Some were shocked in January when the president of the Pharmacy Guild of Australia, Trent Twomey, reportedly called GPs “twits” in a speech to students in Canberra and the Royal Australian College of General Practitioners responded with a statement calling his language “astonishing” and his lobby group “out of control”.
Pharmacy Guild president Trent Twomey.Credit: James Brickwood
In the historical context, though, this little bout of sparring – over giving pharmacists the power to prescribe some medications – was not that unusual.
Doctors and pharmacists have been at each other’s throats since they were separated into different professions in the Middle Ages: one typically diagnosing and prescribing, the other concocting and selling, a state of affairs that has led to friction and occasional outright conflict, such as we have recently witnessed, ever since.
In his scholarly 1992 article for the journal Pharmacy in History, David Cowen pegs the first recorded spat to 1271, when the medical faculty of Paris complained that apothecaries, as they were then called, were encroaching on its turf, and the apothecaries in turn accused the doctors of selling medicine. Relations were only to deteriorate from there.
In 1553 the Lyonnaise doctor and writer Symphorien Champier called apothecaries “deceivers, quid pro-quoers, pirates and cheaters” who were stupid, bungling, prone to falsifying ingredients “and killing off patients before their time”.
A pharmacist responded with a “declaration of the abuses and ignorances of physicians”. A physician subsequently described the typical apothecary as “long-gowned, wraith thin and stinking of urine”.
There was a brief easing of tensions in 1880 with the American publication of a book of advice for young doctors that urged them to be “just and friendly toward every worthy pharmacist”. But “such instances of good will”, writes Cowen, “were deceptive; patterns of behaviour, friction and antipathy, of hundreds of years, were not easily altered. The physicians were constantly and vocally critical of the pharmacists, and the pharmacists returned the criticisms in kind.”
The latest flare-up is once again about territory, sparked by schemes around the country to allow pharmacists to prescribe a small range of medicines such as treatments for urinary tract infections.
The doctors, unsurprisingly, are having nothing of it. “This is actually a business grab as opposed to a healthcare model,” Dr Nicole Higgins of the Royal Australian College of General Practitioners told Sky News in February, suggesting the federal government should explore using supermarkets and even vending machines to dispense prescription medicines – anything, really, other than giving pharmacists more power.
The doctors are now also calling on the federal government to double the amount of medication available on a single prescription. This follows a 2018 recommendation from the Pharmaceutical Benefits Advisory Committee that said 60 days’ supply should be available for 143 medicines used to treat chronic conditions, which would free up doctors’ time and save patients from unnecessary and increasingly costly appointments just to have their regular scripts renewed.
The rub for pharmacists, though, would be fewer return visits from customers, since they could buy double the supply of medication on each occasion. Again unsurprisingly, the Pharmacy Guild is having none of it. As health reporter Natassia Chrysanthos writes, Trent Twomey has reached out to all federal MPs claiming double-length prescriptions would be dangerous – potentially causing supply issues – and warning of “the usual vested interests in the powerful medical lobby”.
All par for the course, really. Which is a pity, given that many of these ideas seem pretty sensible and could probably work well with a little fine-tuning. Pharmacists could reserve the right to moderate the supply of some critical medications, for example, and doctors could in turn cede them limited power to diagnose a handful of agreed-upon everyday conditions. Given the history here, though, don’t expect a truce anytime soon.
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