Radio Interview - Dr Glasson Discusses Morning After Pill Over the Counter Sales Up 60 Per Cent; Pharmacists Treating Patients With Depression

Some people said that it would encourage promiscuity, that in fact it was medically dangerous. There were all sorts of concerns but then there was the other concern that girls, young women, might not want to go to a doctor. They could get the morning after pill over the counter. In fact it might help a lot of them and in fact prevent a lot of unwanted pregnancies.

Well let me tell you in the past 12 months the sale of the morning after pill in Australia has gone up 60% and the Australian Medical Association is somewhat concerned about that.

Joining me on the line, the National President of the AMA, Bill Glasson. Good morning.

DR BILL GLASSON: Ross, good morning to you, mate, and all your listeners.

COMPERE: What's your concern … is it this pretty steep increase in sales?

BILL GLASSON: It is, mate. But the reality is that we came from a very low base. In other words Australia had a very low prescription-dispensing rate of the morning after pill or emergency hormonal contraceptive or whatever you like to call it, compared to say Britain and other countries around the world.

With all the, I suppose, publicity of this, as you said 12 months ago, I think people became aware of it. People know it's out there. And I think people now are asking for it.

Obviously if with this increase in dispensing of it - it was 60% - if that as I say was less unplanned pregnancies, less abortions, then you could argue that's a good thing.

But I suppose our message from last year was that we did not want this just to be a drug of convenience. We didn't want sort of women to, particularly young girls, decide to - you know Sunday morning that they should take this pill for whatever reason… and we should try and look at this from a holistic point of view. In other words not to trivialise women's health, to make women understand that okay attending to an unplanned pregnancy is one thing but the realities of sexually transmitted diseases, particularly Chlamydia, in the sense of affecting women's fertility later in life is a very important one as well as the psychological implications.

If you've got a strong religious conviction; if you're a young teenager or a young person brought up with strong religious views, it has huge psychological implications. So we wanted to keep it within the medical model. If it was going to be dispensed across the counter, then we want some incentive for the women then to see their doctor either the next day or next week to actually have follow up counselling, follow up advice as far as the possibility of having a sexually transmitted disease.

Now if that's occurring, we don't know. We haven't got the data. We don't know whether these women are actually getting the pill across the counter. We don't know how many of them are going to the doctor. And we don't know what the impact will be in the long term as far as, as I said, the incidence of diseases like Chlamydia which is probably the commonest reason for infertility.

And for women out there who are currently struggling to fall pregnant, it is a huge stress and anguish for them. So we'd like to make sure we treat women's health seriously and not trivialise it.

COMPERE: Of course at the time when it was suddenly made available over the counter, it was claimed that pharmacists would have a duty of care in that they would be expected to well counsel, or at least talk to anyone wanting to buy it over the counter without a prescription.

BILL GLASSON: Yes, that's right, Ross, and I think that…

COMPERE: Do you think that's worked?

BILL GLASSON: Well I'm not quite sure. I don't know - I'm sure most of the pharmacists out there are doing their very best to counsel people but we keep saying that, if you're sitting on a counter with three or four other patients next door to you or clients next door to you and suddenly you say to the young woman, well listen, you had unprotected intercourse last night; now the ramifications of this is you might get Chlamydia; you might get a whole lot of sexually transmitted diseases, blah, blah, blah…

Well look it's not the physical sort of facility to do it, number one. We don't think the pharmacists necessarily are trained to counsel particularly on an on-going capacity. And we think that the model should be that that patient should be referred back to their GP for appropriate advice and follow up.

Now there's no regulation that has to occur so it's at the behest of the pharmacist to try and do the right thing, which I'm sure most of them are trying to do, but it's very difficult when there's, I suppose, no other incentive apart from that to get the patient back to the doctor.

COMPERE: The other concern, Bill, as I recall was, okay if a girl or a young woman had this morning after pill, you know once every couple of years simply for one reason or another, okay. But there was a fear that some of them would be sort of serial users of it; it would become a convenience to them. They'd shop around the different pharmacies and get it and in the end it might impact on their health.

BILL GLASSON: That's exactly right. I mean this issue of this being a drug of convenience, I suppose that's the sort of term we'd like them to get across, if it's truly emergency hormonal contraceptive, we have no problem so long as it's kept within the medical model. If it's obviously being used as a drug of convenience, that you're using it a couple of time - two or three times a month, then obviously that is not in the interests of the women's health.

