/ Health, Shopping

Would you buy medicines from a ‘stranger’ online?


Would you buy medicine from a stranger at the side of the road? No, yet many people are doing the equivalent of this online every day, as Alastair Jeffrey of the Medicines and Healthcare products Regulatory Agency explains.

As a rule we tend to buy from sites and brands we know, so why do some people buy medicines from sites that are unfamiliar, offering brands they’ve probably never heard of?

Perhaps some are too embarrassed to speak to their doctor. Maybe they have consulted a doctor but the medication they wanted hasn’t been prescribed.

Dangerous medicines for sale

We know the demand is there because every year we seize millions of pounds worth of medicines, mostly slimming pills and erectile dysfunction medicines that are on route to people in the UK. All of these have been sold online; many will have been supplied illegally and could be unsafe.

A substantial amount are unlicensed generic versions of medicines and are unlikely to meet the required standards of quality and safety. Others may be counterfeit but all have the potential to be dangerous as they may contain impurities, wrong ingredients and sometimes no active ingredients at all.

An example are slimming pills which were seized and found to contain ingredients withdrawn in the UK due to health risks, specifically heart attack and stroke.

So it’s clear that buying medicines in this way is a gamble – there is no way of knowing if they’re manufactured to mandatory standards of quality and safety, nor if they’re stored and transported according to their specific requirements. We’ve found medicines being made in unacceptable conditions which, if you saw, would certainly make you think twice about taking them.

Those involved in selling and supplying these medicines have no interest whatsoever in your health, they are interested only in your money.

Safely buying medicines

To assist patients who choose to purchase medicines online, a European logo has been introduced to identify legitimate online suppliers. All suppliers of medicines must register with the MHRA and display the logo on the pages of their site offering to supply medicines to the public.

Our advice to anyone who’s seeking medical assistance is to visit their GP and get a correct diagnosis. Prescriptions should be fulfilled by a registered pharmacy, either from the premises on the high street or from those operating an online service. Self-diagnosis and self-medication can cause more harm than good.

We will continue to work with technology companies, patient safety groups and other stakeholders to close down sites acting illegally. And, in collaboration with colleagues in Border Force, we will seize illegally imported medicines as they come into the UK. However, demand has a massive influence on supply and if people continue to use these sites, they will continue to operate.

We’re very keen to find out why people use these sites and what their experiences have been. This will assist us in developing a strategy to make people aware of the risks involved and try to divert trade away from criminals and illegal sites.

This is a guest contribution by Alastair Jeffrey, head of enforcement at the Medicines and Healthcare products Regulatory Agency (MHRA). All opinions are Alastair’s own, not necessarily those of Which?

If you’re concerned about a website selling medicines, report them here or contact MHRA’s counterfeit hotline on 0203 080 6330 or by email at counterfeit@mhra.gsi.gov.uk. You can also check if a website can legally sell medicines online here.


They are a means of obtaining prescription drugs without a prescription – your doctor may not want you to have them. A way of self-medicating. UK suppliers will provide these. I do not understand why these UK suppliers are not prosecuted. Perhaps it is not an offence?

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Two size 11s I think just walked in
I do not condone the selling illegally of anything not only of illegal substances because of the harm they might do but I think that this is not about such substances it is about people grasping at a chance to better themselves.
However such purchases may not be the way to go about this

What I also would rile against is that many of these companies will not pay tax and may supply products that are nothing like what they are promoting and if the product damages people can there be a recourse against such.

