Outsider: Valproate is a disgrace happening in real time

Thalidomide happened in the 1960s. Why are we repeating the same mistakes with valproate now? 

I’ll be honest: my original plan for this month was to devise some clever analogy linking the success of the English test cricket team and failure of the Australian side to the despair and frustration community pharmacy contractors are experiencing.

But now I’m not because I’m cross. Halfway through writing this, I sat down to eat my tea and the regional BBC news led with a story about sodium valproate. 

How is this still happening? It’s been almost 20 years since the first peer-reviewed articles linked valproate use in pregnant women to serious harm and birth defects of unborn children.

It’s been 10 years since the MHRA issued guidance to prescribers and pharmacists that valproate should not be given to women of childbearing age without serious consideration of the potential harms.

Yet as I type this, women are speaking out about the harm caused to their children due to being supplied valproate medicines whilst pregnant.

The Hippocratic oath is simple: first do no harm. Of course, pharmacists are not medics and certain historians debate the veracity of some of the things attributed to Hippocrates. Certainly, Kos is not the hotbed of medical ethics it used to be.

But one thing is clear. If the regulator of medicines has issued multiple warnings in the last decade, it is inexcusable that in 2023, women of childbearing age are still being supplied valproate inappropriately and that that supply is causing harm. 

I wanted to write about the challenges pharmacy faces with the emergence of the new commissioning structures. I wanted to write about the time it takes for people to bed down in their new roles; that some people in their new positions will be competent and some will struggle. There is a significant discussion to be had about how NHS reorganisations take more time to fix themselves than the things they were reorganised to fix. 

I also wanted to talk about supervision and ‘Professional Leadership’. After all, the commission has just reported. But I’m not going to. Instead, let’s talk about the lack of leadership in this. 

Community pharmacists are supplying a medicine to potentially pregnant women that can cause birth defects. Forty per cent of the time. This is not the 1960s or 70s. This is 2023, and the tragic effects of Thalidomide are supposed to be a thing of the past. But just because valproate babies don’t have missing arms or legs doesn’t mean they are not seriously harmed. So where is the professional leadership in this?

Is my email inbox full of alerts from my leadership body, or my union, or my trade representative about this? No.

All I get are offers for discounted fridges or a new generic medicines loyalty deal. What I actually need is to be slapped around the face with a huge wet fish and told to get a grip and not cause harm to babies.

Now, alongside all of this there is a massive NHS restructure occurring and bedding down. The formal adoption of Integrated Commissioning Boards is a thing. I gained my pharmacy degree when years still started with a number one, making this the fifth or sixth major structural reorganisation of the NHS that I have experienced in my working life.

Lansley was responsible for probably the most calamitous shake-ups of commissioning, and there is still an awful lot that needs to be said about that.

However, there is no point in my writing about this umpteenth restructure or making witty asides on cricket scores when the simplest, most basic thing pharmacists and community pharmacy can do is being ignored.

Women should be able to be supplied medicines from a pharmacy without fear that it would harm an unborn child. Everyone should be able to access care from all parts of the NHS without fear that they would suffer harm.

Every single dispensing system operated by pharmacies will show a warning prompt when labelling a prescription for a valproate. It will require an active click through. It will then, most likely, print a label as an additional warning.

Yet women and children have still been harmed. And continue to be harmed. Who is clicking through these warnings? Who is ignoring these printed labels?

Community pharmacy faces many challenges over the coming months and years. It may or may not be true that we are in an existential battle for our place in primary care and the medicines supply infrastructure. Millions of people visit community pharmacies every week and they expect and deserve to receive safe and effective care. 

Medicines malpractice is something you learn about at university – it shouldn’t be something you live through. It’s time to make sure the harm caused by valproate stops.

Outsider is a community pharmacist