Drug dealing

I have a headache today. It is the kind of headache I’d associate with a morning after a late night drinking whisky around a camp-fire, characterised by the sensation that the meninges that cover my brain are peeling away from the inside of my skull. Last night I sat outside drinking pints of water reading about the history of the stomach. I do not think this headache is self inflicted.

I do think it is related to the ulcer inside my lower lip that has been there for the last 10 days. I know the ulcer is a sign of a worn down immune system due to late nights fretting about the healthbill and soothing crying children. I know that there is nothing I can do to speed up my recovery, no gels or ointments to put on my ulcer, nothing to boost my immune system. The claims of the drug peddlars mean nothing to me. Only a tincture of time, hopefully only a few more days, will resolve the ulcer and fatigue.

My headache however is another matter. I know from past experience that 2 paracetamol are curative and will see me comfortably through my afternoon surgery and with this in mind I went to a pharmacy. Like every doctor I know, I immediately scanned the shelves for the cheapest, generic version. Pharmacies are an interesting comparison to GP surgeries because in terms of culture and practice they have travelled further down the road that leads to free-market health-care consumerism. That same road we are all being shepherded onto with barely audible bleats of protest or criticism from people educated enough to know better.

I rarely go into pharmacies and I was struck by the amount of glitter on the packaging. It was like looking at cheap jewlery through my steamed up, post cycle ride glasses. Eventually I found the paracetamol. In search of a bargain I looked at the large pale-blue box with a picture of familiar white tablets on the front, but this was £2.75 for 24 dissolvable tablets. I was hoping not to pay more than 2p per ordinary 500mg pill. Further along the shelf was a booklet type packet with a green and yellow cover with silver edging at £1.79 for 14 caplets. Next to it was a similar packet with added red exclamation marks: £2.49 for 14 ‘rapid melt caplets’. I stood there for a couple of minutes before going to the counter and asking for a box of their cheapest paracetamol, 79 pence for 32.

It is all paracetamol. It all does the same thing, but it varies enormously in cost from just over 2 pence to just under 18pence per 500mg. The cheapest version was hidden behind the counter. The expensive versions were laid out at eye level in the main part of the store. The cheapest version is in a light-blue box, the expensive versions are in multi-coloured booklets with reflective covers.

About twenty percent of my patients do not speak english and about 10% are barely literate. Over 100 have learning difficulties, many more left school without qualifications. A large proportion of my patients are chronically anxious. It is very, very easy to take advantage of people like this.

And yet while I was pondering all this at the counter, a stressed young woman in a suit put down £1.79 by the till and waved a packet of 14 paracetamol melts at the pharmacist before hurrying out of the shop.

If we are so easily manipulated with something as simple as paracetamol, is it really so difficult to predict the dangers that await as we travel further down the seemingly one-way road of medical consumerism?

7 responses to “Drug dealing

  1. It’s much the same with bottled water – “The Pure Market.”

    http://witchdoctor.wordpress.com/2009/07/24/alan-milburn-and-the-pure-market/

    In my neck of the wood, the pharmacist, if not too busy, might have been moved to do a mini-consultation – asked about what other tablets I was on, offered advice on how to take the paracetamol, not to exceed the the stated dose etc. Goodness, they might even have asked about my liver! This would all have been a bit of a pest. Nevertheless it gives the opportunity for a qualified professional to point out that there was a “choice” – a cheaper preparation that would have exactly the same effect. How often do professional pharmacists, tied into multinationals, do that? Not very often nowadays I would guess. I would guess too that this is the way of all flesh, and that the medical profession too will succumb to the commercial pressure of their employers if the Health and Social Care Bill becomes law.

    I hope I’m wrong about this.

  2. Yes, it’s bad. I buy cheap supermarket-brand paracetamol, about 1p per tablet — that isn’t hidden, and I think my local pharmacies don’t hide theirs. Ibuprofen’s worse, people buy expensive Nurofen or whatever thinking it’s special… . And probably more people buy it, because they’re scared of paracetamol.

  3. Excellent and neat example of what happens when market forces are brought to bear on health care. Far from competition driving down prices, the market has encouraged branding (and leveraging added value, or whatever it is that the suits do), and so increased prices and profits. Might even make a good Apprentice task:

    Teams assemble. Lord Kruger arrives on an elevated cherry-picker. Nick and Karen are clipped to the sides of the cage. Nick is squinting, Karen has her I’ve just sat on a drawing pin expression, Kruger is scowling.

    Kruger: I’m giving each team 1000 paracetamol tablets, wholesale price 0.00001pence per tablet. Don’t swallow them all at once.

    Teams twitter nervously.

    Kruger: You’re going to take those tablets, dress them up into something fancy, and flog’em to retail chemists. The team that makes the most money will win, and in the loosing team, one of you will have to swallow all the left over tablets. All clear?

    Teams (in unison): Yes, Lord Kruger…

    Teams exit at the double. Kruger can be heard in the background, muttering: “It’s a shambles, a complete bloody shambles…”

  4. You’re advertising Healthspan Glucosamine.
    From their site –
    “Healthspan offer pure, pharmaceutical grade vitamins and supplements, at permanently low, tax-free prices, direct to your door at no extra charge.”

    Ha ha ha
    Sorry, that wasn’t funny. It’s just it’s all so prevalent

    • It happens all the time. I couldn’t have designed it better myself. Marketing subverts itself, continually adopting counter-cultural habits to sell us more stuff we don’t need in the belief that we’re actually doing something rebellious. By having adverts all over my blog for drugs and private healthcare I’m turning that on its head; inviting the mindless compulsion of capitalism to advertise itself. Bring it on.

  5. I’m a pharmacist with my own pharmacy. We sell as cheaply as we can, because we expect to see our patients all their lives. I have no interest in fleecing my friends. I also hold the quaint old-fashioned view that my degree was paid for by UK taxpayers because I had a grant, and they’re entitled to something back for that investment, like free advice on demand.
    But you get the pharmacy you deserve, so if you value a pharmacist’s help, find one you like and support him or her. I can only provide free advice if people bring me paid work now and again. Don’t assume supermarkets are cheaper – they often aren’t – and ask for what you want. When you’re picking a medicine, mouths work better than eyes.

    • I don’t thiink all pharmacies are the same, nor that phamacists are to blame. I think that one perversity of markets is that market values take precedence over social values too often, and that is a recurring theme of this blog. I gave up supermarkets for lent last year and haven’t been back. As for tax-dodging Boots … I gave them up years ago. I think that human relationships are a vital part of human happiness and social flourishing, something far more common in small owner run businesses than the corporate world. Thanks for your thoughts.

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