Firstly I think someone seen fit to start this topic for what reason I know not but I do have views as do many
If we are looking for views and I hope this is why someone started this topic off rather than a load of people landing like a jumbo jet with a load of opinions and no personal experiences or life experiences on this front better to sit quietly

I hope some of the end users will come on and tell us their reasoning behind why they pursue this route.
I have had a quick look around this eve and whilst i cannot understand why one would buy Amoxicillin nor have i any idea why people would need to buy Amoxicillin without going to a GP I would like to know why

Whether its legal. Whether it not is not the question
The question is “would you buy from a stranger what is normally limited to prescription only”

If size 11s lands with all laws blazing we are hardly going to find out as for whatever reason these people may already feel threatened. After all, it is illegal

I believe Which did not start this as a method of instructing or a platform for the police to to make a statement
They have proper channels to be doing that and I dont mean to stop Alistair if he wishes to hang around but this is a consumer site and we are consumers
For some reason some of us find they require to source these items on their own
Which started this as a topic for people to comment on and I’m pretty sure like myself there are those out there who would really like to know the reasons for this.

Firstly To size 11s short and very to the point post
We take regular action. That is probably very correct. Regular Sir is not good enough.
“Self medicating IS DANGEROUS” also lets us know that you assume that all substances purchased are either dangerous or the user is using them incorrectly neither decision of which is up too you Sir.
Innocent until proven guilty??

Probably most folk would not have disagreed with Mr Jefferys but I detest our public bodies arriving on scene with all the answers when in fact if they had all the answers the problem would not exist. Why is this happening???

Sorry Alistair but not everyone is compliant.

Now just in case there are some who have purchased substances online for their better good at least in their own eye’s I am sure we would like to hear your story
Everyone does not have to agree and if everyone could refrain from jumping on the first person through the door we might get to learn something which is the reason i see this topic being started I believe
I am sure I speak for Which and others and can say that perfectly innocent people can register under a pseudonym. post and be gone without size 11 being on their heels otherwise this is completely pointless topic.

So firstly we have to assume that all the substances are not for mind altering purposes. Right!!
I have looked. There are antibiotics as I already said and countless other things that as best I know do not get you high, send you to sleep or that are regularly used in the making of mind altering substances so why are people buying them
They cannot all be hypochondriacs and this is no small business so we need to know the reasons
After all the chickens are full of antibiotics despite all the efforts and the Gov continues to let us consume them by the milion
Secondly we will have to assume that some people for whatever reason self medicate.
It doesnt matter if you approve or disapprove like an Evangelist against Whiskey. You keep quiet. Right
Comment but do not eat the a**** off of someone if they come forward. They are obviously in a worse place than you are. Your worldly wise advice may hurt more than it will ever help

I know. i’ve been told to gather myself together and get on with it. I could write a book on that but other much better qualified people have done just that and the last thing you should ever ever tell someone when they are down is to gather themselves together.
Remember that
They are more likely to find a very high bridge because at that point everything may be their fault and they cant fix it so they just might opt for the other solution
You cannot be carefull enough
These are vulnerable people often with a very high IQ who have been used to figuring it all out and solving problems. Their problem solving abilities may not be just up to scratch when they are exhausted and have ran on adrenalin for years until there’s nothing left to run on
Go get ” Depression The Curse of the Strong By UK Doctor Tim Cantopher”

Thanks Tim should you be looking in.

Lets use a couple of possible situations
We have all read about family members donating live organs. Even non family members which is compassion beyond belief
I’ll interrupt to tell another
I give blood and always have done except for a break of about two years when I found things difficult
I know people who they themselves or family have needed and got several pints of blood.
But donate???? No
I can think as I please but I do not dream of saying anything more to them even if I think this is a very selfish action
So think before you speak.

If you can put yourself in the situation and I wish this upon no one
The situation where your standing looking at a loved one and you, your the only one with the kidney that type matches.
What do you do??????
Its very nice to read about it.
Its very nice to see the two of them on TV with a living success for want of better words but not all are successful and its not without risk for both parties
So????????????? You up for?? Worth the chance??? Someone’s life??? If you dont do it you’ll have to live with the consequences every breath of every day
It’s a biggy, we know

Right you find yourself in the same position but its not a kidney thats needed.
This time its a drug. A drug that has been proven to be 50% successful. Hell even 20% successful.
Sounds simple. Yes? No?
What if our NHS will not fund the drug?
What if our system has not approved the drug?
What if you cannot afford to travel?
What if you yourself are laying at home helpless and half time alone and a drug will let you get up and walk around.
Never mind heal you simply walk around for the next three weeks and that three weeks is all you have.
What will you do?
What if your child was laying its bed? Now I know some will either get right out mad with me or a tear will well up in their eye. Both understandable emotions.
Someone one says to you. That drug is easily available in Mexico. What will you do???

