There\u2019s been a shift in how some medicines and therapeutic products are accessed and used.<\/p>\n
Medicinal cannabis<\/a>, glucagon-like peptide-1 (GLP-1) weight-loss medicines<\/a>, ketamine<\/a>, psychedelics<\/a>, testosterone<\/a> and peptides<\/a> illustrate this shift.<\/p>\n Increasingly, consumer demand, telehealth<\/a>, social<\/a> media<\/a>, wellness influencers<\/a> and<\/a> commercial models<\/a> are shaping how people learn about and access these treatments.<\/p>\n This is different from the traditional doctor-led model, where medicines are generally tested, approved and included in clinical guidelines.<\/p>\n Now we\u2019re seeing what happens when strong consumer demand collides with commercial interests.<\/p>\n There are benefits for improved access to certain medicines, if those medicines are safe, effective, and prescribed and monitored with proper oversight.<\/p>\n But, as we\u2019re seeing, this is not always the case.<\/p>\n When demand meets innovation<\/p>\n A recent example is the launch of LillyDirect, Eli Lilly\u2019s new Australian platform. The platform currently focuses on Mounjaro (tirzepatide), a drug used to treat type 2 diabetes and manage weight. Patients with an electronic prescription can upload it to the platform, have the medicine dispensed through an online pharmacy and delivered directly to their door.<\/p>\n Eli Lilly argues<\/a> the model will improve affordability and convenience. <\/p>\n But doctors<\/a> and pharmacists have raised concerns<\/a> about the lack of continuity of care<\/a> and what happens when prescribing, dispensing and ongoing clinical care become increasingly separated<\/a>.<\/p>\n It is a timely example of what happens when strong consumer demand<\/a> meets commercial innovation<\/a>.<\/p>\n Ketamine is another example. It has long been used as an anaesthetic. But its use for mental health conditions has expanded<\/a>. This includes via private clinics offering ketamine treatment<\/a>.<\/p>\n This creates questions<\/a> about who is providing ketamine treatment, how patients are assessed and monitored, and whether their usual doctors know about their treatment.<\/p>\n These concerns don\u2019t just apply to ketamine. They relate to other drugs when the uptake moves faster than the evidence<\/a> to say they are safe and effective, and the systems needed<\/a> to monitor their safety<\/a>.<\/p>\n Patients may use a drug before we know enough about whether it works, whether there are longer-term harms<\/a>, whether the drug is right for them, how it interacts with other drugs they might be taking, if it is being monitored<\/a>, or when treatment should stop.<\/p>\n Read more: The rise of people power<\/p>\n Patient demand is understandable, particularly where<\/a> existing treatments have not worked, are poorly tolerated, difficult to access, or patients feel they have not been heard.<\/p>\n Greater access to health information can empower patients<\/a> and increase their participation in health-care decisions. But access to more information does not necessarily mean access to better information<\/a>.<\/p>\n Patients are also prepared to advocate for their own treatment<\/a>. That agency is important, but it needs to sit within a system that can assess benefit, harm and appropriate use<\/a>.<\/p>\n Stigma can also influence where people seek care. This is particularly evident with medicinal cannabis<\/a>. But this also affects people with obesity<\/a>, mental health conditions<\/a>, menopause<\/a>, sexual health concerns<\/a>, hair loss<\/a> and erectile dysfunction<\/a>.<\/p>\n People who feel embarrassed, judged or who have had their concerns previously dismissed may be reluctant to raise them with their usual GP<\/a> or seek further care<\/a>. Instead, they may turn to online providers<\/a>.<\/p>\n But patient demand should not substitute for evidence, safety monitoring or clinical oversight<\/a>.<\/p>\n Fragmented care<\/p>\n Treatment may start<\/a> through telehealth, an online platform or a commercial clinic. <\/p>\n But patients do not stop needing their usual health care. They may return<\/a> to their GP<\/a> with side effects, potential drug interactions, requests for pathology (such as blood tests), monitoring, mental health concerns or questions about whether treatment should continue.<\/p>\n This can leave GPs managing the consequences of treatment<\/a> they did not initiate, having limited visibility of the treatment their patient is receiving elsewhere. When treatment is initiated elsewhere, there is often no record of this on the GP electronic medical records<\/a>.