Challenging established wisdoms could lead to progress

I am surprised Terry Maguire says in his letter that community pharmacists should avoid the medicalisation of life when we are already treating other diseases that are also prevalent with increasing age, such as diabetes, hypertension, heart disease, cancer, arthritis and dementia (
The Pharmaceutical Journal 2017;298:100).

Surely the emphasis of our professional being is all about improving the quality of life of a patient, their family and the health economy in general — regardless of age-related morbidity.

In his letter, Maguire also questions the level of research around testosterone deficiency. We should always challenge established wisdoms because that is where progress comes from and, if we did not, then we would never have achieved things, such as pharmacist prescribing, blood tests conducted pharmacies, substance misuse services, vaccinations, immunisations and pharmaceutical care.

In many ways we have the pharmaceutical industry to thank for helping us provide much needed evidence, which has led to innovative services such as blood glucose screening and vaccinations becoming mainstream services and in pharmacies.

From what I know and have seen, testosterone deficiency is a well-established, evidence-based, rational and significant medical condition that negatively affects male sexuality, general health and quality of life. It is an indicator for increased risk of developing diabetes and the quartet of metabolic syndrome (obesity, type 2 diabetes, hypertension, and dyslipidaemia). Therefore — based on previous principles — if there is a disagreement on existing research then surely the bottom line is we can potentially do much more rather than turn a blind eye.

When I was a member of the Young Pharmacists’ Group, we developed a roadmap called ‘A sense of purpose’ in 1996, on which we acknowledged the barriers, provided solutions and had the audacity to ask for clinical extended roles. We had the intellectual resilience to pursue unpopular ideas, having first exercised the discipline of being their strongest critic. Finding out who gets sick, why, what can we do, would it work, what would it cost and do we want to do it. 

It is in that spirit we should look more closely at testosterone replacement therapy because the rewards could be great for patients. In one swoop, improved sexual function, body composition, cardiometabolic profile, quality of life, mental health, physical well-being and the overall healthy ageing of men could be addressed.

Sid Dajani

Andover, Hampshire

Mr Dajani is UK Delegate at the Pharmaceutical Group of the European Union (PGEU) and a member of the Royal Pharmaceutical Society (RPS) Assembly and English Pharmacy Board. The views expressed are his own and do not necessarily reflect those of the PGEU or RPS

Declaration of interest: Mr Dajani has previously received speaker honoraria for a conference from Besins Healthcare UK, which manufactures testosterone products