In 1941 Finland’s leaders, having fought the Soviets to a draw on the latter’s grab for the south-eastern pocket of the country, re-invaded the lost territory when Germany invaded the USSR. This reversed on them, and the USSR looked to take the whole country. Ordinary Finns cursed their fascist-friendly leadership, looked east, looked west and… acquiesced to an alliance with Germany.
I know their feeling whenever I think of the Australian pharmacy question.
Look east and the big chains — Chemist Warehouse, My Chemist and Ramsay — are licking their lips for a taste of that huge prescription drugs market that would destroy the independent pharmacy. Look west and the independent pharmacists make a motza from geographical limits to competition, and then pour donations into the Liberal Party coffers.
The big chains can offer real discounts on basic drugs, which is pretty important, especially for those on disability benefits. Now Health Minister Greg Hunt is reviewing the regulations which protect independent pharmacies from what would otherwise be the bone-crushing impact of the chains.
But to be fair, these regulations have the appearance of absurdity. The blanket restriction is on prescription and some over-the-counter meds being pharmacy only. This means that someone with Type 2 diabetes can’t pick up a spare box of Metformin — a dead-common non-lethal medication — but three 7/11 visits can get you a lethal dose of painkillers.
Even more arcane are the geographical rules. These limit how many pharmacies can be in a given space; a set of rules redolent not so much of the grand old days of regulation Australia, as of medieval guild rules on the use of the adze. This in particular can leave country towns with a single pharmacist, with concomitant higher prices.
The 2015 Harper review of competition targeted pharmacies for the liberating effects of competition, to a limited degree. Now with the five-year review on, the big boys are making a fresh push to abolish both the general pharmacy monopoly on prescription medicines, the ban on pharmacies being in or attached to supermarkets, and the spatial limits on number. Look east, look west and decide… that you have to support retaining regulation.
The independent pharmacy is a vital community resource, and it’s worth subsidising a bit of unearned value to protect them as an institution.
The Harper review and subsequent representations to the current ministerial review make the point that protected independent pharmacies are unique to Australia. That is disingenuous. In the UK, Boots has a near monopoly; in the US, CVS and Walgreens dominate. But that’s the free-market Anglosphere. France has no chains whatsoever due to regulation, and northern Europe had state-run pharmacy systems until recently.
As an observer and a user of all these systems, I’m here to say thank God we kept ours. The US and the UK chains, with their consolidated stores and larger staffs, have destroyed the particular and incommensurable relationship between pharmacist and client. Staff turnover, back-officing of actual pharmacists, and store architecture employing high-walled barriers and limited staff-client interface have trained people to expect nothing other than their cash transaction — with a rattled off series of questions at the end (“have-you-used-this-before-are-you-using-anything-else…” at high speed).
Many pharmacists (more in the UK than the US) do give their customers time and care — but they’re on the clock, and they know the chains employ mystery shoppers to calibrate throughput.
The same effect can be seen in Australian chains. The prescription area is at the back, high-walled, with “leave” and “pick up” booths, and different assistants taking, filling and giving out. They will give advice on particular conditions, but they lack the time and the space to go into any length, as an independent pharmacist does. Since part of the protection and subsidy is payment for pharmacists to extend that time, the big chains’ model appears designed to limit the customers’ ability to acquire such.
This is the form of value — more abstract in measurement, more direct in application — that the burr-headed carb-powered calculators of the Harper report cannot identify. For one immediate role of independent pharmacists is clearly to head off, with extended encounters, unnecessary GP visits for rashes, sprains etc. If Australia were to lose say half its independent pharmacists to chain replacements, GP visits would go up.
But there’s a wider sense in which independent pharmacists provide social capital, and that is simply as a continuity anchor. With the family GP — their whole career in one place — largely gone pharmacists provide a continuity because they have a commercial incentive to stay in the same area over decades. The unspoken truth is that independent pharmacists have a casual community role for the aged and lonely, the very ill and the beaten down.
In my observation, pharmacists encountered socially tend to have a politics somewhere around that of General Rommel, but tend to treat the ill in their shops with kindness and consideration (yes, I know some of them are filling 15 scripts, but still). That doesn’t happen in a Chemist Warehouse.
In the broadest sense, independent pharmacies anchor a sense of locality — and we have lost so much of that with Keating’s universal acid of “competitiveness” that has eaten away shared life (and Labor’s base) — that it’s worth holding on to what we have and rebuilding it, rather than further destroying it for the ravenous interest of the chains, and the self-fulfilling power grab of neoliberal economists.
Indeed an expanded role for independent pharmacists — to be able to extend prescriptions for simple chronic medication, statins, blood pressure, blood sugar meds, without a GP visit — would take strain off the GP system. This would bring them closer to being genuine healers.
If the chains take over, the profession more or less disappears — less Finland, more Poland.