MHRA, the government agency which is responsible for ensuring that medicines and medical devices work, and are acceptably safe recently issued a new advice for children’s over the counter cough and cold medicine ( link ). The landmark finding is that these over the counter cough and cold medicine simply don’t work in children under 6 and should no longer be used. If anything, they are more likely to cause side effects. This follows on from the previous recommendation for cough and cold medicines in children under the age of 2.
Bookapharmacist.com welcomes this report from MHRA (which demonstrates clarity from the top) but it has implication on how we, as front line practitioners in community practice, manage this change in practice. Some of us have somewhat questioned the ‘true’ efficacy of these drugs. After all, we were thought in the school of pharmacy that cold and flu has a viral origin and is self limiting. As an example, a customer is recommended paracetamol but the symptom is still there and then requests another product for cough and cold. The patient takes these medicines and start to feel better. The patient automatically associate the ‘feeling better’ to new medication rather than the self limiting nature of the condition. We now know that the products doesn’t work.
Why might the medicine work for children over 6?
We suspect a placebo effect whereby the key determinant is the symbolism of giving a treatment rather than the medical value. If you are under 6 (or thereabout) then such symbolism is less significant. However, such symbolism is not lost on the very concerned mother who, due to conditioning, expects a medication for her child. So, the medicine may not make the child better but the parents will be happy that they are doing something!
We are aware at bookapharmacist.com that a number of our colleagues are responding by not selling these medicines at all. We absolutely understand this point of view but we will like to offer another viewpoint:
- We think the key point here is for us (as pharmacists) to undertake a patient awareness campaign at every opportunity.
- Denying supply at this stage will only alienate our patients, whose cooperation we need for this transition to work.
- Why was it OK to buy these product yesterday and not today? A nanny state perhaps ? (These are real questions ringing in the patients’ head)
- We can use the power of supply to drive home the change in attitude to these medicines.
- PAGB has produced 2 set of patient information leaflets which can help manage our customer’s expectation:
- The parents need a lot of reassurance that they are doing the right things for their children.
- Even the MHRA says: “….in the meantime existing medicines will continue to be sold as before”
We must avoid knee jerk reactions to these situation and use our unique position to manage what will undoubtedly be an important educational campaign which is not going to be easy simply because we have encouraged a culture of over-prescribing. Medicines are valuable tools in our armoury in combating diseases, but they are definitely not the panacea.
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MHRA Alerts
On a separate issue, we identified a MHRA class 4 Alert with respect to lithium December 2008 ( link ). We think pharmacist working in the community need to tune in to these alerts as they maybe critical in some situation. Did you know you can receive e-mail alerts by visiting the MHRA website ( http://www.mhra.gov.uk ), click on Safety Information tab and follow the link to alerts.
Register there and you can start to receive your own e-mail personalised alerts right away…..why wait?
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The Royal Pharmaceutical Society of GB has produce a Law and Ethics Bulletin update. The update can be reviewed by clicking here