Fintan Moore contemplates the impact of weight-loss drugs, around the waistline and beyond
It is no exaggeration to say that the GLP-1 weight-loss drugs have been the most significant medical initiative in recent decades in terms of societal impact. Patients with obesity who had given up on any hope of shedding excess weight have been thrown a lifeline, and the results for a lot of them have been life-changing. The lost weight has yielded improvements in diabetes, heart disease and blood pressure, not to mention stress on knees and hips. Overall, the contribution of these drugs to the health of the population has been more positive than negative.
That is not to say that the picture is universally rosy. You don’t have to be a hardened cynic to make the observation that despite several years of promotion of ‘body positivity’, the message dropped off the radar screen overnight when drug-induced skinniness became an option. I suspect there’s a quiet raging battle going on throughout the Western world between the marketing departments of Big Pharma and their counterparts in Big Junkfood. And both of these industries have behemoth budgets compared to the funding available for any Government campaigns to help pre-school children develop healthy eating patterns rather than automatically becoming the next generation of cannon fodder as consumers and patients.
Then when we think about side- effects of the GLP-1 drugs, the ones that spring immediately to mind are linked to the GI system, such as nausea and diarrhoea, but there’s another possibility that is statistically relatively rare, but worth being aware of.
It’s a disorder of the optic nerve known as non-arteritic anterior ischaemic optic neuropathy (NAION). This is a syndrome caused by a decline in blood supply to the optic nerve, characterised by the sudden and painless loss of eyesight in one eye, which can lead to permanent blindness. The odds of getting this are low — about one-in-2,000 patients using Semaglutide will develop it in two years, but when you consider that we have 1,800 pharmacies nationwide and the average pharmacy probably has 40-to-50 of these patients, then we’re looking at about 50 cases per two years, or one for every 35 pharmacies. Those are high enough numbers to make it worth keeping at the back of your mind if a patient mentions eye trouble.
Taking the tablets
Every now and again in the running of a pharmacy, somebody will come up with a bright idea to make things run a little bit more efficiently – even something as simple as buying an extra pair of scissors to have one on every workspace can save a bit of wandering around the dispensary.
Some ideas can sound like the brainchild of somebody with a touch of OCD – I insist that prescriptions getting filed in a bundle are folded with the name to the outside rather
It’s a disorder of the optic nerve known as non-arteritic anterior ischemic optic neuropathy (NAION)
than the inside, so it’s easier to locate a particular rx if needed. But every so often a useful improvement lands in your lap as an unintended consequence.
For instance, I had used the Tracelink system for FMD scanning ever since the verification snake slithered into the garden, but they are about to leave the Irish market, so I’ve changed over to Touchstore. The set-up for both is similar, in that a standalone tablet can be used for the display rather than having the information cropping up on the dispensary PC.
However, Tracelink ran on an Android tablet, whereas I had to get a Windows- based tablet for Touchstore, which left me with a spare tablet. So we’ve kept it just for checking Healthmails, because at least one in every 10 phone calls we get is from somebody asking if a prescription has come in.
Now the person taking the call can grab the tablet rather than having to use one of the PCs and don’t have to interrupt the PC workflow.
Slightly pregnant
Despite decades of working with the rules of the PCRS, they can still always find ways to short-change me on payments. Items can have a GMS code that makes them look like a perfectly normal item, until you get a rejected claim and discover that they require prior patient-specific approval, or else they are covered on GMS but not DPS (or vice versa), or are subject to some nebulous maximum allowable quantity per month or per year.
Even when I think I know the rules, I can still find ways for them to screw me over. I recently gave five boxes of diabetic test strips to a pregnant patient with a Coombe Hospital prescription, forgetting that her GP needed to approve them first.
The following month, she also needed insulin and I thought that any patient on insulin was automatically entitled to extra strips — wrong again. That works for regular diabetic patients, not gestational diabetes patients. Anyway, her GP has now arranged approval, but there is still the niggling irritation that there is no retrospective payment for the rejected claims.
After all, the patient was pregnant and needed the strips irrespective of whether or not the approval was in place, so natural justice would see the reclaim being paid.
Sadly, it’s not a natural or just world!
Fintan Moore graduated as a pharmacist in 1990 from TCD and currently runs a pharmacy in Clondalkin. His email address is: greenparkpharmacy @gmail.com.