I know what I would do. Sorry Alistair. I’ll be on a flight and I dont do well with flying but somehow I’ll manage it
I dont care if they stop me and take the stuff off of me. I’ll be back on the first method out again and eventually myself, my wife, someone close will make it
It is that important and it does happen but no one is going to be telling this across the garden fence

Now you may say but that’s different. Yes it is different but lets keep going
Lets say that there are several of these suffers all having met as is often the case
Lets say it only takes one person taking the chance to help several little ones????
Lets say the little one always wanted to go to EuroDisney and this would let them enjoy your one last gift. I’m crying, litterly!!!!

Many of us have had to suffer the white coffin. It’s a tough sight to behold just imagine carrying it

You would and you would not be alone. I havnt but I do know of such and I dont care what size 11 thinks. Size 11 can go to the hot place
Just think of how many little stories that you’ve been told similar. have you heard the whole story

What about the child not so long ago that the UK Gov and size 11s police force had the parenst arrested via interpol for removing their own child from a UK Hospital and on their way via a holiday home in Spain I think it was they were arrested.
The British Public could barely believe it
The parents were willing to risk everything and were trying to get their child to was it Sweden to have some form of treatment
The NHS experts here said it would not work but the parents were up for it so to speak
We know the outcome
The experts can crawl behind as many medical terms and misdiagnosis as they can find but they made a mistake
The parents not the experts were correct. The experts were wrong. The Police were wrong and please dont so big and silly as to say that they were following the law. The law is up for interpretation and the Police are the interpreters before all others. Many Courts have found in favour of the Spirit of the Law it doesnt always have to be the letter of the Law
The doctors actually delayed further what turned our to be the right choice as as best I listened There maybe wasn’t any other choice for those two brilliant parents. Good on you. Three cheers

So those are extreme stories many would say but it is such stories that this unauthorised movement of medicines is born out of.
If enough people need the service the service will be made available and lets not forget this is not the same as a Cocaine or Heroin service although if kept underground those thugs will no doubt get involved if not already and that is the last thing those in need need.

So if there are reasons, genuine reasons then we and our Gov need to fix something to keep this from becoming yet another gangland income
The fact that the law is being broken by many and there is no addiction involved raises a load of questions that need answered

If we come on here and shout our great and high morals at people who are obviously not in good shape either as sufferers or as carers they are not going to come on and tell it how it is. Either way they are suffering it is we not they who need a kick in the behind

I invite I hope on behalf of Which and any reader who is or knows of purchases of prescription medicines online without prescription without the consent of a Doctor to please tells us your story. I for one will try to understand even if others are so fortunate as to not know what real illness is like to see.

Can someone from Which please blow some wind at this.
If no one comes forward we are no worse off. if they do we just might learn

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Oh Dear??
Around here Size 11s refers to the two big shiny polished boot toe’s that used to patrol the streets and did not know when to stop as they had the authority to go where they chose they thought
Hope that doesnt destroy your evening

Benny says:
19 May 2020

How can you be confident of the quality and information, and that the manufacturer of a product is reliable pls?

I have never purchased prescription drugs online. If a drug I needed was not available via the NHS I would ask for a private prescription, but that has not happened yet.

It is good to hear that illegal suppliers are being closed down.

