Letter for Mr Tucci regarding incident on Dec 15 2011
Antony Tucci
Pharmacist
Boots The Chemist
Commercial Way
Woking February 15th 2012
Dear Mr Tucci
I am writing this letter because of what happened at the Boots pharmacy counter last December 15th. However, before I go on to outline the details of my complaint, I want to say something about aspirin.
I have made a study of aspirin using the internet and I think that I probably know and understand much more about aspirin than you do even though you are a qualified pharmacist. There should be no surprise about this because you are obliged to know the properties and characteristics of hundreds of drugs while I have been able to concentrate my interests on just one drug. However, given that aspirin is a drug that gets so much publicity in the national news as, every year, yet another new health benefit of taking regular amounts of aspirin is discovered, I am surprised at how little you seem to know about the properties of aspirin. For instance, you did not seem to know – or maybe you were just pretending to me not to know – that one 300 mg tablet of aspirin daily is within the range of what is considered to be a normal dose. If you recall, we had an argument over this matter. Furthermore, from my researches, I can tell you that 300 mg daily is sometimes even classed as a low dose.
I have been very interested in aspirin for a number of years because of the range of health benefits it offers. Every year, it seems, yet another new and welcome effect of taking aspirin is published. Aspirin has long been considered a wonder drug. By trawling the internet, I have learnt quite a number of interesting facts about aspirin, as listed below, but I have not always taken note of the website where I found the information. Where I can, I will provide the link so that you can check the information for yourself.
1. 2 per cent of people taking a junior aspirin (75 mg) daily experience stomach bleeding.
2. This rises to 4 per cent of people taking a standard 300 mg tablet daily.
3. Of those taking 3000 mg or 4000 mg of aspirin daily – that is 10 to 14 300 mg tablets a day - about 20 percent of people will experience stomach bleeding.
(My comment on this is that one can deduce that 96 per cent of people who, like me, take 300 mg of aspirin a day do NOT experience stomach bleeding; and even of those who take massive doses of 10 to 14 tablets a day, 80 per cent do NOT experience stomach bleeding. It is safe to infer from this that most people are very tolerant of aspirin.)
4. I came across a large-scale study in which a large number of people taking aspirin daily were asked to report ANY kind of side effect, including stomach bleeding, resulting from their daily use of aspirin, and it was found that only about 15 per cent did so. I came across this survey a long time ago, so I do not have the precise details to hand, but I took note that about 85 per cent of people taking aspirin daily do not, like myself, ever experience any kind of side effect and can be considered to be very tolerant of aspirin.
5. I draw your attention to the following link from Harvard Medical School:
http://www.intelihealth.com/IH/ihtIH/WSIHW000/35320/35329/1418715.html?d=dmtHMSContent
I quote from the link:
“In the study, 861 patients were assigned to take either 600 milligrams of aspirin a day — roughly double the dose that most people get if they take a daily aspirin — or a placebo pill. The study lasted 10 years. Four out of five people assigned to take aspirin were able to stick with this treatment. But 1 out of 5 people had side effects that made them stop.”
It should be noted that these patients were taking 600 mg a day for TEN YEARS but 80 per cent were able to continue with the treatment despite the double dose of aspirin per day for the extended period of ten years. This result is in line with the point made in point 4 above.
6. I draw your attention to another link, provided by the reputable Cancer Research UK:
http://scienceblog.cancerresearchuk.org/2010/12/07/expert-opinion-aspirin-and-cancer-the-unanswered-questions/
From this, I quote:
“Thirdly, we don’t know what dose of aspirin is best. While the current paper has looked at 75mg of aspirin we don’t know that 150 or even 300mg isn’t better. This is vital – the commonest reason drugs don’t work is the dose is wrong.
A premature rush to using aspirin in too small a dose in the population could result in many people being deprived of benefit.”
I have highlighted the last sentence because you seem to be one of the people in “a rush” to impose dosages of only 75 mg. You insisted that you would only sell me 75 mg aspirins unless I provided a prescription from my doctor for 300 mg aspirins. (Has anyone in the whole country ever been asked to provide a prescription from their doctor before a pharmacist would sell some aspirins to a customer? Isn’t this taking nannying to extremes? Isn’t this a clear demonstration of unwarranted discrimination against me?)
