Memorandum by Organon Laboratories (WP
18)
Organon Laboratories Ltd. is a research-based
pharmaceutical company with a long-standing interest in contraception
and pregnancy, having developed and produced a wide range of contraceptive
products over a great many years. We therefore read with interest
the Government White Paper, Choosing Health: Making Healthy Choices
Easier.
We are grateful for the opportunity to submit
evidence to the above inquiry and have a number of observations
to make which I have set out below. We would like to stress that
they are restricted to the sexual health content of the White
Paper and are made on a corporate basis on behalf of Organon Laboratories
Ltd.
1. WHETHER THE
PROPOSALS WILL
ENABLE THE
GOVERNMENT TO
ACHIEVE ITS
PUBLIC HEALTH
GOALS
1.1 Organon believes that the combination
of broadening the reach of information on sexual health and the
commitment to modernisation of sexual health services proposed
in the White Paper will be key in achieving the Government's goals.
The expansion of information in ways that meet the needs of
young people will increase their knowledge, but will also raise
their expectations of sexual health services.
1.2 It is therefore important to ensure
that sexual health services are configured so that expectations
raised through better information provision can be met, which
implies that not only will the combination of the two elements
be important but so will the co-ordination between them. We
believe that the proposed audit of contraception services in 2005
should provide a solid basis for this to happen.
1.3 The White Paper highlights two major
components in sexual health: the rise in STI rates and the high
teenage pregnancy rate. The two are clearly linked; for example
information on both can (and should) be communicated simultaneously.
Likewise health care professionals (HCPs) can provide services
that will address both simultaneously. However, it is important
that both components and their different needs are dealt with:
considering one or the other will not automatically deal with
both.
1.4 There are differences in the methods
by which the different needs of effective contraception and protection
from STIs are satisfied. For STIs, the important role of condoms
and other barrier contraception is clear, but studies show that
these are not the most effective means of contraception, and in
any case the selection of a suitable method of contraception may
be based on additional factors.
1.5 One of the most important of these factors
is the degree to which the way the chosen contraceptive method
is used suits the user. No single method is ideal for everyone
and so whilst it is important to stress the use of condoms for
protection against STIs, it is equally important to encourage
the additional use of a method of contraception that the user
finds easy to use and which provides a more effective means of
preventing pregnancy.
1.6 The White Paper proposes the development
of a new national campaign targeted at younger men and women to
ensure that they understand the real risk of unprotected sex and
persuade them to the benefits of using condoms to avoid the risk
of STIs or unplanned pregnancy. Organon would urge the Government
to design the campaign so that it promotes the combined use of
condoms (primarily for protection against STIs) together with
other forms of contraception to prevent unplanned pregnancy more
effectively. The combined use of condoms and other forms of
contraception was first promoted in the mid 1980s through the
term "double-dutch"—implying the use of both.
1.7 The importance of selecting a method
that suits the needs of the individual user also means that it
is important to have a full range of contraceptive methods and
services available. The reference to this in the White Paper,
relating to the audit of contraception services in 2005, is particularly
encouraging. The selection of a contraceptive method that is easiest
for the user increases the likelihood of the appropriate use of
the method and thus its effectiveness.
1.8 Availability of, and access to, a full
range of contraceptive methods is therefore important in minimising
pregnancy rates in any age group, including teenagers. To meet
the Government's public health goals in this area, people need
to be aware of the wide choice that is available to them, so health
education programmes will need to reflect this. Organon urges
the Government to ensure such programmes should not only explain
each method, but should encourage people to consider if or how
each method would fit into their lifestyle.
2. WHETHER THE
PROPOSALS ARE
APPROPRIATE, WILL
BE EFFECTIVE
AND WHETHER
THEY REPRESENT
VALUE FOR
MONEY
2.1 Organon believes that the proposals
in the White Paper to take a proactive approach to information
on sexual health across a broad range of outlets and media are
highly appropriate. Indeed, we would encourage this to be taken
even further. Greater consistency of messages across all sources
of information will, we believe, be important.
2.2 Organon believes that it is important
to have information available across the full range of media and
presented in different styles. Clearly there are some areas where
more information is needed, for example the White Paper proposals
to produce targeted information for specific groups are very helpful.
But there may be ways in which existing information can be made
more effective. We would like the Government to encourage ideas
to improve accessibility of information across all media.
2.3 If people cannot find the information
they need, the reason may be that, though it exists, it is not
sufficiently accessible. The proposal to provide advice on sexual
health in settings where young people go is particularly important,
therefore. A similar consideration also applies to a medium
of communication that is growing in importance—the Internet.
