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Australian Journal of Pharmacy : February 2005
news news HE Australian Medical Association (AMA) has continued its aggressive stance against pharmacy, attacking the Pharmacy Guild of Australia on the capa- bility of pharmacists to supply emergency contraception over the counter and deliver support services for depressed peo- ple in rural and remote regions. AMA president Bill Glasson said that a 60 per cent increase in sales of the emer- gency contraceptive levonorgestrel (Posti- nor-2) pointed to it being used as a drug of convenience, thus highlighting inade- quate training received by pharmacists. Yet this is despite recently published research that demonstrated no increase in unprotected sex when levonorgestrel is available over the counter. ‘We don’t think the pharmacists are trained to counsel, particularly on an ongo- ing capacity,’ said AMA president Dr Bill Glasson to 3AW’s Gary Warnecke. ‘And we think that the model should be that that patient should be referred back to their GP for appropriate advice and follow-up.’ He said the AMA was concerned that they had no way to ascertain the pro- portion of these women referred back to doctors. However, a recent US trial has shown no difference in the rate of unprotected sex or patterns of normal contraceptive use between women who bought OTC emergency contraception, women given a supply in advance, and women who obtained it at a family planning clinic. The researchers wrote in the Journal of the American Medical Association that the data supported the previous scientific litera- ture, which showed that among young, sexually active women, unprotected inter- course led to the use of emergency con- traception, not the reverse. Mr Glasson also slammed a new pro- ject aimed at examining whether phar- macists can help treat depression in coun- try areas with shortages of doctors and mental health workers. He said the project would trivialise and AMA attack on pharmacy continues T ‘dumb down’ mental illness and its treat- ment. He said the project was being pushed by the Pharmacy Guild, which was ‘out there trying to make pharmacists de facto doctors’. ‘Your pharmacist (may) say, “listen, Bill, I think you’ve got a problem here, you need to go and talk to your GP about this”. ‘To actually diagnose me and say “here’s an antidepressant”...would be going back to the Dark Ages,’ he told 3AW listeners. ‘I’d suggest the Pharmacy Guild pulls its head out of that avenue and let the pharmacists, the true professionals, actu- ally do what they do best and that’s being pharmacists.’ Pharmacy Guild of Australia director of rural and professional services, Lance Emerson, said that ‘the AMA obviously hasn’t taken the time to understand this project, and has once again gone off shooting from the hip. ‘This project is all about improving medication management of depression and the pharmacist’s role in optimising medication use for those already diag- nosed by their GP. ‘I’ll repeat: pharmacists and the Guild have no interest in diagnosis, and we have told the AMA this time and time again.’ The depression support program being referred to involves researchers from Charles Sturt University (CSU) and Syd- ney University, who have recruited 37 NSW pharmacists and divided them into two groups. One group will be trained in managing depression, and the other left untrained. Feedback from the two groups’ depressed patients will be analysed. ‘If the AMA believes that this is not an appropriate role for pharmacists, then what is?’ Mr Emerson asked. ‘People with depression in rural areas deserve the best care possible, by all the members of the health care team, so we see this as a deserving area for investigation.’¦ Higher pregnancy chance with overweight women on the Pill O VERWEIGHT or obese women have a much higher likelihood of becoming pregnant while taking the oral contraceptive pill, US researchers have found. The study, published in the January issue of Obstetrics and Gynaecology, found that overweight women were 60 per cent more likely to become pregnant while on the Pill, and obese women were 70 per cent more likely. The researchers, from the Fred Hutchinson Cancer Research Center in Seattle, compared the weight and body mass index (BMI) of 248 Pill users who became pregnant, and compared them to 533 women who also took the Pill but had not become pregnant. 68 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 FEBRUARY 2005 ‘If causal, this association translates to an additional two to four pregnancies per 100 women-years of use among over- weight women, for whom consideration of additional or effective alternate contra- ceptive methods may be warranted,’ the authors wrote. They said that the higher pregnancy risk also translated into several obesity- related complications of pregnancy, including gestational diabetes, high blood pressure and Caesarian delivery. Possible reasons for the higher likeli- hood of Pill failure included the increased metabolism seen in overweight people, which could shorten the Pill’s duration of action. An increased hepatic metabolism in obesity was another possible factor. ¦