In response to the defence offered in this AJP article by compounding pharmacist Daryll Knowles and MWI chief spruiker Geoff Jowett (and concerns expressed by Jarrod McMaugh and Jignesh Patel) I provide the following additional information.
S2 “A compounded medicine should be prepared only in circumstances where an appropriate commercial product is unavailable…..The compounding of a medicine (whether prescribed or not) that would be a close formulation to an available and suitable commercial product, and would not be likely to produce a different therapeutic outcome to the commercial product, should not take place. In the case that such a medicine has been prescribed, the pharmacist should notify the prescriber that this medicine cannot be compounded under these circumstances.”
First of all, following a review of the risks and benefits of diethylpropion and related anorectic drugs by the European Committee for Proprietary Medicinal Products (CPMP), the European Commission decided that the drugs’ licences should be withdrawn. Licences were withdrawn in the UK on April 9, 2000 and the drug was also withdrawn by the sponsor in Australia, Canada, and the majority of other countries of the world.
Second, a related weight loss medication, phentermine (Duromine modified release) is registered by the TGA for the management of obesity as a short-term adjunct in a medically monitored comprehensive regimen of weight reduction.
S15. “Pharmacists should ensure that every patient or their agent are offered counselling and relevant consumer medicine information on each occasion a compounded medicine is supplied. Written consumer medicines information leaflets are not usually available for compounded medicines. However, alternative written information should be provided by the pharmacist to assist in the communication of the following counselling points to facilitate the safe and effective use of the compounded product:
- an explanation of why a compounded product is being supplied, and how this differs to a commercially-available medicine which requires the manufacturer to meet the requirements of the TGA for addition of medicines to the Australian Register of Therapeutic Goods;
- instructions on the correct use of the product;
- the appropriate storage requirements and expiry date of the product;
- the side-effect profile of the product, any contraindications and any other specific counselling points which would normally be contained in a written consumer medicines information leaflet, and
- how to report adverse events”.
Patients have reported both to me and Prof Dixon that the medications arrived by mail from the compounding pharmacy and no written information was provided about the dot points above. Hence the AHPRA notification of compounding pharmacist Daryll Knowles.
In the AJP article Mr Knowles asserted that:
- Diethylpropion was associated with less reported adverse reactions than celecoxib; however given the vast difference in prescribing rates that defence is meaningless.
- The TGA had provided him with an permit to import diethylpropion. Given that the TGA have a track record of bizarre decision making that is also an unsatisfactory justification.
- There have been no reported adverse reactions to diethylpropion dispensed by ACP. Given that ACP provides no information to patients about such matters and the doctors involved do not follow up the patients or adequately respond to their concerns that is hardly surprising.
- He is considering legal avenues for his slanderous statements. As have others in the past.
With respect to the prescribers at the Medical WeightLoss Institute (MWI), Dr Thomas Goyer the initial doctor involved, has had unfavourable comments made about him by the Judge who heard the AMI case concerning the promotion and supply of medications for erectile dysfunction, with whom Dr Goyer was also involved. He has also had a number of conditions placed on his practice by the Medical Council of NSW &/or AHPRA.
The MWI modus operandi appears based on that of the AMI; MWI recruit vulnerable patients by placing prominent advertisements making extravagant claims; they order a large number of pathology tests of dubious relevance (at taxpayers’ expense) to give an appearance of authenticity; their doctors write ‘scripts for a cocktail of complementary and prescription drugs without seeing or examining the patients, and a closely related compounding pharmacy dispenses the drugs and fails to provide patients with the information expected by the Pharmacy Board’s Compounding Guidelines.
I suggest readers of AJP watch both Dr Goyer’s and Mr Geoff Jowett’s promotional videos, review the additional information below, and then make up their own mind about MWI and whether you, as a pharmacist, would dispenses their medication.
- Yet another weight loss scam (Dr Thomas Goyer, Geoff Jowett).
- Australian Male Hormone Clinic (AMHC)
- More on MWI; prescribing dangerous drugs withdrawn from Australian market
- AMI begat MWI begat AMHC begat ACTIVATE
- MWI: Patient stories