One wrong foot after another: the ethics of the Pharmacy Guild’s deals

The Pharmacy Guild has a deal that encourages pharmacists to sign up patients to Pzifer’s support programs. Marcus Q

First it was the Pharmacy Guild’s deal with Blackmores that raised ethical concerns. Now it’s the Guild and Pfizer.

Both deals involve undisclosed payments from drug companies to Guild subsidiaries to ensure that dispensing software identifies certain prescriptions on which pharmacists are prompted to take action.

In the Blackmores case, to on-sell Blackmores “companion” complementary medicines with prescription drugs; in the Pfizer case to sign up patients prescribed nine Pfizer brand name drugs to the company’s “support” programs.

Pfizer Australia CEO John Latham has argued that their deal is totally different from Blackmores. Pharmacists are merely being paid a $7 “administrative fee” for the time taken to sign up a patient.

Latham said the deal costs the patients nothing and supports quality use of medicines.

Patients who sign up, for example to Pfizer’s cholesterol-lowering medication program, receive weekly emails, advice and access to support tools encouraging medication adherence, healthy diet and exercise.

So what’s wrong with that?

First, although pharmacists obtain consent for patient contact details to be made available to Pfizer, pharmacists apparently don’t inform the patient that they get paid for each referral.

In my opinion health professionals should disclose such remuneration as an integral part of obtaining informed consent.

Second, I believe that a drug company directly conducting such programs has its own conflicts of interest.

One of the patient support programs recommended, for instance, is for Pfizer’s blockbuster cholesterol-lowering medicine Lipitor (generic name atorvastatin).

This drug loses its patent early next year and will face intense competition for more cost-effective generic versions.

Although the disclosed aim of the Lipitor support program is to improve health outcomes, an undisclosed aim may well be to enhance brand loyalty.

The result could be that enrolled patients will be less likely to accept generic substitution when the Lipitor patent expires.

There’s good evidence that poor patient adherence to important medication can result in poor health outcomes.

There’s also evidence that certain interventions can enhance medication adherence.

However, in my view such programs should not be run by drug companies because their need to maximise profits (for example by promoting brand loyalty) may override the patients’ interests of swapping to a more cost-effective generic drug.

In addition, drug company “educational / promotional” material often maximises product benefits while minimising potential adverse effects.

It will not provide comparative information about the pros and cons of alternative brands.

My own preference is for patient information to come from independent sources such as the National Prescribing Service.

The Pharmacy Guild’s involvement in such schemes is equally problematic. The Guild’s membership includes 5000 owners of community pharmacies and while it provides a powerful lobby for owner’s self-interest it does not represent the many more professional pharmacists who have expressed concern about such deals.

For example, the pharmacists’ union - the Association of Professional Engineers, Scientists and Managers Australia have said the Pfizer deal was yet another example of the owners’ guild abusing the good name of pharmacists to boost profits. They have called for it to be abandoned. The Consumers Health Forum has also expressed concern.

The Guild national president, Kos Sclavos, rejected suggestions these programs could undermine the confidence patients have in pharmacists.

“These programs have been around for two decades,” he said.

However, times change and community and health professional attitudes also change. Some years ago one medical software vendor did a lucrative deal with a number of pharmaceutical companies to run advertisements for the latest and most expensive pharmaceuticals flashing up in doctor’s prescribing computers, all day, every day.

This caused a public outcry from both health professionals and consumers and it was ultimately abandoned both by the software vendor and Medicines Australia (the prescription industry body). The Code of Conduct of the latter now says, “Advertisements for prescription products must not be placed in any section of prescribing software packages.”

I would hope that the Pharmacy Guild and their dispensing software subsidiary will come to a similar conclusion about prompts from drug companies in their own software.