Guardian and Michael Rosen in agreement - a major issue.
Michael Rosen says:
From a purely selfish point of view, I worry about this as I am hypothyroid and need daily meds. I know others in the same situation. Well, millions of us are, aren't we? Anyone with chronic conditions that need daily meds to stay alive.
Guardian says:
NHS medicines shortage putting lives at risk, pharmacists warn
Unpublished figures reveal a doubling of products in short supply over past two years
indeed this is rather worrying, for all patients requiring treatments for a variety of health issues.
Only this morning I spoke with a pharmacist at Boots regarding a brand of statins (have only started these 4 months ago) because I am always given the TEVA brand to which I react badly, although the pharmacy have included NO TEVA in my records… So l refused the TEVA brand, was told they would source another brand. When it was delivered it was in an ALMUS box but on the back of the tablets blister pack TEVA was indicated…. So I phoned again and was told ALMUS wasn’t a brand of medication but a packaging brand (very new to me!)… And that pharmacists could use an ALMUS box for any medication brand! Is that legal ? Not ethical really. A true fobbing off situation.
The pharmacist told me they’re having a lot of problems getting medications since 2016 getting much worse now. She told me it’s due to 3 major events: Brexit, the war in Ukraine and the incredible greed of the pharmaceutical companies together with low income to dispensers (that make 4 events). She added all the good brands are sold to countries that pay the higher price and the NHS only gets what’s left and often not the best brands. She told me it was a nightmare every day.
Almus is a company that orders in medicines packaged in its livery (colours, font, design) but could be from any manufacturer.
The boxes will have the product licence number (PL) on the outside and the name of the manufacturer. But they could change from one dispensing to another.
Almus are, basically, owned by Amerisourcebergen Uk Holdings Ltd.
Part of Amerisourcebergen Corporation - which seems now to be Cencora, Inc., a sizeable chunk of which used to be owned by Walgreen Boots alliance.
I can't get my head round why some pharmacies choose to get Almus branded product when the manufacturers' own branded products are available. For example, why do they get Almus levothyroxine instead of Accord levothyroxine? Doesn't it cost more to get special runs made in Almus livery? Doesn't it confuse patients (and others)?
However, whereas many Almus products have changed manufacturer, their levothyroxine has always been Accord (or Actavis under its previous name).
Thank you for explaining. However my local pharmacy (not boots) seems to buy TEVA levothyroxine…have done for years so I have to get this from Boots pharmacy from the next little town. The same for my B12 ampoules…
When generics and branded products are mentioned I get mega mixed up trying to understand it all. Nevertheless, I suspect some of your answers are here at : npa.co.uk -Why am I not making enough margin? Understanding Margin Delivery- Key points to this webinar, and there are different points listed. You may already be aware of the content.
Also there is good insight if you google (I think): pharmacy-forum.co.uk-Confusion over prices.
I also found somewhere that the monthly drug tariff is not necessarily correct as many products are subject to CONFIDENTIAL price negotiations with the NHS and the list price is not the price that is eventually paid. I think you are already aware of this.
I think a big part of the difficulty understanding generics vs branded is that the discussions are always about one specific circumstance.
For example, Prozac was launched as a new anti-depressant covered by patents. When, around twenty years later, the patents lapsed, other companies launched near-identical 'copies'. They were sold as Fluoxetine - the formal chemical name for the active ingredient.
We can easily see branded (Prozac) and generics (and Fluoxetine). Makes reasonable sense.
There is really just one big issue - if they are authorised 'good' copies, why does it make any difference whether you get the brand or a generic? In general, it shouldn't make any difference.
But we have all sorts of oddities regarding thyroid medicines.
The first levothyroxine was generic. (Way back around 1957.) Then it was branded as Eltroxin within a couple of years. Also, neither levothyroxine nor liothyronine were ever patented.
And, until recently, there was no other branded levothyroxine product. However, many years later the company also produced a generic product. Which was genuinely identical. And sometimes Eltroxin was totally unavailable for extended periods of time. We kept wondering if it had disappeared forever.
When levothyroxine oral solutions were launched, none of them were branded.
Other makes of levothyroxine tab;et came to market, and none were branded.
