Blogs are not edited by PJ staff*. The opinions expressed in this blog do not necessarily reflect those of The Pharmaceutical Journal.
*Blog pieces that have previously been printed in the PJ and Clinical Pharmacist are edited.
By Lin-Nam Wang
This weekend, a man came into my pharmacy and handed me a black bin-bag.
Inside was £2,250.
Ok, so it wasn’t in cash, it was in medicines. To be specific, it contained, unopened, 30 boxes of Lyrica 75mg, 24 boxes of Tegretol Retard 200mg, 5 boxes of Tegretol CR 400mg, 1 box of Topamax 100mg, 1 box of Topamax 50mg, 15 boxes of Frisium, 1 tube of Eumovate, 3 boxes of paracetamol and various blister strips.
And here it is folks, in all its glory....
Why? (The Lyrica alone, at the prescribed dose of four bd, would have lasted the patient seven months.)
Then anger. Not at the patient, but at the fact that our system is still letting things like this happen.
I doubt very much that the patient was aware of the value of what she had been hoarding. And that is the crux of the problem. I don’t believe any patient would want to have to incinerate a 2000 BMW 3 series SR saloon (Exchange & Mart, 8 January 2012) or throw away a Cartier Love ring in pink gold and diamonds (Cartier website, 8 January 2012; BF take note if you’re reading!). Or to return tickets for a week on Paradise Island in the Bahamas (Lastminute.com, 8 January 2012; ditto BF!).
Some might class these items as luxuries so, in these days of belt tightening, let’s put it in perspective: we’re talking half a years’ worth of food and alcohol for the average family of four (at 2011 prices, Metro), my mother’s gas, electric and water bills for the year or, if you want to be virtuous, 132 cataracts operations (Sightsavers 8 January 2011).
I do come across the odd couple of hundred pounds of waste every now and then (ie, a 32-inch Toshiba widescreen TV [Amazon.co.uk, 8 January], my annual GPhC fee, the Marc Jacobs "hobo" bag in black and in orange [BF, again, take note!]) – and I’m sure you will have seen the same, but this has taken first prize in my book.
The patient, who had died, had been dispensed repeat prescriptions by the same pharmacy, over and over and over again. Some bags had not even been opened. There are so many holes in the net this patient could have slipped through. (Incidentally, I phoned the pharmacy and they told me the patient had never had an MUR so we can only guess if that would have changed anything.) Simply asking people to “please only order what you need” is not enough. And we can’t police people.
We need a different approach. It’s time to talk about the money. My money, your money, their money.
Human nature is such that when no value is attributed to something people take it for granted. In the world of pricing psychology, it’s believed that when something is free, people behave more irresponsibly (“Free is a Magic Number?”, Tim Baker, The Pricing Institute). On the rare occasion that the money side of things is mentioned, I find that patients are almost always surprised to know what their medicines cost.
The debate on prescription charges will continue but in the meantime, we could, at least, make costs clear. And we need to instil a better sense of civic duty in patients. Our dispensary computers already work out prices for private prescriptions and print these on the labels. How about adding some extra wording on labels? Something like:
“This box/course of medicine costs the NHS £XX. Please look after YOUR NHS: don’t keep more than two months' worth of medicines at any one time.”
It would be worth the extra printer ink.
We are so fortunate to have a system that allows free medicines. It would be interesting to know whether countries in which people have to pay have the same problems with waste.
We need some sort of campaign to make the public aware of exactly how much their medicines cost. This might slot in nicely with Government’s Big Society ideas. Who knows, maybe one day, pharmacists will be saying things like: “These tablets need to be taken every day for you to get the best from them. And, just so you know, each box is worth £28”.