According to what is being referred to as drugs
Many folk have trouble with synthetic Thyroid medication and get along better with old fashioned Piggy derived desiccated stuff
This is not a funny subject and many Doc’s simply toe the line and will not prescribe NDT (natural desicated Thyroid) Prior to TSH testing which was brought about by the main manufacturer of the synthetic verions the problem was dealt with on ones symptoms and it worked pretty good. My Grandmother was one of those but once she had to go the man made route she went down hill like speed skier
So if you are fortunate to have an agreeable Doc great but there are 1000s who cannot get along with anything other than the natural stuff
I would not however suggest delving into the many potentially such as i am on and for the most part my Doc changes my script provided of course that I provide a reasonable reasoning behind any change
I have 2 really good Doc’s who now I’m not bluffing because they knew me when I was working the clock around and they know to a degree that I done myself in as such so I’m not on the bluff
However I am in a situation where the same health center and Docs have been there forever and i know that many others seldom see the same doc twice in a row which I dont think is a good thing
Overall I dont like self medicating but having inside knowledge that many in the UK would be lost without a perfectly natural substitute that is all too often refused and for no other reason that business I would suggest perhaps not being as fast off the mark to say No No No
Every situation requires careful evaluation and sometime people get so far down they are grasping at straws

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This article completely describes why no one should ever buy these items on line and without medical permission. I wonder if anyone will be brave enough to admit doing so? They would deserve sympathy for trying to deal with their ailments, but, maybe, a help line or two could be flagged to give them an alternative strategy, if it’s not too late. Like others, I am glad that you are containing the problem, which is similar to that of counterfeit goods that are also unsafe to use.

In his introduction, Alastair Jeffrey mentions seizure of drugs sold illegally. I would be interested to know if this job is delegated to Trading Standards and what penalties are applied to the companies selling these drugs.

Thanks very much for your reassuring reply.

Another unmentioned facet of buying drugs on-line was a well-known on-line pharmacy company was selling its patient list. Still in business.

” Pharmacy2U: NHS-approved online chemist fined £130,000 for …
Oct 20, 2015 … The country’s largest NHS-approved online pharmacy has been fined … The details sold by Pharmacy2U, which dispenses medicines to patients on … an online system of repeat prescriptions which allows medicine to be posted to patients. … NHS England welcomed the fine, describing the company’s …”

More detail
” According to the ICO, the company not only sold on user data without proper consent, it made some astonishingly crass choices of customers to sell it to, including a lottery company registered in Australia’s Northern Territory.

It wasn’t as though Pharmacy2U was unaware of where the data was going, either, with the ICO’s Penalty Notice stating that the lottery company submitted its proposed customer mail with the order for user records:

The mailer was headed “Declaration of Executive Order” and went on to say that the recipient had been “specially selected” to “win millions of dollars”. The mailer contained a form which recipients were asked to complete and return within seven days along with payment of an unspecified sum of money by cash, postal order, cheque or credit card. The form also requested date of birth, email address, telephone number and mobile number.

You may have received this sort of snail-mail from “lottery” companies before, perhaps even wondered where they got your details from. You’d probably have been gobsmacked (to use the medical term) if you realised that the pharmacy you used to fill prescriptions from your GP might have been responsible. The ICO report continues:

Pharmacy2U approved the order with the words “OK but let’s use the less spammy creative please, and if we get any complaints I would like to stop this immediately”. The data was sent to Australia. ”

Well that really nails the them huh!

I had a brief attempt to find if Which? has ever mentioned them but not much joy. This reaction is where I would hope should have been [was?]

” BMA response to the £130,000 fine for Pharmacy2U for breaching data protection rules
(issued Wednesday 21 Oct 2015)
Responding to the announcement that Pharmacy2U will be fined £130,000 for breaching data protection rules, Dr Paul Cundy, BMA GP IT committee chair, said:
“This fine and the findings of the Information Commissioner’s Office’s (ICO) report raise serious concerns about the handling of personal data by Pharmacy2U, which is the UK’s largest NHS approved online pharmacy. Although the BMA welcomes the Information from the ICO investigation, we are pushing for custodial penalties for those who wilfully or recklessly abuse personal data. In our view, the current financial penalties do not offer enough of a deterrent. It is not yet clear whether any further action will be taken by the General Pharmaceutical Council or Care Quality Commission, with which Pharmacy2U is registered.”

