The February issue of the Drugs and Therepeutics Bulletin, a BMJ
journal,has an editorial entitled "Prescribing foods?". I regret that
despite my forty years of BMA membership and BMJ readership, I can only
read an abstract, as I am considered a 'non-subscriber':
http://dtb.bmj.com/content/51/2/13.extract
So I must also link to a Daily Telegraph article. It is by the DT's
Medical Correspondent,
who I can ass...
The February issue of the Drugs and Therepeutics Bulletin, a BMJ
journal,has an editorial entitled "Prescribing foods?". I regret that
despite my forty years of BMA membership and BMJ readership, I can only
read an abstract, as I am considered a 'non-subscriber':
http://dtb.bmj.com/content/51/2/13.extract
So I must also link to a Daily Telegraph article. It is by the DT's
Medical Correspondent,
who I can assume HAS read the editorial:
http://www.telegraph.co.uk/health/healthnews/9868852/GPs-wasting-millions-
of-pounds-prescribing-gluten-free-foods.html
It appears that the D&TB editors have taken exception to the cost of
treating coeliacs in the UK, quoted at £27M/year. They claim that
prescription
"inhibits competition meaning a loaf of Gluten-free bread can cost more
than £5, compared with £3 in Tesco". They further claim that prescribing
gluten-free foods is unnecessary as they are freely available in shops.
I would ask if these two male editors, for surely, like the PM who
did not know what milk cost, if they have any idea how much an ordinary
loaf costs
in comparison? (£1.40) Or why they consider that coeliacs, with an
unpleasant, lifelong diesease that can be complicated by osteoporosis,
infertility, dermatitis, lactose intolerance, other autoimmune diseases
and Hodgkins lymphoma or adenocarcinoma, and is successfully treated at
relatively low cost should not have that treatment on the NHS? And why
coeliacs should be singled out against diabetics (annual cost to the NHS
?9.6BILLION) or asthmatics (?1 billion)?
I do not defend the provision of 'pizza bases', nor that anyone who
makes a 'life-style choice' to go gluten-free should get their chosen diet
on the NHS. I just plead that clinically diagnosed coeliacs, who have to
work hard to avoid the gluten that creeps into foods of many types, may be
provided with a palatable gluten-free bread, Glutafin Fresh, that is NOT
available without a prescription.
Dr.John Davies, FRCA
Albert House
Haverbreaks
Lancaster LA1 5BN
Conflict of Interest:
First, I must declare an interest. My partner is a coeliac, who must rigorously avoid gluten because otherwise she suffers severe symptoms, abdominal pain, and diarrhoea.
DTB Vol. 50, No. 9, September 2012 - Prescribing perfectly
In your leading article on this subject you ask reactions. As a
retired pharmacist with a long standing experience in community pharmacy I
recommend the following:
There is no perfect prescribing as long as this is left to humans.
Computers may be of help but their output is as good as their input may
be. Humans are never perfect, even doctors a...
DTB Vol. 50, No. 9, September 2012 - Prescribing perfectly
In your leading article on this subject you ask reactions. As a
retired pharmacist with a long standing experience in community pharmacy I
recommend the following:
There is no perfect prescribing as long as this is left to humans.
Computers may be of help but their output is as good as their input may
be. Humans are never perfect, even doctors are not. The circumstances in
which they prescribe leave all chances for mistakes.
For that reason as early as the XIth century an independent and
separate task was given to the prescriber and the dispenser. In my opinion
this measure is the best safeguard to ensure good prescribing.
With to-day's many new drugs known as biologicals, it is almost
impossible for the prescriber to know all side effects or interactions.
Hence a close cooperation between prescriber and dispenser is very
necessary. This can be done over the telephone but sometimes it is
preferable that the two have a personal contact. The computer is not
always a reliable source of information. All side effects and interactions
and, eventually, the contra-indications will always be introduced later
than they got known.
In this country -the Netherlands- nearly everybody is linked to one
specific pharmacy. The advantage is that the pharmacist knows his patients
almost as well as their doctor. Through the regular FTOs
(pharmacotherapeutical meetings) organised by most pharmacists there is a
regular contact between the two groups. This is the base of a confidential
and professional relationship required for regular consultations.
