why is B12 so Taboo within the NHS

[fireyanth]

quick question.

Why are our UK doctors so against prescribing B12 injections if they are so inexpensive?

In this country they are a prescription drug, yet we can import them from other countries??

something doesn’t feel right.

[wedgewood]

Because there are no “ Brownie Points “for prescribing them , and nurses who administer them have to be paid out of the budget that they are allowed .

[Pickle500]

Because its not their domain. They get 30 minutes of training on B12 in medical school.

They're out of their depth because nutrition is a big gaping void in their knowledge.

Its a depressing reality Im afraid. And it means they avoid anything outside of the prescribing rules given to them.

[deniseinmilden]

Bonkers, isn't it!

At one time B12 was available over the counter and it wasn't given any particular medical status so although there was an appalling lack of knowledge within the medical profession about nutrition due to no big pharma funding, it wasn't seen as a problem either.

Roughly speaking the change in attitude from "don't care" to "it could be deadly" was due to a blanket change in status of injectables from PML (Pharmaceutical Manufacturer's License) to POM (prescription only medicines) by the UK government about 10 to 15 years ago and included vitamins and mineral preparations. It caused havoc in the agricultural and veterinary industries because products we used frequently for the health of our animals were suddenly not available. You try telling a cow in a field or a sheep on a hillside to "take her tablets" every day (!) whereas a boosting injection as necessary was possible.

This was a UK law, passed irrespective of Brussels, long before Brexit, and showed that the UK could do what it liked if it wanted to, regardless of Europe.

Because injectable vitamins and mineral preparations suddenly came under the jurisdiction of Drs who had to issue prescriptions for them, they suddenly changed to "potentially dangerous" status in the minds of many medics.

There were changes in the preservatives allowed too and I suspect it was this, combined with the decline in volume used (it wasn't usually cost effective to call a vet out for a vitamin injection when drenches were available, just difficult), that has subsequently lead to the withdrawal of a lot of the vitamin and mineral injectables that were available, so now even vets can't get them, despite finding them highly effective.

[Gambit62 Administrator]

They are a prescription drug because they are injections. You can supply B12 for non-medical reasons (as a vitamin supplement) without a prescription - but once you are using it formedical reasons it is covered by the UK rules that make any injected medications prescription only.There have been moves, particularly in the EU to prevent UK patients ordering medications that are only available in the UK with a prescription to demonstrate that they also have a medication. However, this tends not to bite because there is no way of knowing that the customer is requesting for medical or non-medical reasons (ie as a vitamin supplement or beauty treatment).

Personally I would have to say that this is a situation in which the 'law is an ass'.

[Dilly_blue]

I agree with all of the above, and my feeling is also that doctors don’t really understand the nature and implications of a B12 deficiency, so don’t take it seriously enough.

In this way, it becomes an ‘easy win’ for their budgets, to reduce the number of B12 injections that they give, and also reduce the number of patients that they have to give them to.

The nurse who gives me my injections tells me that there are huge numbers of people that come in to the practice for B12 injections - all of which will probably be every 3 months… (as I am only on every 3 months after 6 loading doses despite neurological symptoms). So the staffing costs of injecting every other day until no more improvement, then twice weekly, weekly or monthly (or even 2 monthly) for a huge number of people would probably have a really significant impact on staffing budgets (as well as prescribing budgets)…

[Hidden in reply to Dilly_blue]

As you say, the cost of this on surgeries is quite significant. I dont know if it was done on purpose but I went into the surgery months ago and the nurse was signing off B12 prescriptions, in one day it was 25. ( we are in quite a small surgery, so just imagine how many get B12 in a town or city)

This is all the more reason why B12 should be OTC.

If the NHS want to limit who can buy OTC then they could issue a card giving them permission.

It's all wrong people should have to fight on many fronts to keep healthy...... when that little bottle containing red liquid can make all the difference.

[helvella in reply to Hidden]

If the NHS want to limit who can buy OTC then they could issue a card giving them permission.

I think that something like this could underpin the treatments for many patients. There have been various expert patient programs. There have been systems which allowed some patients access to blood test results - even before doctors had seen them - and long before "NHS app" access was allowed. Just the other day, I listened to a program in which both the husband and the children (I think teenagers) were trained to provide injections within end of life care - within limits, and with support if needed.

