Privacy issues and Plan B: the Canadian Pharmacists Association responds
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《加拿大医疗协会学报》
We find it surprising that CMAJ, an internationally respected medical journal, feels the need to create controversy at the expense of another health profession. In the December 6 issue, CMAJ dedicated 2 full pages to present its position that pharmacists' services are not professional or kept confidential, and that pharmacists should not be paid for the services they provide.1 An editorial published in late March regards the consultation a pharmacist provides regarding emergency contraception (EC) as treating women as "fair game for unwanted questioning and unsought advice — at their own expense" and refers to "a lingering paternalism in matters affecting women's reproductive health ... still hiding behind the counter."2 These 2 articles certainly come across as part of a continued campaign by CMAJ against pharmacists.
Pharmacists are highly trained health professionals who practise under regulations, standards of practice and a code of ethics similar to that of physicians. For CMAJ to hold the position that a pharmacist can't ask a woman for her name negates the relationship that they have with their clients. If a woman does not wish to give her name, pharmacists can use their professional judgment and still provide the drug. However, her name and address would be required in provinces where reimbursement is made under a provincial health plan.
Imagine the outrage if the Canadian Pharmacists Association (CPhA) were to suggest that doctors should not ask a woman her name if she is asking for EC, or that they not be paid for the service they provide. Further, for CMAJ to suggest that the information a pharmacist collects is not kept confidential is irresponsible. Any information provided is private, secure and confidential, which would not be the case if the product was available in a convenience store or supermarket. Pharmacists will dispense about 400 million prescriptions this year, many involving very personal information about treatment for HIV, sexually transmitted infections and mental illness, among other conditions.
CMAJ's position flies in the face of the medical professions' recognition of the importance of collaborative, interprofessional practice where physicians and other health care providers have a clearly identified and valued role. The CPhA does, however, recognize that CMAJ does not necessarily represent the position of the CMA, with whom we have a valued collaborative relationship aimed at improving Canada's health care system. In fact, CMA's response to Health Canada's consultation on EC indicated support for the regulatory change and Schedule II status "on the condition that the change in the prescription status of levonorgestrel not deprive its users of the opportunity for counseling and follow-up, which are critical components of the promotion of sexual health." The College of Family Physicians of Canada, the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian Nurses Association also supported this regulatory change and reviewed the CPhA guidelines and screening form.
The purpose of moving Plan B to Schedule II was to make it more accessible to women (thus reducing unwanted pregnancies and abortions), while still ensuring the appropriate level of counselling from a trained health professional. Pharmacists have no interest in a woman's sexual history except to determine if Plan B, which has maximum effectiveness for only 72 hours, is appropriate for their situation, as outlined in the assessment in SOGC's clinical practice guidelines on EC.3 The guidelines are not new and represent best standards of practice. A physician or nurse practitioner would ask a woman requesting EC the same questions. Many women who ask for Plan B have a lot of questions and misinformation, and appreciate the opportunity to speak with a pharmacist. Pharmacists frequently find that a fair number of women who ask for EC do not, in fact, require it and therefore do not pay for or use an unnecessary drug. When providing EC, pharmacists also routinely refer women to a physician for long-term birth control and screening for STDs.4
It is interesting that the article concludes by admitting that no women have complained to privacy commissioners. We believe that women are actually benefiting from pharmacist counselling on EC, and this is an issue manufactured by CMAJ to grab some headlines. The real health issue that CMAJ should be addressing is that in Canada 1 in 4 pregnancies ends in abortion. Increased access to emergency contraception with an opportunity for the woman to consult with a health professional can significantly reduce the number of unwanted pregnancies.
REFERENCES
Eggertson L, Sibbald B. Privacy issues raised over Plan B: women asked for names, addresses, sexual history. CMAJ 2005;173(12):1435-6
Emergency contraception moves behind the counter [editorial]. CMAJ 2005;172(7):845.