This will in the long term result in far less prescription errors
than any highly advanced computer. Both groups nowadays cannot function
anymore without its help. But however advanced it is the human factor
which renders it successful.
And what applies to primary care should be copied in secondary care
in the same manner.
The recent DTB update on the drug treatment of neuropathic pain.
Part 2: antiepileptics and other drugs (DTB 2012;50:126-129) is a welcome
summary of prescribing, and a reminder of the poor quality of the evidence
behind the guidance.
However, it may be prudent to add a warning about pregabalin.
The Summary of Product Characteristics (SPC)(1) states: Cases of
abuse have been reported. Caution should b...
The recent DTB update on the drug treatment of neuropathic pain.
Part 2: antiepileptics and other drugs (DTB 2012;50:126-129) is a welcome
summary of prescribing, and a reminder of the poor quality of the evidence
behind the guidance.
However, it may be prudent to add a warning about pregabalin.
The Summary of Product Characteristics (SPC)(1) states: Cases of
abuse have been reported. Caution should be exercised in patients with a
history of substance abuse and the patient should be monitored for
symptoms of pregabalin abuse.
A review(2) carried out in Canada concluded that while pregabalin was
not likely to be abused by non-drug abusing subjects, it does have
euphorigenic activity and may be subject to abuse in susceptible
populations.
In recent years, it has become apparent that pregabalin is used
recreationally, with initial reports that it is widely traded in prisons.
This has resulted in prison prescribing guidance(3) cautioning against its
routine use. Recent local reports suggest that street use has now become
widespread, pregabalin is increasingly offered as an alternative to
heroin, and overdoses have been reported. It is discussed in detail in
online drug users' forums - www.bluelight.ru has a "Wonders of Pregabalin"
thread.
There are also increasing concerns regarding the difficulty in
withdrawing pregabalin. The SPC(1) warns of withdrawal symptoms which
include insomnia, anxiety, flu like symptoms and convulsions.
Prescribers should be aware of these issues when considering
prescribing pregabalin for neuropathic pain. Consideration could be given
to the off label use of duloxetine as an option for patients with a
history of substance misuse, as recommended in the prison prescribing
guidance(3).
1. Summary of product characteristics
http://www.medicines.org.uk/EMC/medicine/14651/SPC/Lyrica+Capsules/
2. Canadian Agency for Drugs and Technologies in Health: Abuse and Misuse
Potential of Pregabalin: A Review of the Clinical Evidence; April 2012
http://www.cadth.ca/media/pdf/htis/april-
2012/RC0348%20Pregabalin%20draft%20report%20Final.pdf
3. Royal College of General Practitioners & Royal Pharmaceutical
Society: Safer Prescribing in Prisons Nov 2011
http://www.rcgp.org.uk/news/2011/november/~/media/Files/News/Safer_Prescribing_in_Prison.ashx
The February issue of the Drugs and Therepeutics Bulletin, a BMJ journal,has an editorial entitled "Prescribing foods?". I regret that despite my forty years of BMA membership and BMJ readership, I can only read an abstract, as I am considered a 'non-subscriber': http://dtb.bmj.com/content/51/2/13.extract
So I must also link to a Daily Telegraph article. It is by the DT's Medical Correspondent, who I can ass...
DTB Vol. 50, No. 9, September 2012 - Prescribing perfectly
In your leading article on this subject you ask reactions. As a retired pharmacist with a long standing experience in community pharmacy I recommend the following:
There is no perfect prescribing as long as this is left to humans. Computers may be of help but their output is as good as their input may be. Humans are never perfect, even doctors a...
The recent DTB update on the drug treatment of neuropathic pain. Part 2: antiepileptics and other drugs (DTB 2012;50:126-129) is a welcome summary of prescribing, and a reminder of the poor quality of the evidence behind the guidance.
However, it may be prudent to add a warning about pregabalin.
The Summary of Product Characteristics (SPC)(1) states: Cases of abuse have been reported. Caution should b...