A while ago, +Adam Jacobs or @DianthusMed brought to my attention to the fact that Amazon UK are selling unlicensed medicines imported from the US via its Marketplace whilst he was looking for some anti-allergy medicines. Adam got in touch with Amazon, and the particular brand he bought are no longer available on their website, but of course there are still a whole range of other unlicensed loratadine brands available to buy with just one click.
I dug a little bit deeper and discovered that this could actually be more dangerous than some non-drowsy anti-allergy medicines- along with some problems selling licensed medicines as well.
Some inane browsing brought me to a page selling Syndol. I noticed it because of the price- its being sold at a whopping £39.99 for 30 tablets. I presume this is due to the fact that Syndol are currently on a long term manufacturing problem. Syndol do have a UK product license, and are sold over the counter in pharmacies. They're kept behind the counter for a number of reasons, and require quite a lot of patient counselling for appropriate use: they contain paracetamol, therefore shouldn't be used in conjunction with any other paracetamol products (they're one of those shiny combination products which people might not realize contains paracetamol). They contain codeine, which is very addictive and should be used for no more than 3 days at a time. They contain doxylamine, which causes drowsiness, making them even more abusable and dangerous. I use these occasionally myself if I get horrible, migraine-type headaches. They seem to work, but I also sleep the sleep of the dead for 5 hours, then wake up feeling zombie-like for a good few hours after that. If I sell these over the counter, I check that the patient isn't using them regularly, that they understand about the paracetamol, and that they will make me drowsy. Whilst the sellers do state they might need more information from you before selling them, they seem to me to be pretty inappropriate for an internet sale- sometimes you can tell if a patient is misusing them by their body language etc. the largest pack size it is available in is 30, for all of these reasons. And charging £39.99 for an addictive substance which is out of stock elsewhere just seems manipulative.
And here's the most horrifying thing: Amazon, trying to be helpful, suggest a package that we can buy, based on what other customers have bought together:
This is, of course, just the tip of the Iceberg, Click on the Sleep Aid tablets and you're encouraged to buy Sleep Aid, Sleep Aid and Unisom. Click on Sominex (a UK-licensed product) and you're advised to buy it alongside Sleep Aid and Nytol. Any of these combinations have a huge potential to harm.
I'm going on about licensed and unlicensed products here. So what am I on about? Well, in the simplest terms, a product that is licensed in the UK, and used according to the manufacturer's instructions, is guaranteed to have met certain standards of quality, efficacy and safety. If it hasn't got a license, you haven't got that guarantee. It might be fine, or it might be made of rat poison and brick dust, you just don't know.
I know I get taken in by these packages on Amazon all the time, when I'm buying DVDs or books, or other items. At least none of these are going to have that much of an effect on my health (although I'm sure some would argue that my love for Korean extreme horror must be having some effect).
This sort of multi-product purchase encouragement goes against many of the reasons why products are sold through a pharmacy in the first place.
Amazon have been through the mill lately, what with the Keep Calm and Rape T-shirts and their selling of unlicensed cancer medicines. Well, I'm going to add my little chirp to all that noise too. I'm sure there are complicated technical reasons behind why they have this frequently bought together sections on medicines, but frankly I don't care.