I'd argue for much the same across a range of medicine. The one issue is that it should not be done with the aim of saving money - even if that is often a benefit.

[Janma123 in reply to Hidden]

My hubby had very low b12 caused by years of taking metformin and omeprazole. Unfortunately it wasn’t diagnosed until after a stroke which affected his understanding - he was convinced the doctors and I were in cahoots and trying to poison him especially as it was a red liquid! He reluctantly had the injections for a while but we swapped to high dose tablets during the pandemic when the surgery stopped giving injections.

[Hidden in reply to Janma123]

Without going into detail, I understand and resonate with you.

We are left to do our best in providing care !

🙏 you find peace ,comfort and support.

[helvella]

For information:

The website openprescribing.net allows anyone to check numbers of prescription right down to practice level - for England only (sorry other three nations).

The link below selected for

Hydroxocobalamin 1mg/1ml solution for injection ampoules by all CCGs in May '22

Interestingly, Hampshire, Southampton and Isle of Wight and Kent and Medway have the most prescriptions. But if you change it to be against list size (rather than nothing) Northumberland and Castle Point and Rochford and have the most per person on their lists.

openprescribing.net/analyse...

Cost/numbers over last 12 months across England:

Last 12 months (Jun '21—May '22)

Cost (£) 3,658,563

Items 2,488,132

Map of B12 prescriptions by area of England May 2022

[Hidden in reply to helvella]

Hi helvella,

The white areas on the map .... let me guess !

[helvella in reply to Hidden]

In order, from bottom, by number of items (ampoules):

Halton

Blackpool

Warrington

East Stafffordshire

West Lancashire

Am wondering if any of this is due to different practices such as prescribing a box or a single ampoule for a single patient - or bulk purchase and given without individual prescriptions?

[helvella in reply to helvella]

Interestingly, Wirral has the highest at 10.29 per 1,000, with Gloucestershire third at 9.17 ampoules per 1,000 patients. Down to Warrington at 1.16 per 1,000.

Massive variations!

Particularly odd, in my view, that Warrington and Wirral are right next door to each other yet occupy opposite ends of the scale.

openprescribing.net/analyse...

(Originally attached wrong map image)

B12 ampoules by list size - effectively per patient

[Hidden in reply to helvella]

Very difficult to judge the true figures, as gloucester in second map is red,Yet a significant portion of gloucestershire is the opposite side of the scale.

[helvella in reply to Hidden]

You can go down to individual practices, if you wish. And see from about Hucclecote (46.72) down to Princess Road (0.41). From June 2017 to May 2022.

You have to hover over the bottom of the graph to get details on a popup.

openprescribing.net/analyse...

[Hidden in reply to helvella]

Just like to add to the equation, how many people in gloucestershire have given up fighting there doctors for B12 Injections, and purchase them from Germany.I know a lot. !!!

Perhaps details from Germany of where they send B12 too, would indicate why sudden changes in areas.

[fireyanth in reply to Hidden]

This would be hard to judge... I have just scrutinised the figures in our local area, and the highest figures per 1,000 are at surgeries in areas where there are high numbers of asian people in their community, and if my research is correct, don't this demographic suffer more with B12 deficiency?

[helvella in reply to fireyanth]

That makes less sense as, so far as I understand, that is mostly dietary deficiency. For which an oral product might be perfectly acceptable.

[Pickle500 in reply to helvella]

They may drop off the regular monthly injections but they would still need loading injections. And if it's neurological, which many dietary deficiencies are, it would need every other day to resolve.

So I'm not sure it could be as clear cut.

[MoKayD]

My doctor told me that during the 1960s and 70s, here in the US, doctor's gave out B12 injections like they were candy. For some reason it's just dropped off the radar for today's medical professionals. Maybe because the pharmaceutical industry can't make money off of it.

[wedgewood in reply to MoKayD]

Your last remark hits the mail on the head ! 100%!

[helvella in reply to MoKayD]

Reference to the phrase "vitamin shot" was widespread across USA media of the time. Though the precise meaning seemed never to be spoken. Could have been B12-only or a cocktail.

[MoKayD in reply to helvella]

My doctor was referring to B12 shots only, not multiple vitamin cocktails.

[jade_s in reply to MoKayD]

I read about this very recently somewhere and there was some explanation about why doctors stopped giving them out and for the life of me I can't remember where I read it! If I every find it back, I'll let you know!