March 13, 2007
Viagra, the impotency drug, is one of a growing range of prescription-only medicines that can be bought over the counter from chemists. While patients might welcome the change, many doctors are deeply concerned.
Here, Dr Richard Vautrey, a GP in Leeds and a member of the British Medical Association’s GP committee, explains why:
Can you imagine queuing at the pharmacy counter, among scores of Saturday morning shoppers with their bottles of shampoo and boxes of plasters, to explain you’re having a bit of rather personal bother and could they sell you something for impotence, please?
Not only can you buy Viagra, the impotency drug, without a prescription, but people are also being encouraged to buy heart medication, high doses of hormones and an increasing range of other potent medications over the counter.
Supposedly, it’s less fuss - and less embarrassing - than going to your GP, but it does make you wonder if we doctors are being increasingly sidelined.
You can see why the Government wants to encourage cutting out the middle men. You, the patient, will be paying for your drugs: this will mean a smaller NHS prescription bill for the Government; fewer trips to the surgery for patients and larger dividends for the pharmaceuticals’ shareholders.
For instance, the contraceptive pill, which is free from your GP, could soon be available over the counter - but you would possibly have to pay the full price.
Levonelle, the so-called morning-after pill, costs about £24 over the counter, but is free from your doctor.
At £50 for four tablets, Viagra is quite a luxury purchase at Boots. Most men are not eligible to get Viagra on an NHS prescription, and instead I’m obliged to give them a private prescription. However, four tablets will cost about £20 - that’s less than half the pharmacy’s price.
By avoiding a trip to the surgery, you’ll be paying more in cash. More importantly, though, will you be paying more in missing early detection of other, more serious, problems?
When women choose to obtain the contraceptive pill through their GP, they can be sure they are using the right drug for them, and that this method of contraception is the most appropriate for their needs.
Doctors can remind women about cervical smears - and, unlike the pharmacist, perform them.
We can keep a check on all sexual health concerns. These could be missed opportunities when you buy the Pill over the counter.
Then there are statins - clever drugs that really seem to lower levels of bad cholesterol and genuinely prevent heart disease. There was immense excitement when these went over the counter in 2005.
If you have cardiovascular risk factors, your doctor will probably put you on 40mg a day. But if you go to the pharmacist instead, they will sell you Simvastatin at a dose of 10mg a day - their only option.
There is a real question mark over how effective such a low dose is, yet there is a risk that anyone who is self-dosing on statins will assume they can relax now they are taking ‘one a day’.
They may not even bother to change the rest of their lifestyle - cutting back on alcohol, smoking and fatty foods, taking up exercise, and having regular blood pressure checks at the surgery. This could cost them their lives.
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And although drugs bought at your pharmacist are safe, they must still be handled with care.
Viagra can’t be mixed with certain heart drugs, such as nitrates, because it is believed the two can counteract each other. Statins can occasionally upset normal liver function. This is a cause for genuine concern.
As a GP, I will know what my patients have already been prescribed. But how can a pharmacist be sure he is being told the truth? After all, patients don’t have to show ID before they make a purchase.
The group most at risk with Viagra - those with heart problems, taking nitrates - may have the most reason to avoid telling the pharmacist their full history.
And if they fear that revealing what drugs they are on will cost them the chance of the drug they crave, are they all going to do the honest, sensible thing? In the U.S., the pharmaceutical companies can advertise their branded products to the public. Is that the next step here in Britain?
Currently, your GP can act as an honest broker, well placed to advise you on which drugs are suitable. We can give patients the best possible independent advice about whether a drug would be right for them to use; or, indeed, to advise against taking any drug at all if we think lifestyle changes might be more appropriate.
Drug companies exist to make money, and their priority is to encourage as many people as possible to use their particular products. We can protect patients from this pressure and discourage you from using drugs that will do you little good - or, potentially, could do you harm.
I worry that with more and more drugs - from statins to mild antibiotics, to perhaps even the contraceptive pill in the future - being handed out by pharmacists, we are weakening our whole system of general practice.
GPs base decisions on wide knowledge and comprehensive, lifelong practice records. This enables them to work in a preventative as well as a reactive way.
But stop telling us what drugs you’re on, and how can we serve you as well as we do now? And as drugs become more readily available, there is a serious risk that people will turn to them too quickly and too often.
GPs rarely hand out cough medicine and vitamins on prescription, because there is no good evidence they work - but these things sell in huge numbers in pharmacies.
If we learn to turn to drugs too quickly, without giving other treatments or lifestyle changes a chance, we may not find the real answer to our problems - and we will certainly waste a lot of money.
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