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Lizards, Easter eggs and saving community pharmacy

Outsider contrasts the rosy past with the current stark realities

Putting pen to paper just before the Easter holidays, our anonymous correspondent dreams of better days… and then remembers the realities of the present 

Picture the scene. It’s Easter Sunday. You’re in the middle of a blessed four-day weekend with no rota cover in sight. The day is your own and dinner has not only been served but greedily demolished.

You stagger from the dining table to the couch, full of roast meats, chocolate and regret. Flicking through the channels on your TV, you settle down to an obscure American channel showing reruns of sitcoms. It will do as background noise. During one of the commercial breaks, an advert for the latest lizard movie franchise is played, followed soon after by the natty, yet penetrating chords of Ian Bairnson’s double necked electric guitar. Oh-oh-oh it’s magic, you know. Or as it’s better known to anyone who’s watched American TV in the last few years – Oh-oh-oh-Ozempic.

Ian Bairnson – a Shetlander who would go on to perform the guitar solo at the end of Kate Bush’s debut Wuthering Heights – and a couple of Bay City Rollers stand-ins were once in a band called Pilot. Their single Magic is now one of the most recognisable jingles on American TV and certainly the most famous chord progression in medicine.

Direct to consumer marketing in the UK is nowhere near the level it is in the US, but it does exist – even if it’s not technically allowed. You can’t walk into a rest room at a service station or sporting venue and not be regaled by an advert for erectile dysfunction, hair loss or weight loss. They may be obfuscated behind a condition-based service, but there’s only one endpoint in these things and it’s always a big brand, first-to-market pharma company product.

While it may not have been the first to market, semaglutide, of all the glucagon-like-peptide receptor agonists (GLP-1s), is taking the world by storm. It was widely reported in the aftermath of the Academy Awards in March that these were the “Ozempic Oscars” due to the slimmed down appearance of the stars in their fashion house glamour. Social media was awash with guessing who was, and who wasn’t taking it.

Twenty years ago, you could well have worked in a pharmacy with a weight loss service, but it was worlds apart from what is now possible. Back then, these services were either based on crash diets and overpriced milkshakes or a three-times-a-day capsule, where the first sign of it working was faecal incontinence. Today, you can offer a weekly or monthly injection that is, well, magic.

Pharmacy is great. That lizard movie trailer you dozed off in front of… the Gila Monster is a beaded lizard, about a foot long, native to northern central America. It has a painful (but rarely lethal) venomous bite, described as being like “hot lava running through your veins”. The venom contains many bioactive peptides, and one of them is exendin-4, a glucagon-like-peptide receptor agonist whose synthetic equivalent exenatide was first isolated in 1992.

There is now a huge market for direct-to-consumer medicine of a specificity and potency never before possible (though often claimed). This is an incredible opportunity for community pharmacy, should it be able and willing. The innate nimbleness and extended accessibility community pharmacy offers compared to other providers, even online, should see the sector triumph.

Indeed, some providers already are. Alongside the big brands advertising in men’s toilets, there are already innovative pharmacists using GLP-1s alongside continuous blood glucose monitoring and other lifestyle interventions to offer transformative services to patients. All with no faecal incontinence!

It’s exciting. It’s one of the most exciting fields in community pharmacy since, well, I don’t recall. It’s also fast paced, which means the science and evidence is rapidly developing. Let us hope the regulatory environment (and the regulator) can keep pace.

Sadly, the fever dream of venomous lizards, 1970’s pop and the conceit of saving community pharmacy must end and a stark reality emerge.

You awake on the Tuesday to find community pharmacy just where you left it. Bereft of leadership and befallen by IT failures that bedevil the latest, greatest flagship service.

No synthetic lizard venoms to be seen here. Not a Scottish power pop tune to be heard. Only the continuing failure of the Pharmacy First IT infrastructure, hampered by bad planning, bad timing and a stunningly obtuse introduction of multi-factor authentication.

Integrated Care Systems are increasingly frustrated by community pharmacy’s ability to shoot ourselves in the foot on this one. It certainly isn’t helping us become more integrated. Pharmacy First referrals should be easy, and they’re anything but. Oh-oh-oh-it’s – damn I need to verify my log-in doesn’t quite have the same ring to it. 

Outsider is a community pharmacy commentator

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