Much of the chronic illness we see all around us is caused by eating too much (and in particular, sugar and salt), drinking too much alcohol, abusing psychoactive drugs, and cigarette smoking. These are lifestyle choices that the individuals in question CHOOSE TO PAY FOR. So, it seems to me that a case can be made to incentivise the changing of these lifestyle choices by requiring patients to pay a nominal prescription charge for their medication. I have long believed that a nominal 50p per item charge for everyone, perhaps capped at a maximum of four chargeable items per prescription would go some way to addressing the calls we are now hearing for people to take more responsibility for their own health. A nominal charge of perhaps £10 or £20 should also be payable for use of accident and emergency services, but that is another story. These charges would be no different to the "excess" that we all are expected to pay in respect of car or home insurance.
To sensationalise the issue by referring to people making choices over whether they should eat or pay for "essential medicines" being used to treat "life-threatening conditions" appears to me to miss the point. Medication may well extend the life of patients with lifestyle-related chronic ill health, but it is not in any sense an "antidote" to the "poison" they are paying for and self-administering. Yes, the NHS has enabled us to live longer with our chronic ill health, but that is not the same thing as saying that, thanks to the NHS, we are all able to enjoy a healthy and productive old age.
In dermatology, when a patient presents with an avoidable condition such as contact dermatitis, they may be prescribed medication to treat the acute symptoms, but they are always also advised to avoid future contact with the offending substance. Patients will almost always comply with this advice / instruction. Similarly, patients whose illnesses are caused by gluten or peanuts or lactose, or even by their prescribed medication will all want to avoid future contact with the offending substance. Yes, this may happen because the cause and the unpleasant effect are easily linked in the minds of the patients. But when the unpleasant effect of the offending substance does not occur for months and even years (whilst pleasurable effects occur immediately) the unwillingness of patients to change their lifestyle / behaviours is perhaps understandable. But, if the NHS is truly to deliver "patient-centred care", healthcare practitioners should be prepared to tell patients the "brutal truth" when it is their overindulgence that is evidently the cause of their medical problems. And they have similarly to advise patients that the first step must be to address the overindulgence, and that treatment of symptoms with medication should be contingent upon the patient first taking ownership of the problem and addressing the cause of their illness. After all, why bother visiting a GP at all if you do not prepared to take advice and show that you are serious by paying a nominal prescription charge? And indeed, why have we bothered spending all those billions of pounds on medical / healthy living research only for the outcomes to be ignored?
So, the common-sense approach in my view is to charge everyone a nominal sum for their prescription items, not to hand them out free of charge. The behaviour change that the 5p plastic bag charge in Wales initiated shows that a nominal charge for a prescription item could well change not only behaviour but also the health of the nation for the better.
Comment on: The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance
Experiments in rats established many, many years ago that "the more you eat the sooner you die". In the human context, this should now be refined to read "the more [sugar] you eat the sooner you die".
And since that first experiment in rats, billions have been spent on carrying out research into diseases that are ultimately caused by glucose (and indeed other reducing sugars) reacting with amino groups on amino acids (for which read "proteins") to form Schiffs bases that then, through a couple of further irreversible chemical steps (Maillard reaction), become "advanced glycation endproducts" (dubbed, for obvious reasons, AGEs). AGEs wreck proteins; those structural proteins that turn over most slowly in the body are the ones that take the biggest "hit". The chemical mechanisms by which this occurs are well described in the literature. The only way in which AGE production in the body can be slowed is by reducing dietary sugar intake and hence minimising the probability that the first Schiffs base reaction, which is reversible, does not progress to the downstream reactions leading to AGE formation.
The medical professions seem unable to advise patients that notwithstanding the billions that have been spent on drug research into symptomatic treatments for the diseases ultimately caused by AGEs, and despite all the medication that we pharmacists dispense in good faith, the best "medicine" is simply to eat less ... in particular to eat / drink much less sugar (and to move about more).
I have to admit to being baffled by the GPhC view that the distinctness of the professions of pharmacist and pharmacy technician needs to be emphasised to the extent that a pharmacist will no longer be able automatically to register as a pharmacy technician.
Currently, the pharmacy technician skill set is a subset of the pharmacist skill set. A pharmacist should be able to perform all of the tasks performed by a pharmacy technician but in addition is able to carry out a clinical assessment of prescriptions (and other clinical / prescribing activities). In a similar way, the skill set of a dispensary assistant is a subset of the skill set of a pharmacy technician. And the skill set of a medicines counter assistant is a subset of the skill set of a dispensary assistant.
But when would a pharmacist ever seek registration as a pharmacy technician? I would suppose that this might happen when a fitness to practice issue has been identified that has resulted in the pharmacist's registration with the GPhC being suspended or erased. In this case, it might be appropriate to not allow automatic registration instead as a pharmacy technician. But otherwise, the default position should be that a pharmacist is, by definition, competent to perform all duties expected of a pharmacy technician.
It is not easy to discover exactly what the supposed differences are between the "pharmaceutical-grade" chondroitin sulfate used in this study and the allegedly inferior "nutraceutical-grade" materials used in earlier studies. Neither this study nor any of the earlier cited studies provides any meaningful comparative analytical data on the chemical compositions of the chondroitin sulfate products used. The reader is simply asked to accept that "Chemical analysis of purity and active ingredient content of a randomly selected sample of the active study treatment capsules was conducted by an independent laboratory (Chemika, Australia) immediately after delivery of each batch of study treatment capsules to the dispatching centre. At each analysis, purity and stated active ingredient content was confirmed." I would characterise this as a serious failure in both the reporting of these studies and in the peer review of this and the earlier manuscripts!
I'm not sure I understand the logic of restricting non-essential amino acids in the diet. Tumour cells are unlikely to be monoclonal so will [probably] be able to find a way of circumventing shortage of an amino acid such as serine that can be synthesised. This is why monoclonal antibodies used as anticancer agents are unlikely by themselves ever to produce total remission of a cancer, but that is another story. Glycine shortage would present a higher hurdle to overcome. An alternative and perhaps more practical strategy that is worth exploring, which occurred to me many years ago when I was carrying out research in the field of oxidative stress, would be to totally eliminate vitamin E and vitamin C from the diet. Vitamin E protects cell membranes from disruption by "reactive oxygen species" [ros] that are inevitably produced by living / dividing cells as they extract energy from fuel molecules. Vitamin C regenerates vitamin E when it has taken an oxidative "hit" from a ros. So, dietary vitamin E + vitamin C depletion should produce a metabolic environment where dividing cells self-destruct – an effect not dissimilar to that produced by cytotoxic agents that target dividing cells. The main problem would be to devise a diet that is totally deficient in vitamins C & E. The answer might be to just eat grilled oily fish and absolutely nothing else for a couple of weeks or longer. If I am not mistaken, oily fish (salmon; mackerel; etc) contain neither vitamin C nor vitamin E.