2.4 The White Paper refers to a MORI study
in 2003 showing that the Internet is used as a source of health
information more frequently than "traditional" media
such as television, books, magazines and newspapers. This is supported
by a study published in 2001 in the United States of America,
which reported that 75% of young people that use the Internet
go online for health information, of whom 44% have sought information
on sexual health.[55]
2.5 The White Paper also mentions confidentiality
as an important factor and this may be an important perceived
advantage of using the Internet. A 2004 paper from the UK reports
that access to the Internet in the home is common and that 22%
of computers in the home are located in a young person's bedroom[56]
which provides a high degree of privacy. The same paper, however,
highlights the risk of gaining access to websites containing adult
material when using the internet to look for information on sexual
health—it says that 57% of 9-19 year olds in the UK who
use the internet at least once a week have reported coming into
contact with pornography online. Those seeking health information
are more likely to encounter it.
2.6 Since the Internet is growing in importance
as an information source, Organon would like to suggest that the
Government encourage initiatives to improve access to UK informative
websites on sexual health that will encourage more people to use
them and protect them (particularly young people) from accidentally
entering pornographic sites. This suggestion may require a different
approach to the internet by taking a strategic view of all information
provided from all informative UK sites.
2.7 With a greater degree of coordination
to facilitate easier and more prominent access from general search
engines such as Google, the already excellent individual websites
provided by a range of organisations including Government departments
and non-government organisations could become an even more effective
and valuable resource. The key advantage of this would be that
people may be more likely to use this to inform themselves before
consulting a health care professional or to reinforce their understanding
following such a meeting. This, in turn, would help to relieve
the pressure on HCPs, who are in the difficult position of having
to provide greater amounts of information within the already constrained
time available in an average consultation.
3. WHETHER THE
NECESSARY PUBLIC
HEALTH INFRASTRUCTURE
AND MECHANISMS
EXIST TO
ENSURE THAT
PROPOSALS WILL
BE IMPLEMENTED
AND GOALS
ACHIEVED
3.1 As the White Paper implies, there seems
to be a need to provide sexual health information and services
in settings where young people go, ie outside the surgery. The
amount of information involved in covering all methods of contraception
is too much for HCPs to convey in the time available in a typical
consultation and beyond the ability of users to absorb such a
lot of information. Yet, it is very important that users are
able to make a choice of method that is informed by knowledge
of everything that is available. This suggests the need for information
and advice sources outside the normal consultation of which the
Internet is one possibility. Organon would like to suggest
that the Government encourage other innovative ideas to provide
information for users outside the consultation and co-ordinated
in such a way as to support the needs of HCPs, even where some
additional funding may be required.
3.2 As already mentioned in 1.7, there is
a need to ensure that a wide range of contraceptive methods is
available to maximise the overall effectiveness of a contraceptive
service by matching the lifestyle needs of users to appropriate
contraceptive methods. Each method should therefore be equally
accessible in order to ensure that the user's needs are the main
factors in their choice of contraception. Organon would like
to encourage the Government to ensure the optimum accessibility
of all methods of contraception through the existing infrastructure
and mechanisms, and to address any issues where access could be
improved.
3.3 Organon has experience of one example
that illustrates the point made in 3.3 above. Women choosing to
use long-acting methods, such as the contraceptive injection,
the intrauterine system (IUS) or the contraceptive implant, that
need to be applied by HCPs should ideally be able to have them
at the time of their initial consultation (unless there are medical
reasons for doing otherwise). However, women choosing the contraceptive
implant cannot have it fitted at the first consultation if they
go to a GP surgery. They must first take a prescription from the
surgery to the pharmacist to obtain the item. They must then later
return to the surgery for it to be fitted, because the implant
is not covered by section 44.5 of the Red Book (the Statement
of Fees and Allowances for General Practitioners). Unlike any
other method of contraception, for those who have chosen this,
there is thus a delay in obtaining their contraception and a potential
additional risk of a person failing to return with the implant
and remaining at risk of unplanned pregnancy.
3.4 As the Health Select Committee stated
in the recommendations of its 2003 report, there is a crisis in
the sexual health of this country. Its specific inclusion in the
White Paper is a significant boost to the perceived priority of
sexual health, but this priority needs to be constantly reinforced
throughout implementation of the recommendations. This does
not appear to be matched by incentives for HCPs to take up the
recommendations through the GP contract, where sexual health and
contraception are relatively low on the priorities. Organon urges
the Government to consider the addition of some such incentives
as an effective way of rewarding the implementation of the White
Paper proposals.
We very much hope that our points will be taken
into consideration and we thank you once again for the opportunity
to comment.
January 2005
55 Generation Rx.com: How Young People Use the Internet
for Health Information. Rideout, V; Kaiser Family Foundation;
December 2001. Back
56
UK Children Go Online. Livingstone, S and Bober, M; Department
of Media and Communications, London School of Economics and Political
Science; July 2004.
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