Society of Obstetricians and Gynaecologists of Canada. SOGC Clinical Practice Guidelines. 2003. Available: www.sogc.org/guidelines/pdf/ps131.pdf (accessed 2005 Dec 12).
Soon JA, Levine M, Osmond BL, et al. Effects of making emergency contraception available without a physician's prescription: a population-based study. CMAJ 2005;172(7):878-83.(George Murray)
Pharmacists are highly trained health professionals who practise under regulations, standards of practice and a code of ethics similar to that of physicians. For CMAJ to hold the position that a pharmacist can't ask a woman for her name negates the relationship that they have with their clients. If a woman does not wish to give her name, pharmacists can use their professional judgment and still provide the drug. However, her name and address would be required in provinces where reimbursement is made under a provincial health plan.
Imagine the outrage if the Canadian Pharmacists Association (CPhA) were to suggest that doctors should not ask a woman her name if she is asking for EC, or that they not be paid for the service they provide. Further, for CMAJ to suggest that the information a pharmacist collects is not kept confidential is irresponsible. Any information provided is private, secure and confidential, which would not be the case if the product was available in a convenience store or supermarket. Pharmacists will dispense about 400 million prescriptions this year, many involving very personal information about treatment for HIV, sexually transmitted infections and mental illness, among other conditions.
CMAJ's position flies in the face of the medical professions' recognition of the importance of collaborative, interprofessional practice where physicians and other health care providers have a clearly identified and valued role. The CPhA does, however, recognize that CMAJ does not necessarily represent the position of the CMA, with whom we have a valued collaborative relationship aimed at improving Canada's health care system. In fact, CMA's response to Health Canada's consultation on EC indicated support for the regulatory change and Schedule II status "on the condition that the change in the prescription status of levonorgestrel not deprive its users of the opportunity for counseling and follow-up, which are critical components of the promotion of sexual health." The College of Family Physicians of Canada, the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian Nurses Association also supported this regulatory change and reviewed the CPhA guidelines and screening form.
The purpose of moving Plan B to Schedule II was to make it more accessible to women (thus reducing unwanted pregnancies and abortions), while still ensuring the appropriate level of counselling from a trained health professional. Pharmacists have no interest in a woman's sexual history except to determine if Plan B, which has maximum effectiveness for only 72 hours, is appropriate for their situation, as outlined in the assessment in SOGC's clinical practice guidelines on EC.3 The guidelines are not new and represent best standards of practice. A physician or nurse practitioner would ask a woman requesting EC the same questions. Many women who ask for Plan B have a lot of questions and misinformation, and appreciate the opportunity to speak with a pharmacist. Pharmacists frequently find that a fair number of women who ask for EC do not, in fact, require it and therefore do not pay for or use an unnecessary drug. When providing EC, pharmacists also routinely refer women to a physician for long-term birth control and screening for STDs.4
It is interesting that the article concludes by admitting that no women have complained to privacy commissioners. We believe that women are actually benefiting from pharmacist counselling on EC, and this is an issue manufactured by CMAJ to grab some headlines. The real health issue that CMAJ should be addressing is that in Canada 1 in 4 pregnancies ends in abortion. Increased access to emergency contraception with an opportunity for the woman to consult with a health professional can significantly reduce the number of unwanted pregnancies.
REFERENCES
Eggertson L, Sibbald B. Privacy issues raised over Plan B: women asked for names, addresses, sexual history. CMAJ 2005;173(12):1435-6
Emergency contraception moves behind the counter [editorial]. CMAJ 2005;172(7):845.
Society of Obstetricians and Gynaecologists of Canada. SOGC Clinical Practice Guidelines. 2003. Available: www.sogc.org/guidelines/pdf/ps131.pdf (accessed 2005 Dec 12).
Soon JA, Levine M, Osmond BL, et al. Effects of making emergency contraception available without a physician's prescription: a population-based study. CMAJ 2005;172(7):878-83.(George Murray)