SO yes support your local pharmacist it makes sense particularly when payment systems and pharmacy sites can go down or have problems shipping.

DeeKays post regarding different tolerances to new drugs is an interesting and worrying concern . No doubt on the Web more information exists on this NDT matter.

Dieseltaylor wrote: “DeeKays post regarding different tolerances to new drugs is an interesting and worrying concern . No doubt on the Web more information exists on this NDT matter.”

Anyone can report a problem with a licensed or counterfeit drug to MHRA via the Yellow Card scheme: https://yellowcard.mhra.gov.uk

Traditionally, reporting was done by doctors and pharmacists using yellow cards supplied with the British National Formulary but the public have been report adverse drug reactions for years.

Melissa says:
8 January 2016

I have ordered prescription drugs online, after being prescribed them from healthcare professionals. It has saved me time and is very easy to order a repeat. As long as you follow the guidelines and buy from a reputable company it is a useful service in my opinion.

I have never bought prescription meds online without a prescription and when buying with a prescription only from uk based pharmacies be they online or high street based. I do however occasionally buy non-prescription over the counter medicines online and a large number of supplements due to a chronic health condition. However they too are bought from a major supplier in the US.

While I would not risk buying prescription meds online without considerable research into the seller and the meds origin because too much can go wrong. I have seen docos of the fake pills that are made and truth is we just don’t know what is in untested pills. I do though understand why some people are drawn to do so. GPs are often up against NICE guidelines and funding guidelines as to what they may prescribe for given conditions, even if they want to, and while some may be willing to write private prescriptions not all are. Unfortunately the ‘sue culture’ has made some GPs nervy of going outside official guidelines which protect them should anything go wrong. I have experienced this myself suffering from M.E. for which there is little helpful advice and most of that counter-helpful. Even when a specialist recommends a particular medication GPs will not always comply with prescribing it. But then I have heard of cancer patients having the same problem.

Consequently I have encountere a few people who have purchased medication from overseas as it has been the only way to obtain medicine that is life changing to them. For that reason they are willing to take the risk.

I think there needs to be some conversation about what stops gps exploring medications options, particularly when recommended by a specialist. Is our NHS being run by a bunch of bureaucratic guidelines that GPs daren’t cross? Because it should be about what is truly best for the patient.

Really all prescription medicine should be under supervision of a medical practitioner and I encourage people to seek second and third opinions rather than self prescribe and buy dodgy meds online. Better to pay to see a private GP. The risk is just too high.

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Wendy and Duncan your right on the money
There’s enough driving it underground already
Wendy thank you for your honesty and and taking the time to post
If it were ever possible and if you have contact with such see if they’ll write their story

It would seem that drug companies are reflecting the downturn in basic input prices in a way that might make you understand why people seek alternatives when they are impoverished. This but one example:
” Pfizer Inc (PFE.N), which plans a $160-billion merger with Ireland-based Allergan Plc (AGN.N) to slash its U.S. tax bill, on Jan. 1 raised U.S. prices for more than 100 of its drugs, some by as much as 20 percent, according to statistics compiled by global information services company Wolters Kluwer.
Pfizer confirmed a 9.4 percent increase for heavily advertised pain drug Lyrica, which generated $2.3 billion in 2014 U.S. sales; a 12.9 percent increase for erectile dysfunction drug Viagra, which had 2014 U.S. sales of $1.1 billion; and a 5 percent increase for Ibrance, a novel breast cancer drug launched last year at a list price of $9,850 per month, or $118,200 per year.”