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I had told you that I have been taking a 300 mg aspirin daily for 25 years. My body is now accustomed to that 300 mg of aspirin and there is evidence, available on the internet, that people who suddenly stop taking aspirin can be subject to a rebound effect where, in the short term, they become more liable to a heart attack or a stroke . Obviously, one must consider the possibility that this rebound effect could also occur to someone who suddenly and drastically lowers his intake of aspirin from 300 mg to just 75 mg, yet you seem to be unaware of this possibility and, if I had followed your advice, I might, by now, have experienced a heart attack or stroke. So much for your professional judgement and duty of care of which you made so much about when last we met on December 15th!!!
There have been a number of surveys showing that aspirin can offer a degree of protection against a range of cancers – bowel, lung, breast, prostate, colorectal, esophageal, stomach, ovarian, and others– and that the older the person taking the aspirin, the greater the protection provided by the aspirin. It is also claimed that aspirin protects against Alzheimer’s disease. Many other benefits are also claimed for aspirin.
The following two sites – for healthfully.org – are probably not published by any major health organization, but a trawl of the internet will throw up plenty of evidence of reliable surveys carried out by reputable medical researchers that will validate the claims made on the healthfully.org websites. It just so happens that I saved these two healthfully.org websites on my computer but did not save the others.
http://healthfully.org/aspirin/index.html
http://healthfully.org/aspirin/id2.html
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We come now to the question of what dose would be suitable for me – 75 mg daily or 300 mg. I have considered this matter carefully. I have been taking 300 mg of aspirin daily for about 25 years since I was about 50 years old without ever experiencing the slightest ill effect. To me it seems clear that I am one of the fortunate majority of people who are very tolerant of aspirin. Indeed, it would not surprise me that even if I took 3000mg or 4000mg of aspirin daily- as in point 3 above - I still would not suffer any bleeding of the stomach because I know from long experience as a qualified chemist that I am very tolerant of chemicals.
I have never discussed my intake of aspirin with my doctor because there has never been any need to do so. For me, aspirin has always seemed a very safe drug and I have no need of any doctor to tell me it is safe to take a 300 mg of aspirin daily because I know it is safe. And I have even less need of some pharmacist to try and dictate how much aspirin I should be allowed to take and I would resent any pharmacist trying to do so because I would consider it is none of their business. Pharmacists have, of course, a duty to advise where they think it is appropriate, but it should not go further than that and I would consider it unprofessional for a pharmacist to try to go further. Customers have to be allowed to do whatever they want to do with their lives.
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I have noticed that in surveys where patients were treated with aspirin to help ward off cancer – as in the link in point 5 above – they were not treated with junior aspirins but with 300 mg or double-dose 600 mg of aspirin daily. It seems clear from this that the doctors carrying out these treatments were themselves sceptical that a very low dose aspirin would be sufficient. Well, I, too, am sceptical that a junior aspirin would be sufficient if I am to get the full benefit of what aspirin has to offer. I am obviously very tolerant of aspirin. I am fortunate to have inherited “strong genes” from my parents and have consequently never suffered anything seriously wrong with my body and my stomach and digestive system are still in very good condition. I have therefore decided that the optimum dose of aspirin for me is 300 mg daily, and I intend continuing to take 300 mg daily for the rest of my life – whatever your opinion and your professional judgement happens to be.
It is interesting to note that in the early decades of the last century when aspirin was the only analgesic and anti-inflammatory drug available to doctors, patients with chronic conditions such as arthritis used routinely to be prescribed up to 15 aspirins daily, and there is anecdotal evidence that they tended to live to ripe old ages. And now we know why. Aspirin not only protected them against strokes and heart attacks but also against a long list of common cancers and maybe also against Alzheimer’s disease.
I have checked to see what daily dosage of aspirin is officially recommended by medical authorities. I checked both the MHRA and the NICE websites but could not find what I was looking for despite lengthy searches. Only the Mayo Clinic website came up with a clear guide:
I found this on a Mayo Clinic website:
“What's the best dose of aspirin to take?
