Is community pharmacy on a road to nowhere?

If the community pharmacy sector wants to work better with other healthcare providers, something has to change.

Health Minister Greg Hunt recently announced that the Federal Government rejected many of the proposals in the King review of the community pharmacy sector.

This means for example that pharmacies will not be required to separate alternative remedies, including homeopathic products, from evidence-based medicines.

Community pharmacy owners want to be taken seriously as healthcare providers yet, at the same time, they continue to behave like a commercial interest group.

Recent actions of the sector, such as the pro-codeine lobby, raised many eyebrows. Political donations and backdoor lobbying are still the norm in this industry.

Chemist shop model

“The Guild looks forward to continuing our close dialogue with the Government on all matters to do with the sector and community pharmacy’s role,” said Pharmacy Guild President George Tambassis in response to the announcement by Minister Hunt.

And the Guild’s David Quilty stated: “When it comes to pharmacy, the Federal Government has taken the very reasonable approach that when something works very well, why tinker unnecessarily with it?”

These responses speak for themselves.

The question is, does the chemist shop model work ‘very well’, or is it relying on lotions and potions, anti-competitive regulation and protection, lobbying and political donations to stay afloat?

In the Financial Review Stephen Duckett commented, “Once again, the power of sectoral interest groups in Australian health policy is exposed.” And, “Once again, the public interest has lost out.”

I couldn’t agree more.

I’m looking forward to the day the community pharmacy sector shakes its retail sales focus – we need more team players and collaboration.

A victory for common sense (and patient care)

Yesterday Sonic Healthcare pulled out of their deal with Sigma’s AMCAL pharmacy chain to sell blood tests to pharmacy customers. I believe it was a wise decision to withdraw from this so-called ‘screening program’.

Just think about it. If it is up to AMCAL pharmacies their customers will be able to purchase for example a vitamin D blood test for $89.50 to ‘screen’ for vitamin D deficiency.

Initially the president of the Royal College of Pathologists of Australasia (RCPA) said: “They are all valid tests and they can all be done on patients without symptoms or abnormalities in those areas.”

But look at the recent Choosing Wisely recommendation by the RCPA:

Vitamin D screening

The RCPA’s position statement on the use and interpretation of vitamin D testing also clearly states: “The testing of healthy individuals will reveal a significant subgroup with low 25OH‐D (vitamin D) levels. This leads to treatment and perpetuates repeat testing without information as to whether such patients will benefit from vitamin D supplementation.”

Although I am sure that AMCAL’s ethical standards would not have allowed staff to push vitamin D pills for customers with low levels, I understand why Sonic has withdrawn from the initiative as it wasn’t exactly the best example of ‘screening’.

It looks like it was just about commercial stand-alone pathology testing without pre-agreed collaboration with doctors. There was no medical involvement or integration with other healthcare providers and the out-of-pocket costs for patients would have been high – with no Medicare rebate.

I imagine there were also some ethical dilemmas. Take the RCPA’s Code of Ethics, which contains the following principle:

To protect patients from harm. This includes commitment by each individual to the achievement and maintenance of clinical competence and professional standards; to referring issues beyond their clinical competence, scope of practice or accreditation; and, taking appropriate action when the conduct or lack of competence of others places patients at risk of harm.”

I really like the online RCPA library. For example, I found an excellent document titled ‘Making sense of testing; a guide to why scans and health tests for well people aren’t always a good idea.’ It explains why and how testing can cause harm (see image).

Why and how medical tests can cause harm
Source RCPA Library: ‘Making sense of testing; a guide to why scans and health tests for well people aren’t always a good idea.’

The RCPA Code of Ethics further urges fellows and members of the pathology college to “maintain professional integrity” and to “recognise and eliminate conflicts of interest that interfere with free and independent medical or scientific judgment.” As it happens, the President of the RCPA is also CEO of one of Sonic’s pathology companies.

I congratulate Sonic Healthcare on its decision and I’m pleased to see that a corporate giant in Australia seems to have made the decision to follow ethical principles instead of prioritising commercial interests over professional standards. Let’s see what the pharmacy sector will do next.