Editorial: Good idea to free up obesity drug

A decision to permit pharmacy sales of the weight-reducing drug Xenical is to be welcomed. When Xenical was available only on prescription, doctors were heard to complain that its heavy advertising was putting them under pressure from patients wanting to try it. Now, lo and behold, the Medical Association is disappointed that it will be available over the counter. Doctors, it says, have a better understanding than pharmacists of a patient's overall health.

By all accounts, the drug is not hard to understand. It works by inhibiting the body's absorption of fat. If a person takes the drug and continues to eat fatty food the consequences will be unpleasant. That does not seem difficult for a pharmacist to explain, or a patient to comprehend. The drug must be accompanied by a careful diet.

Too many drugs are restricted for the sake of the rare patient who might misunderstand or wilfully misuse them. In this case people with eating disorders such as anorexia are said to be at risk if they have easier access to Xenical. The Ministry of Health's medicine classification committee was not persuaded that the drug would be abused by such people, or that it would cause significant harm if they did take it. The manufacturer, Roche, is more cautious. It plans to require chemists to record sales and will instruct them that the drug is to be supplied only to adults over a specified level on the body mass index.

It is in chemists' interests to ensure that their customers understand any drug sold across the counter. It was not so many years ago that the Pharmacy Guild was fighting moves to deregulate its own industry and arguing that their ethical dispensing would be undermined if general retail chains such as The Warehouse were allowed to set up discount pharmacies. In fact, pharmacies can survive supermarket competition, just as wine shops are doing, by selling reliable advice on the product.

General medical practitioners, in turn, can offer advice superior to a pharmacist's and for that reason their business is hardly threatened when a drug is removed from the prescription list. GPs will know the customer's personal condition in a way that a pharmacist will not, and GPs might more readily advise non-pharmaceutical solutions to minor illness. In the case of Xenical, they point out that the ideal response to excess weight is not a pill but a change of diet, lifestyle and more exercise.

But that is hardly a reason to restrict access to a reasonably safe drug. In a less-regulated environment people would be able to choose whether to consult a doctor for the widest advice on remedies, a qualified chemist for pharmaceutical advice, or simply go to the supermarket for the cheapest supplies of a drug they know well. In general people should be trusted with that much choice about their health. They should not be treated like children.

But some, of course, are children, well into teenage years and beyond. These are the people who would abuse drugs if they were more readily accessible. The scourge of pure methamphetamine in the country over the past year or two has already brought restrictions on legitimate sales of a useful remedy, from which "P" was being illegally made. Thus the majority are penalised for the sake of a tiny foolish minority.

Drug regulation has to weigh up the cost and inconvenience to the majority against the risk to the minority. In the case of P, the risks users pose to themselves and to others sadly justifies the restrictions on pseudoephedrine. Strongly marketed drugs such as Xenical are at the other end of the spectrum. The misuser will soon suffer sufficient discomfort to become better informed, and to treat all heavily advertised chemical remedies more warily. Drug advertising alerts the public to what is available but it is not intended to be the last word. Even drugs provided without prescription need to be accompanied by a word of advice.