Select Committee on Health Written Evidence


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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