
Many people need their chemist, especially those who rely on their pharmacy to deliver medications, particularly those caring for loved ones at home. However, as pharmacies look for other ways to save their business, cutting free deliveries and ‘dosette’ boxes which help patients keep track of their medicines is just one way to reduce losses. Perhaps this is to make way for the drone deliveries we have been warning of.
So what of the future of ‘community pharmacists’? Four out of five people live within a fifteen-minute walk of one (how convenient for fifteen-minute cities) and in deprived areas there are twice as many pharmacies as in more affluent areas. Many pharmacists say they can’t even cope now, let alone take on the extra responsibilities that Pharmacy First will demand of them.
Pharmacy First is a huge step for many pharmacists to take. Will there be enough staff to deliver it? Will the scheme work in England—or will it fail miserably, only to be replaced by drone deliveries and online ordering? If listening to pharmacists is anything to go by, I fear the latter.
Janet Morrison, CEO of Community Pharmacy England, said in response to the programme:
It is critical that we keep highlighting the crisis facing pharmacies, and the impact it has on patients and local communities, so we were pleased to be able to do so in a primetime TV programme. The documentary captured the issues well, and in a way that was simple and easy to understand. This all helps to build wider awareness of the problems, supporting the case for more investment and support for pharmacies. Our thanks go to the ITV team and all the pharmacists and others who took part in the programme.
People in local communities recognise that community pharmacies are integral to the fabric of their daily lives, as the interviews in the programme made clear. And the documentary also laid bare the impact that it can have on patients when pharmacy services or medicines are not available, whether because of supply issues or because pharmacies are being forced to stop providing free services due to financial pressures.
The ITV findings on pressures were sadly consistent with our own regular polling of pharmacy owners and with the findings of our Pressures Survey last year. Unfortunately, we expect that the results of this year’s survey—which will launch in early March—will make for yet more distressing reading as the situation for pharmacies remains incredibly difficult. Capturing this data remains a critical part of our evidence-gathering supporting the case for more funding and support for community pharmacy.
The new vaccines to expect in 2024
With more and more vaccines coming down the pharmaceutical pipeline, the US Centres for Disease Control and Prevention (CDC) are recommending new vaccines for adults and children in 2024. Many of us have become used to being invited for the annual flu shot, but in 2024 it’s all change. Do you know what has been added to the recommended American vaccination schedule?
The invitation has been extended to recommend that all adults and children over the age of six months should receive the Covid-19 vaccine.
For the first time, monkeypox, alias Mpox, is being formally recommended on the vaccine schedule for those who are deemed as ‘high risk’, which includes members of the LBGTQ community.
Respiratory Syncytial Virus
Pregnant mothers who are nearing the end of term in autumn or winter will be invited to take Pfizer’s new Respiratory Syncytial Virus (RSV) vaccine. If they do not receive it, their babies will be given a shot of the monoclonal antibody Beyfortus, which was approved by the FDA in July 2023. Finally, not to be forgotten, the elderly will also be offered a new GlaxoSmithKlein RSV vaccine.
Meningitis combination vaccine
Pfizer us busy pumping out as many new pharmaceuticals as possible in the shortest achievable timeframe, including a new vaccine to protect against meningococcal disease. Penbraya debuts in 2024. Whilst this will not be recommended for all patients, it will be recommended for some adults and children. Penbraya will cover meningococcal groups A, B, C, W and Y: this is the widest range in one shot ever to be offered. Are you up for a new Pfizer jab? It’s a no from me, despite my son nearly having lost his life at three weeks old from meningococcal septicaemia.
DSM–5–TR panel members received $14m in undisclosed industry funding
Thanks to Cheryl Grainger for sending me this story in Medscape.
The Diagnostic Statistical Manual of Mental Disorders is a handbook compiled by the American Psychological Association. It is used by clinicians and psychiatrists as a tool to help them to make a diagnosis. It contains descriptions, symptoms and criteria of each recognised mental health illness. However, it appears that about 60% of US physicians who served as panel members have received an eye-watering total of $14 million in publicly undisclosed industry funding.
While many members (merely) received remuneration for food, travel and consulting fees, a third were found to be receiving payments for services such as serving on a ‘pharmaceutical company speakers bureau’. Clearly, the revolving doors at the APA are in full swing, but alarmingly this does not appear to concern them too much: it seems a blind eye will continue to be turned and the revolving doors will continue to swing. This remuneration seems a common practice in 2024; in my day, it was called a conflict of interest and wouldn’t have been allowed.
If you are living in Northern Ireland and were planespotting recently, you may have caught sight of Bill Gates’ £70 million Gulfstream jet flying overhead. His private plane took off from Los Angeles and was thought to be heading for Davos. I am sure Bill will be doing more networking and fearmongering than skiing.
Gates has described his private jets as his guilty pleasure. I would argue they are his sheer hypocrisy. Not content with one private jet, he has four. As if that wasn’t enough, recently Sir Bill flew to Australia with colleagues from his energy company Breakthrough Energy, whose goals are to drive innovation in sustainable energy and to reduce greenhouse gas emissions. You can’t make it up,
We have been reporting the likelihood of the emergence of Disease X for many months. Let me be clear: the world is apparently expecting a deadly new virus capable of killing millions, but no-one knows about it yet. Scientists have been busy working away in their labs to design a vaccine. But my question is, how can you design a vaccine against nothing? Perhaps by the time you are reading this, it will have all become clear, when the World Economic Forum enlightens us all at Davos this week? Failing that, maybe Bill Gates and his ‘germ team’ have discovered another deadly pathogen.
This week’s blog is a little shorter than usual because I am learning how to operate a different computer system. Am I allowed to blame my generation and my age, or are there thousands of silver surfers who may as well have PhDs in how to work a computer? I am afraid I am not one of them, so it is taking me a little longer; please bear with me.
Last week, I urged you to keep an eye on the volcano in Iceland, as locals were worried that their government was more interested in opening up tourism again than in protecting their civilians from a potential further eruption. Where have we heard that before? On Sunday 14 January, their worst fears were realised and there was another eruption. It would seem that once again, the locals were right.
With container ships now being rerouted around the Cape of Good Hope, my previous warnings of disruptions to the supply chain were also not in vain. Though today you may be seeing full supermarket shelves of goods, next week the picture may look different. Do you have a plan in case shortages occur? Do you have enough medication to get you through if your medicine is unavailable, and are you willing to be given an alternative that you may never have tried before? Please continue to check the patient information leaflet that should come with every medicine.
Until next week, keep looking up.
Then shall two be in the field; the one shall be taken, and the other left. Two women shall be grinding at the mill; the one shall be taken, and the other left. Matthew 24:40-41