Adding price tag to packs headline grabbing gimmick

Adding the price tag to prescription medicines worth more than £20 in England is just a “headline grabbing gimmick,” which, among other things, could potentially mislead patients into believing that cheaper drugs are somehow less important, says an editorial in Drug and Therapeutics Bulletin (dtb).
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On 1 July this year, health secretary for England Jeremy Hunt announced plans to print the indicative cost of medicines on all packs of those worth more than £20 alongside the phrase “funded by the UK taxpayer.”
 
The initiative aims to encourage more people to take personal responsibility for the use of finite public resources, added to which the health secretary claimed that the move would help cut waste and improve patient care as more people would be inclined to take their meds.
 
But dtb is unconvinced. There is no evidence to back the move, nor does such a strategy feature in any national or international guidance on ways of making sure people stick to their prescribed drug regimen, it says.
 
Sticking to a prescribed course of drugs can be difficult even for those who pay for their prescriptions, it says, adding that the approach could have several unintended consequences.
 
These include worrying elderly or vulnerable patients, such as the mentally ill, who may see themselves as a burden on society and consequently not take their medication, or leading people to view cheaper drugs as less important, says the editorial.
 
Last year, the average cost of medicines dispensed in England was £8.32, with drugs costing under £20 comprising a far higher volume than those costing more than £20, it says.
 
“Although there is no link between the NHS price of a medicine and its clinical efficacy, we believe that there is a risk that the price might be misinterpreted as an indicator of the medicine’s value,” says the editorial.
 
“A patient taking a number of drugs may gain a biased understanding of their treatment, with inexpensive drugs used for heart disease being considered less important than a high cost drug used to treat pain,” it continues.
 
Furthermore, the price of a drug may not represent the true cost to the NHS, because some cheap drugs are expensive in terms of the monitoring and follow up they require, the editorial points out.
 
There are practical considerations, as well, says dtb, including who is going to foot the cost of the changes required to the packaging. And many containers are already small, making it hard to include the mandatory dosing information and warnings, let alone anything else, it says.
 
Further crowding of the container with extra words could make other far more important information less clear, and potentially lead to mistakes being made, it suggests.
 
Improving a patient’s willingness/ability to stay the course of treatment requires some investment, in terms of the time needed to have an informed two way discussion with the patient, and this may ultimately be far more useful than simply including the price tag on the container, says dtb.
 
“The most expensive drugs are the ones dispensed but never used, and it is not clear that this headline grabbing gimmick will do anything to improve adherence,” it concludes.
 
Very little evidence for cutting out certain carbs to ease irritable bowel
 
Value of FODMAP diet, developed in Australia to curb symptoms, questioned
 
There is very little evidence to recommend avoiding certain types of dietary carbohydrate, known as the FODMAP diet, to ease the symptoms of irritable bowel syndrome, or IBS for short, concludes a review of the available data in Drug and Therapeutics Bulletin (dtb).
 
IBS is characterised by abdominal pain/discomfort and altered bowel frequency in the absence of any obvious gut abnormalities. Symptoms can include abdominal bloating, which eating can worsen.
 
Up to one in five of the population is thought to be affected, with women twice as likely to develop IBS symptoms as men.
 
Treatment options include dietary and lifestyle advice, psychotherapy, and drugs to curb painful spasms and associated diarrhoea and/or constipation.
 
Dietary advice usually includes the recommendation to reduce intake of insoluble fibre, limit fresh fruit to three portions a day, take regular meals, avoid rushing food or eating on the go, and to steer clear of the artificial sweetener sorbitol.
 
The low FODMAP diet, which was developed in Australia, is based on the observation that certain types of short chain carbs are poorly absorbed by the small intestine and that IBS symptoms worsen when these are eaten.
 
These short chain carbs are present in wheat, onions, and legumes; milk; honey, apples, and high fructose corn syrup; and the artificial sweeteners used in confectionery (sorbitol and mannitol). They are rapidly fermented in the gut, increasing water volume and gases.
 
After assessing the available published evidence and the three UK guidelines on the management of IBS, dtb says that all the trials provide some evidence that patients feel the diet reduces some of the symptoms.
 
And one study indicates that the diet changes the profile of the bacteria in the gut, although what the clinical implications of this are, or, indeed, what the long term effects might be, are unclear, says dtb.
 
But data to back the use of a low FODMAP diet as an effective treatment to control symptoms “is based on a few relatively small, short term unblinded or single blinded controlled trials of varying duration,” it cautions.
 
And dietary manipulation is not without its drawbacks as some people fail to maintain a balanced diet when trying dietary exclusions, says dtb.
 
While some guidelines suggest that a low FODMAP diet might be appropriate for motivated patients for whom other treatments have failed to relieve symptoms, this should only be done under the supervision of a dietitian with specialist expertise in this type of dietary intervention, it recommends.
 
And it concludes: “However, we believe that patients should be advised that there is very limited evidence for its use, the ideal duration of treatment has not been assessed in a clinical trial, and its place in the management of IBS has not been fully established.”