And so particularly in those cases, they could be identified and saying to the person concerned, well listen this is not in the interests of your health; we feel that you should or must go and talk to your doctor about this issue. And to make sure you get appropriate contraception. Obviously whatever you're on at the moment is not working or you're not taking it properly. Therefore you need appropriate contraceptive advice. And so go to your family planning clinic, go to your GP, talk about the issue so that this drug is used in a mature and appropriate way.

So I think that we've got still a lot of learning to do here. I think we need a lot more data to analyse what this 60% increase, how many of these patients actually have gone back to their doctor, how many of these scripts - these prescriptions have actually been dispensed from a doctor; how many have been dispensed across the counter without a doctor being involved at all.

So it is really a matter of trying to be, as I said, mature, and trying to make sure that we look after women in a holistic way and make sure that in five, ten years time these women aren't turning up at the infertility clinics saying, listen, I can't fall pregnant now because I've got Chlamydia or whatever disease that has led to my infertility.

COMPERE: Bill, just while I've got you on the line, there was a story yesterday, or a report yesterday that there's a proposal around to allow pharmacists to counsel customer, well, yeah, customers, who have depression and in fact issue anti-depressants to people without them necessarily going to a doctor.

BILL GLASSON: Yeah. I mean, Ross, obviously we've got - this is a similar view as the morning after pill, in the sense that the pharmacist, (a) they don't have the training, (b) they don't have the physical facilities to actually question you about your depression.

Because if you're depressed, you may need to just talk to somebody, talk to your GP, talk to your psychiatrist or your psychologist or whatever, you may not need a pill.

If you do need a pill, the important role of the pharmacist, and this is where to educate the pharmacists is important, to explain to the patient what this - that this particular drug is, what interactions it has with the other medication they're on, what side effects - and most of them do have significant side effects - what side effects they have. And so to actually build with the GP and the psychiatrist about their disease process, in other words, be part of a team, not be an independent person out there diagnosing depression and really, you know, it's just not appropriate.

I'm sure the average pharmacist doesn't want to get involved. This is the Pharmacy Guild, by the way, who's pushing this. And the average pharmacist is mature, they're professional and they know their role and they do their role really well. And we've got one group within the pharmacy organisation, called the Pharmacy Guild, which is out there trying to make pharmacists de facto doctors.

And the reality of that is if you're going to substitute people in the system, you substitute them as part of a team, where your GP is always the cornerstone to the system. You might have nurses, pharmacists, psychologists, et cetera, working as part of that team.

But the buck must stop with the GP, because he or she must be the one that controls the holistic aspect of the patient, because it's more than just having depression. The depression may in fact be due to a physical problem, they might have a thyroid dysfunction, or something physical actually leading to depression.

And so I think it's really going - trivialising, it's dumbing down the process and mental illness. And can I say, Ross, and use this opportunity, that if there's one issue, two issues I want to drive before I finish in the middle of this year, is one is the fact that we're not putting enough resources into mental health, the government is not putting enough resources in, full stop. And that and indigenous health are the two areas that this current government has to really target.

And so I think it's important we're talking about mental health… because I come from the bush, and I've got more of my mates out there who have committed suicide than have been killed in car accidents. And most of those are because they've got this macho image, they're male, they're in the bush and particularly indigenous males, they don't go to the doctor.

So we want to educate people, educate the community about the importance of the fact that each and every one of us during our lifetime will have a mental disease. We will. It will be some form of depression, or some sort of reaction of depression. We'll have it. It's a normal part of life to have some sort of depressive illness. We have to indicate to the community about that and have to normalise it, to make sure that if I've got a problem, I go and talk to my doctor about it.

You may talk to your pharmacist, don't get me wrong, your pharmacist will say, 'listen, Bill, I think you've got a problem here, you need to go and talk to your GP about this. You appear to have possibly some sort of depressive illness', but not to actually diagnose me and say, 'here's an anti-depressant'. Well, that would be, you know, going back in the Dark Ages.

So I'd suggest the Pharmacy Guild pulls its head out - pulls its head out of that avenue and let the pharmacists, the true professionals, actually do what they do best and that's be pharmacists.

COMPERE: All right, thanks, Bill.

BILL GLASSON: Thanks, Ross.

COMPERE: Thanks, Bill, for your time. Good to talk to you.

Bill Glasson, National President of the Australian Medical Association.