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Now now Doc, it’s not all bad

Asda’s latest inhaler initiative received some heavy scrutiny from Dr Livingstone, writes locum Peter Dawson, but I for one think it exemplifies the financial reality of today’s health service

In response to the Asda evohaler initiative, Dr Livingstone wrote: "We need to unmix the message: is asthma an illness or a marketing opportunity? I, for one, will continue to take it seriously.''

Well of all things. That last phrase none too cleverly suggests that the association of financial reward with a clinical indication reduces the seriousness with which the illness is treated. Now that's either rank hypocrisy or a telling damnation of the medical profession. Pay for performance is embedded in general practice. Only last week the BMJ reported that that performance declines when financial incentives are withdrawn.

Let's rid ourselves of can't and recognise that the answer to Dr L's question (ironic or not, it is worth answering) is that the message is inextricably mixed and not just for asthma. We may as well try and unmix a mug of cocoa. All illnesses are marketing opportunities. Always have been, always will be – or at least until capitalism runs its course.

The continual medicalisation of normal behaviour is simply a grander example of how all illnesses are marketing opportunities.

All illnesses are marketing opportunities. Always have been, always will be

Asda's innovative approach to increasing sales, not to mention the associated linked business – here's your evohaler, now let me show you our new DIY home - spirometry kit complete with HD 3D DVD on pulmonary function testing in the store - will be lauded by its American owners Walmart. And doubtless Walgreens has already instructed their UK outlet Boots et al to follow suite. Patients will appreciate the improved access to care, the PGD will ensure patient safety and standardised decent care, albeit at the expense of the continued decline of pharmaceutical care into uncritical compliance with an algorithm and compliant, but poorly controlled patients, will doubtless be referred off to the asthma clinic.

Asda's initiative exemplifies the financial reality of today's health service. We really ought not to use it for professional point scoring.

Peter Dawson was recently described by a student as a pharmacist who must have seen a lot of changes. He has. Currently he is a locum pharmacist and Guardian and C+D columnist. He can also be found here or Tweeting at @peterdawson19

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