I realise that fortunately the NHS does wield a club against these pharma companies. However I am also aware of the stoked populist campaigns for highly expensive drugs to be approved for use in the NHS.

Many of the well known brands of drugs are not available on NHS prescription once the patent has run out and cheaper alternatives are available.

It’s worth reading Ben Goldacre’s book ‘Bad Pharma’ to learn a bit about what the large pharmaceutical companies can get up to.

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Duncan, I too am against privatisation of the NHS but privatisation is not necessarily a privilege of the wealthy. Many poorer people are being referred to expensive private practice from the NHS in order to decrease waiting lists at the expense of the taxpayer. The more this is allowed to continue, the more funding is being syphoned away from the NHS, a vicious cycle, not forgetting PFI of course introduced by Tony Blair and associates, for which the taxpayer is still paying the price.

Do you know what triggers your migraine which occurs normally as a result of a trigger, for example, many of the usual C`s, chocolate, cheese, caffeine, citrus fruit and juices are easily avoided but less so with anxiety, stress (although still avoidable) resulting in arguably the most difficult of all to treat without medication, hormonal imbalance. Are you aware you can also experience migraine without the headache? It can manifest in eye flashes (the aura) also visual disturbance, nausea and frequent tummy ache, the latter more common in young children who often go on to suffer the headache as adults.

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This discussion is supposed to be about buying medicines online, Duncan. I don’t believe what I said was factually incorrect.

Different brands of the same medicine can differ from the well known brand, though that does not necessarily make them inferior. Many people, including myself, get on fine with whichever brand we are given, but sometimes people like yourself are affected by one of the ingredients. Unfortunately there is no way of knowing unless an individual is known to be sensitive to one of the ingredients, in which case this should be recorded, just like reactions to penicillin-based antibiotics.

I presume that your preferred version of latanoprost is Xalatan. Xalatan eye drops contain a preservative too – probably benzalkonium chloride. That obviously does not affect you but can cause problems for others. See Wikipedia for more details.

I certainly don’t support privatisation of the NHS.

I am trying to determine why anyone would want to buy drugs online. Common sense tells me that it is a foolish and dangerous way to self medicate. I attempted above to demonstrate how it is possible to avoid popping pills with total disregard of the possible consequences. Could it be through desperation when prescribed drugs are not working or are people reluctant to visit their GP for advice. There are perhaps some justifiable reasons, for example, when GP waiting times are sometimes 3 weeks away, which is a long time when one is in considerable pain. Maybe that promised operation is 3/4 or even more months away. It may be through psychological reasons when one is unhappy with ones weight or appearance or other personal problems too embarrassing to discuss with ones GP.

Whatever the reason, people resorting to such senseless practice in a country where free healthcare is available to everyone is indicative of either failures in access to this healthcare or the mentality of people who, in seeking a quick fix are putting their lives in danger and possibly the lives of their nearest and dearest.

It would be interesting to know about the reasons for self-medication, which I agree is foolish and dangerous. There’s a clue in Alastair’s introduction: “… we seize millions of pounds worth of medicines, mostly slimming pills and erectile dysfunction medicines that are on route to people in the UK.” Men find the latter condition embarrassing to discuss and I doubt if many GPs will prescribe slimming pills, certainly not DNP, which I have seen warnings about but is readily available online.

I think you are right about desperation. I have known people experiment with alternative medicine when suffering from continuous pain. It is unacceptable that anyone should have to wait for treatment and no doubt this encourages self-medication.

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Wow and once my posts were “too much info” about digestion
Still its fact. We have one,, sorry half of us have one. Most of use one so they are useful and instead of the obvious being hidden as it often is its out where it should be here
Bring in on but keep it under cover it you would. The art work is not to my taste

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I think Duncan that is what would be agreeing to I dont remember exactly the topic or post but what seemed fairly benign to me was too much for some whilst whatever I had written was about the truth
I was just amused by your post
Keep the truth coming forward

I agree Wavechange, I omitted to include the most obvious being the tempting and easy internet access as Alistair alluded to in his introduction.