<\/p>\n If the treating GP cannot see what has been prescribed or dispensed, it is harder to know<\/a> whether a treatment is appropriate, identify potential drug interactions and adverse effects, or recognise other safety concerns.<\/p>\n Medicinal cannabis illustrates this problem particularly clearly<\/a>. National medicinal cannabis approval data<\/a> show rapid growth in access, including for mental health conditions, chronic pain and sleep disorders.<\/p>\n But these data cannot tell us how many individual patients are being treated, what is actually dispensed or what happens to patients after treatment begins. <\/p>\n Other drugs have specific issues<\/p>\n Peptides are more complex. Some are increasingly promoted for wellness, anti-ageing, performance and body image, despite limited evidence<\/a> about their benefits and risks<\/a>. For consumers, it can be difficult to tell<\/a> the difference between a promising new therapy and a commercial claim that has moved ahead of the science.<\/p>\n Testosterone shows how treatment can also become tied to self-optimisation and body image. Social media marketing promotes treatment<\/a> for low testosterone (\u201clow T\u201d) through messages about restoring youthfulness, muscularity, sexual performance and becoming a better version of yourself. This marketing also directs consumers towards testing, treatment and commercial clinics.<\/p>\n GLP-1 medicines are different because there is strong evidence they work for conditions such as diabetes and obesity<\/a>.<\/p>\n But interest is rapidly expanding<\/a> into other areas, including substance use disorders and Alzheimer\u2019s disease, even though these medicines are not currently approved for many of these uses. <\/p>\n This expansion is occurring alongside strong consumer demand, social media interest, and the growth<\/a> of private<\/a> and online prescribing models<\/a>.<\/p>\n Psychedelics raise similar issues around strong public interest, advocacy and commercial activity<\/a>. These also require clear safeguards<\/a> around who should receive treatment, in which setting and how this should be monitored. <\/p>\n Commercial interests also need to be considered. Where the same business<\/a> attracts the patient, prescribes, arranges dispensing and provides follow-up, there are legitimate questions about financial incentives to prescribe<\/a> and clinical independence<\/a>.<\/p>\n Read more: Patients can demand more than access<\/p>\n Getting access to medicines right is not just about making them available. It also means knowing when a treatment should not be started<\/a> or when it should be stopped.<\/p>\n This changes the conversation about consumer advocacy. Advocacy does not have to be about access alone. Patients can demand better evidence, better monitoring and safer care \u2013 from a health system that integrates their treatment choices with their everyday health care.<\/p>\n Equity matters too. Increased consumer access does not necessarily mean equitable access. Many of these treatments are privately funded<\/a>, so access may depend heavily on the ability to pay<\/a>.<\/p>\n What can we do?<\/p>\n One solution is to make better use of the health data we already collect. GP electronic medical records<\/a> could help identify patients already using rapidly adopted treatments, track other medicines and outcomes, and identify gaps in monitoring<\/a> and possible side effects. <\/p>\n These medical records could help connect patients to clinical trials. This way, treatments already being used in the community contribute to the evidence needed to determine whether they are effective and safe.<\/p>\n When demand and innovation move faster than evidence and oversight, access to medicines cannot be the only measure of progress. Access must also be appropriate, evidence-based and safe. <\/p>\n That means making these treatments more visible across the health system<\/a>, strengthening safety monitoring<\/a>, and better connecting them with a patient\u2019s usual GP and the rest of their health care.<\/p>\n Innovation may continue to move quickly. Our systems for generating evidence and protecting patients need to move just as fast.<\/p>\n","protected":false},"excerpt":{"rendered":"There\u2019s been a shift in how some medicines and therapeutic products are accessed and used. 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