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Week-in-Review Guest Editorial: DTP...OFT...OMG!

In the final Week-in-Review for 2007, PMLive's guest editor is Jim Thomson from the European Alliance for Access to Safe Medicine (EAASM), who reveals his reactions to the OFT report into direct-to-pharmacy models adopted by a number of pharmaceutical companies

The Office of Fair Trading (OFT) has struck a blow for patients. Indeed, it has struck two: it has warned of (and therefore prompted action on) the risks of badly implemented direct-to-pharmacy (DTP), while identifying the benefits of DTP (potential and existing). Well done.

It is interesting to note that the immediate reaction to the OFT findings, was to suggest that the DTP model could cost the NHS (and, obviously, health services across Europe and beyond should it be implemented there) "hundreds of millions." 

There is nothing quite like the word "millions" to strike fear into the hearts of governments and economists alike, in equal measure. There is also talk of patients having to wait for their medicines. As a patient safety advocate, these were my immediate concerns when I first heard of the DTP initiatives. I was so concerned that I immediately rang the company promoting the model, to seek assurances that supply would not be interrupted and that costs would be maintained.

Of course every delivery model has the odd hiccup, but I haven't noted an epidemic. Perhaps the reality lies beneath the headlines. Let's take a look.

The OFT voices concern as a result of DTP that, price increases could ensue. It advocates a strengthening of measures to ensure they don't. The very last thing that anyone wants is more expensive medicine. I applaud the OFT for championing this concern and for recommending on behalf of patients, measures to protect against it.

That said, to assume that DTP is about pricing alone, is to completely miss the point. The OFT is right to raise its concerns over pricing but interestingly, when examining the possible consequences of DTP (price increases and shortages) it uses the same word twice. That word is "could".

DTP "could" increase prices. Has there been any evidence of this and if so, to whom?  The patient? I think not. DTP "could" result in shortages. Have patients really had to wait for essential medicines?  Has the real-life experience of the patient worsened?  What is pretty obvious is that DTP "could" and more importantly "does" increase the security of the supply chain. 

In the absence of effective communication to the contrary, it is likely that patients naturally assume that their medicines leave the point of manufacture and arrive at the pharmacy unmolested. In reality, this is akin to believing in the Teletubbies.

What DTP does (and, as a patient it is my fervent hope that those companies that have been preparing DTP programmes but awaiting the outcome of the OFT investigation, now move into overdrive) is add security to the supply chain. This is the security that patients deserve and, as importantly, that doctors crave.

12th December 2007

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