Beryl – I am wondering if it is cheaper to buy some drugs online than pay prescription charges.

I would certainly avoid buying anything requiring a prescription online without first consulting my GP.

I would buy generic meds such as paracetamol but only from reputable pharmacies such as Boots or Lloyds. I normally buy these from the supermarket when doing the two weekly shop or online shop when I am unable to travel.

Me too. I buy mine from the local Tesco, which is more convenient than other pharmacies. I’m impressed by the Tesco pharmacy, which is efficient, holds good stocks and has twice picked up a potential problem with a prescribed drug.

I was just trying to think of reasons why people might order prescription drugs online. Another reason could be that many don’t live near a pharmacy.

I haven’t bought drugs online well that’s a lie I did buy a bottle of codeine syrup online (from a UK pharmacy) because it’s sold as “cough syrup” buts it’s just codeine and it’s almost impossible to buy otc it’s very useful for supplementing cocodamol tablets that I was prescribed so I could cut down the paracetamol (the dangerous bit in cocodamol).

Anyway I know of people who HAVE bought prescription drugs online to self medicate and this is why: they suffer from illnesses that have no treatment like fibromyalgia. There are treatments that are being trialled and even prescribed in other countries that the avg patient stands no chance of getting so they research the drug concerned then track it down online because it’s not a recognised treatment by the NHS the person will never be “allowed” it.

In short desperate people…. I haven’t done so I do suffer fibromyalgia, functional neurological disorder & a few other bits so I know people who are in that boat and have tried it and that’s why unfortunately.

Thank you Richard, Keep them coming

I wished my gp to prescribe me a drug used by other people with one of my conditions. They refused. I believed it was my right to make my own decisions about my health so I bought it from a pharmacy when abroad and tried it. It is now (more than 10 years later) a product available OTC in Britain.

I am not an idiot, I know the risks of purchasing from websites – but I would like to be able to buy legitimate products without having to go abroad to do so. My gp will not go against national prescribing guidelines and he says he cannot write private prescriptions for me so I would have to find another gp to do so. There is another drug I would like to try – the safety record is good (been used for years in higher doses for a different problem) but it doesn’t fall with NICE guidelines. Why should I be prevented from trying something I am willing to pay for and that poses no risk to my health if I can buy the branded version from a legitimate website?

Mr Jeffrey you force desperate patients into a black market and therefore put more lives at risk than you help. What we need is less hounding of gps like Dr Sarah Myhill who will go beyond NICE guidelines.

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duncan, I agree with much of this. Professionals who understand medicine should run the NHS – doctors, consultants, nurses (bring back the matron!) should play a much larger part in running the NHS, assisted by accountants and managers rather than the other way round.

I would also look hard at the services the NHS provides and restrict its “free” mandate to those that are essential. This would mean some hard and unpopular choices but I believe we should target limited resources more effectively. I will myself be no doubt unpopular for suggesting this, but there are instances where the ability to pay may require some treatments to be provided at the patients expense if they are not essential to health. IVF perhaps, surplus skin removal after treatment for avoidable obesity. It is better in my view to offer this than to deny treatment to those unable to contribute.

I would also look hard at free prescriptions to universal groups – over 60’s for example. Many can afford to pay and contribute to the huge cost of drugs, and there is a prescription pre-pay card that limits costs to around £2 a week, so hardly breaking the bank. That might free up more money for other treatments.

Good man Duncan, I was talking to my Doc yesterday about this very manager problem. He was on for throwing the lot out. He said when he was young there was none of this manager high paid nonsense and hospitals and health centers ran fine. He is 63 and the practice did not jump on the funded bandwagon the father said he had morals. A real good little health centre where you can often get same day appointments and nearly certainly next morning