§ LORD ARCHIBALDMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
§ [The Question was as follows:
§ To ask Her Majesty's Government whether, under the National Health 3 Service (a) dispensing chemists (and medical practitioners who dispense their own medicines) are permitted to dispense medicines and pills without labelling them in such a way as to make contents and dosage recognisable by the patient; (b) dispensing chemists are instructed not to label medicines with their contents and to obscure, or remove, the labels affixed to proprietary brands of medicines, and, if so, what is the reason for this; and whether Her Majesty's Government do not agree that, in the case of patients whose condition calls for the use of a large number of different pills and medicines, there is a grave danger that failure to label them may lead to patients taking the wrong drugs or the wrong dosage.]
THE EARL OF ONSLOWMy Lords, the arrangements which Her Majesty's Government make under the National Health Service with pharmacists and doctors for the dispensing of medicines are on the general understanding that professional services will be provided according to the normal practice in their professions. It follows that pharmacists and doctors are not given any permission or instructions as suggested in (a) and (b) of the Question.
As regards point (a), Her Majesty's Government understand that a pharmacist would regard it as professionally incorrect, either in private or National Health Service dispensing, to label medicines to show the nature of their contents unless instructed by the doctor to do so. The dosage would be shown on the label if the necessary instructions were given by the doctor on the prescription. In the absence of such instructions, the pharmacist would indicate on the label that the medicine was to be taken as directed by the prescriber.
As regards point (b) of the Question, Her Majesty's Government assume that the reason for removing or obscuring the name of a proprietary preparation is that the pharmacist has not been instructed by the prescriber to disclose the nature of the preparation. I might add that very often some of these preparations come out of much larger containers, and a few tablets or a small amount of liquid medicine is put into the private bottles of the chemist, and the label added.
4 It is understood that where a number of items are prescribed for the treatment of a patient the doctor would normally indicate on the prescription the amount and frequency of the dosage of each item. In accordance with the practice I have already explained, the pharmacists would reproduce these instructions on the label. The patient should consult the pharmacist if he has difficulty in distinguishing between the various items or in interpreting the written directions; and should consult his doctor if he cannot recall any verbal instructions.
§ LORD ARCHIBALDMy Lords, while thanking the noble Earl for his answer, may I ask whether he will ask his right honourable and learned friend the Minister of Health to give this matter further consideration? Would he accept from me that this is not just a personal idiosyncrasy expressed in the question, because judging from the number of people, including Members of your Lordships' House, who have commented on the difficulty they themselves have encountered in this matter, it seems to be a very widespread problem. Would he ask the Minister to consider that in modern dispensing there are quite a number of pills, for example, which, to the lay person, are quite undistinguishable one from another but which are intended for very different purposes, and if it so happens that a patient suffers from two different complaints requiring these two different pills it is very easy for a mistake to be made. I do not want to go into detail but I am simply asking at this stage that the Minister should be asked to look at this question again to see whether a practice could not be laid down which would be safer for the lay patient.
THE EARL OF MORLEYMy Lords, on this question of removing proprietary labels or of simply putting "To be taken as directed", may I say that it is a very dangerous practice indeed. I have several bottles marked "To be taken as directed" but I have not the faintest idea what they are, and doctors have had to look at them very carefully before they could tell me what they are. It is very very much more simple if the proprietary label is left on and there is put at the back how often it is to be taken. I have twice found myself taking the wrong bottle.
THE EARL OF ONSLOWMy Lords, I am sorry for my noble friend behind me; and I hope he does not make that mistake again. I understand it is not a question of defacing the bottle. If, for instance, one bought aspirin it would have the maker's name on it. It is a question of these pills and liquid medicines being made in bulk and dispensed in the chemist's own bottles. Of course my right honourable friend the Minister and his Department, and all doctors, always strongly advise people to destroy any medicines left over when they have finished a course of treatment for a specific illness of which they have been cured; and they advise that for the very reason that people may sometimes think, "I have a headache and had these pills three months ago; I will take one of those". But the headache may have quite a different cause and require a different medicine. That is why everybody is advised to destroy left-over medicines.
§ LORD ARCHIBALDMy Lords, I suggest that the reply we have just heard does not touch the point I was making. I was not dealing with medicines left over at the end, but with medicines absolutely similar in appearance being used at the same time for a course of treatment. When the prescription is handed in at the chemists, the patient gets two little white boxes which are marked "The tablets, to be taken as directed". I am not concerned about "taken as directed", for it is a matter for the doctor; but if two similar medicines are being used simultaneously, to put on each "The tablets" is not satisfactory. I am asking that that point should be looked into.
THE EARL OF ONSLOWCertainly I will draw the attention of my right honourable friend to what the noble Lord has said.
§ LORD DOUGLAS OF BARLOCHMy Lords, may I ask the noble Lord also to invite his right honourable friend to consider this from the point of view that if the patient does not know what the medicine is that he is getting, and in an emergency has to go to some doctor other than the one who has prescribed the medicine, he may be given something which is entirely incompatible with the medicine he has been taking.
THE EARL OF ONSLOWMy Lords, that is slightly wide of the present Question, but again I will draw the matter to the attention of my right honourable friend. However, I understand that often in the opinion of the doctor who has treated the patient it is not wise for the patient to know the exact ingredients of a particular pill or medicine he is given.
§ LORD STONHAMMy Lords, would the noble Earl be prepared to reconsider his statement about throwing away surplus medicine? Many medicines are suitable for recurrent bouts of the same illness. Would it not be wise to label them so that in the interests of economy they should not be thrown away but kept for later use?
THE EARL OF ONSLOWObviously, in some cases there are pills which would be kept, but it is wise on the whole, as I think most noble Lords would agree, that a strange medicine chest full of all sorts of odds and ends dating back to your great grandmother, is generally better destroyed than kept.