There's no uniform dose of aspirin you should take to get the benefits of daily aspirin therapy. You and your doctor will discuss what dose is right for you. Very low doses of aspirin — 75 milligrams (mg), which is less than a standard baby aspirin — can be effective. Your doctor may prescribe a daily dose anywhere from 81 mg — the amount in a baby aspirin — to 325 mg (regular strength). “
(When I mentioned the Mayo Clinic to you, it was obvious that you had never heard of it. The Mayo Clinic is a very important medical institution in the USA. See what a Wikipedia link has to say about the Mayo Clinic:
http://en.wikipedia.org/wiki/Mayo_Clinic )
One final word about my intake of aspirin. It is my belief that Katrina Schifano or some other member of the counter staff has given you false information about me, claiming that I made multiple purchases of aspirins in the past and that I had been misusing aspirin. There is not - and has never been - any justification for this claim which, I believe, has its origins in someone making such a claim about me in the past without bothering to check with me first. Why should anyone ever want to misuse aspirin? I value my health too much to ever want to risk it by taking excessive amounts of some drug. Members of the counter staff have caused trouble for me before by making their false claims and causing each new pharmacist to have a mistaken opinion of the kind of person I am.
I hope you have taken particular note of what I have just said because whatever your counter staff have told you about me is not to be trusted. It is because they continually stir up prejudice against me that I have had so much trouble at the pharmacy counter. Your counter staff make it impossible for me to ever be treated in a normal manner by a new pharmacist. I sometimes feel that the counter staff are motivated more by malice than the duty of care that they so hypocritically profess.
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I come now to what happened at the Boots pharmacy counter last December 15th. I wanted to buy two packets of aspirins, each containing 16 300 mg tablets. You refused to sell me them to me unless you first obtained the permission of my doctor on the telephone. I was very upset to be treated in such a patronising and offensive way – as though I could not be trusted to make a sensible judgement myself about my intake of aspirin. I felt insulted at being treated like some ignorant and irresponsible moron. I pointed out that I had been taking 300 mg of aspirin daily for 25 years and I was amazed that you did not draw the obvious conclusion that I was one of the majority of people who are very tolerant of aspirin and who should be allowed to purchase aspirin in 300 mg amounts. You claimed that in your professional judgement I should only be allowed to take junior aspirins. If you recall, I got so upset by your attitude that I got into something of a state and was offered a chair to sit on. What I was experiencing was an adrenalin surge brought on by anger and distress at being treated yet again in such an appallingly bad way. You seemed to lack any kind of respect for me and for my own judgement and you seemed not to understand what constituted a properly professional way to treat a customer. I am a retired professional person myself so I do know something of what a professional attitude should be.
You made great play of your duty of care as though the law imposed some very heavy burden on you as a pharmacist. Well, I have news for you. We all of us have a duty of care all the time and in everything we do, and the law – the moral law - insists that we conduct out lives with due consideration for others. I accuse you of failing in your duty of care to me by causing me such anger and distress without good reason. Yes, of course, as a pharmacist you have a duty to monitor the behavior of customers and the drugs they buy and you have an obligation to check that customers are aware of potential problems in their use of any drugs obtained at the pharmacy. But once a customer has been made aware, then that is your professional job done. I will say that again- with emphasis: then that is your professional job done. It is not professional to refuse to sell a grown adult, in full possession of his faculties, some drug that you think he may be misusing. If the customer is misusing the drug then that is no business of the pharmacy providing the pharmacist has carried out his obligation of warning the customer. If the pharmacist claims that he could be prosecuted for selling the drug to someone who he thought might be misusing, then that is utter nonsense. Any case brought against the pharmacist would fail – just as a cycle or motorcycle retailer could not be successfully prosecuted for selling a cycle or motorcycle to someone who was later killed in an accident. In the case of the sale of aspirin, the law is very simple: a retailer is allowed to sell up to 100 aspirins per transaction. Nothing more than that. The law does not impose any special duty of care on the retailer. What does constitute an unprofessional and inconsiderate attitude and a failure of care is to so upset a customer at being treated like some ignorant and irresponsible moron that he is taken physically ill. What if I had had a heart attack as a result of your behaviour? What price your professional judgement and your duty of care if that had happened?