I will have to spell it out again.  This time in simple words that even a Labour Secretary of State may just be able to understand.   Intelligent readers may skip the next bit because you will be fully aware and able to put two and two together to make four, not twenty two.  Right, here goes.

Pills (and, Mr Johnson, that includes all medicines) are what doctors use to make sick people better.  We call it curing them although sometimes they simply prolong life or treat an illness.  I'll not go into greater detail as it may confuse you.

They cost a great deal of money to develop and are covered by a patent for a few years to prevent other manufacturers copying them.  The original makers give them a name called the brand name but they also have a chemical name, the generic name.

When the patent runs out there is often a free-for-all as generic manufacturers around the world compete to rapidly produce the generic version of the branded pill.    Generic pills are much cheaper than branded versions because the maker does not have the research costs to bear.

Whichever it is, brand or generic, it has to be paid for.

Now, Mr Johnson, for the drug distribution system which has worked very satisfactorily since before you were a boy but which you are showing signs of destroying or as you might say, putting the boot in.

Pills are purchased by wholesalers and wholesalers sell them on to chemists and dispensing doctors who supply them to patients.  All three of these need profit to continue to provide the service. The thing is, however, they have to come to you to be paid for the pills.   Now you, Mr Johnson, and your predecessors are compelling, ordering, forcing, bribing and threatening GPs and other doctors to only use generic medicines because they are cheaper.  The doctor or chemist receives a discount from the supplier..

Conveniently for you, you have forgotten that there is a Discount "clawback" scheme for both chemists and doctors, so you are already grabbing back a large chunk of the profit and so both of them are forced, to stay viable, to chase for even more discount or even cheaper generics.   And, don't forget this either, Mr Johnson, you have succeeded in ensuring that GPs must prescribe upwards of 85% generics - or else they will be fined by some PCTs.

We'll forget about the confusing effect on the elderly when they receive different coloured or shaped pills each month and are told they are the same.  You wouldn't care or understand that.   We will just concentrate on the price and the value for money or the danger of cheapness.

Are you following the story so far?

Not satisfied with a cheaper version of a pill, you insist, through the Category M system on reducing the price you will pay the doctor and chemist even further.   And this has frequent spiralling turns of the screw (see the item from www.dotpharmacy.com below).  So the amount you repay becomes less and less and less.   You call it getting value for money.  I call it reprehensible negligence.

I'm sorry this is turning out to be a little long for you but bear with me, I have nearly finished

If you, Mr Johnson (and that ass of a PM who really controls the money) insist on repaying the doctors and chemists ever declining minimal amounts for the generic then they, for their part must seek cheaper and cheaper sources for the generic so that they can continue to provide the service to patients.   That is why I mentioned that you are wrecking the system.

In turn, the wholesaler must seek cheaper and cheaper sources, too.   There is no choice.

Now, it may surprise you but if you pay peanuts then you will get peanuts.

But you are not buying washers, or widgets, you are actually, Mr Johnson, you are actually buying pills.   And what do pills do, Mr Johnson?   Yes, well done, you've remembered.  They are what doctors give patients to make them better.

Only, if buffoons at the Department of Health, led by yourself, compel doctors to prescribe cheaper and cheaper pills the pills won't make people better.   Instead, if they are made from cheap and nasty ingredients in the Third World, they may not work or they may even make them worse or, heaven forbid, may even kill them.  Especially if they are counterfeit or contaminated.   Maybe you should Google "counterfeit drugs".  You could learn a thing or two.

It won't be the doctor's fault, it won't be the chemist's fault and it won't even be the wholesaler's fault, Mr Johnson.  It will be yours but since you never admit to any fault, you will sail blithely on to your deserved obscurity leaving the maimed and the sick behind you.  But that won't trouble you because, as ever, you will blame the doctors.

The item below, from dotpharmacy, may also interest you.  Because it is written on behalf of High Street chemists it concentrates on the profit angle rather than the patient.  A pity, but it does rehearse the point very nicely.

Now, Mr Johnson, if that was too difficult for you, then I can sum it up in four words:   "Cheap pills can kill"

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From:  dotpharmacy.com, 4 October 2007

Contractors, wholesalers and manufacturers have reacted angrily to the government’s raid on generic purchase profits, which representatives said could cost each pharmacy up to £40,000 a year.

The Pharmaceutical Services Negotiating Committee said contractors faced a £400m a year cut from current category M margins. This represented a lack of joined up thinking by government and sent mixed messages about what it wanted from pharmacy, industry leaders said.

Steve Dunn, group managing director of wholesaler AAH, said too little progress had been made in increasing service provision and that cuts in traditional funding meant pharmacists were left with the worst of both worlds.

Celesio, which owns AAH and Lloydspharmacy, said the tariff changes would lose it 30 million euros (about £20m) this quarter.

But Warwick Smith, director of the British Generic Manufacturers Association, said the £400m cut was in line with government’s agreed £500m limit on total purchase profit. “It’s just the system working as it was intended,” he said.           

However, stakeholders said “wild” fluctuations in retained profit made financial planning difficult for contractors.

Wholesaler Phoenix ’s chief executive Paul Smith said: “To be able to plan for and make the necessary investment in pharmacy services to deliver the contract to best effect, we need a degree of certainty and stability that is currently missing.”

Some also suggested the category M mechanism could threaten medicines supply. The Company Chemists’ Association said: “CCA members are concerned that the repeated focus on a small number of frequently prescribed medicines is distorting the category and jeopardising the continuity of medicines supply.”

PSNC said this quarter’s tariff had been cut by £100m, but the annual reduction was provisional.

Head of finance Mike Dent said: “The DH’s analysis of the outcome has not been accepted by PSNC and we are subjecting it to exhaustive investigation.” Adjustments were likely to be made in January, he added.

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(6/10/07)