Then, seemingly out of the blue, Aristo first launch their generic levothyroxine. Then add a branded product - Vencamil.
Overlapping somewhat, the only liothyronine product was the branded Tertroxin. The company then de-branded that in order to circumvent pricing regulations of branded medicines.
Since then, other liothyronine products have come to market, None branded.
Sometimes, people get the idea that "generic" products will be anonymous tablets supplied loose (e.g. in a pharmacy-supplied pot). This is very far from reality where we almost invariably get product in the manufacturers' packaging - or a formal packaging agreement as with Almus.
But the standard model simply doesn't make sense for the thyroid medicines we have in the UK. Hence the discussions about generics that might apply to some other medicines, make no sense. There is absolutely no reason to consider Eltroxin or Vencamil superior due to their being branded products.
ADDING!
Two other factors.
A brand is specifically prescribed. Hence a GP can write a prescription for Eltroxin or Vencamil. This is more satisfactory as it is a direct command rather than adding an advisory/request - "Please supply Mercury Pharma".
Prescribing a brand might make a difference to the cost - to the pharmacy, to the NHS, etc. A branded form might be more, or less, expensive to the pharmacy and to the NHS. Too complicated for me to understand!
Where Aristo (generic) and Vencamil (branded) are concerned they are the same product but one is generic and the other branded.
"Branded generic prescribing undermines community pharmacy funding by affecting the amount of buying margin earned by pharmacies. This margin is given as an incentive to drive down prices to the NHS overall and if it is not earned within the year, all category M generic prices are uplifted as a result, meaning all CCGS are penalised." npa.co.uk proposes that since there is a lack of understanding of how community pharmacy funding works , local practises, PCNs and medicine management teams should be signposted to the npa funding webinar series to help improve understanding.
The amount of margin earned is affected by the pharmacys' individual dispensing mix (the amount of brands versus generics they dispense) and trying to beat the category C reference product price by prescribing a cheaper brand. This does not reduce costs to the NHS.
But they don't provide any rational, reasonably simple, consistent approach to specific requirements - like lactose-free. And, in the case of medicines like levothyroxine (which is sometimes classed as having a "narrow therapeutic index") it is clear that changes to make affect patients so there needs to be a way of sticking to the same make.
I mean, I might be fussy about levothyroxine, But I've never even bothered to check a paracetamol. True generic prescribing needs formulations which cause no-one any issues. For example, all ingredients acceptable to vegans, all religions, most known allergy issues, etc. While we have lactose, mannitol and acacia, that is just not feasible.
Agreed. All levothroxine tablets are contra- indicated for me . Ibs sufferers should avoid Aristo/Vencamil because of maize/corn starch .
The BNF has an entry for Aristo and a separate one for Vencamil 100mcg tablet. There is also an entry for Levothyroxine sodium 100mcg tablets lactose free Imported Germany. This is obviously Aristo/Vencamil. It , however, does not name what it is ,has no indicative NHS price, nor drug tariff price. The BNF is not informative at all.
Glenmark would have been suitable for everyone, including me. As you know, we have tried to get to the bottom of why it was discontinued , but without success. In the USA there is , or has been, a class action because pharmaceuticals companies were carving up the market between them in such a way that I think they cooperated with one another to make sure they were all getting market share. I think this is happening in the UK as well. I think Glenmark has only been available on 2 separate occasions, for a few months only each time. I think it has been allowed in when there is a genuine national shortage, to plug a temporary gap only. Glenmark is an INDIAN multinational headquartered in Mumbai, India who also manufacture in Monroe, North Carolina, USA.
Israel based Teva had to agree to sell Actavis Generics Assets and Operations in the UK and Ireland to Accord Healthcare, which is a subsidiary of India's Intas Pharmaceuticals for £603 million, 6/10/2016 and an Accord manufacturing plant in Barnstaple, UK. It was a European Commission requirement which also resulted in Pfizer owning 10% of Teva via the Pfizer-Allergein deal. Teva agreed to pay $200 million dollars in fines and divest a key generic drug treating cholesterol to settleprice-fixing charges from the US Department of Justice, and then settlement is the largest penalty paid for a domestic anti-trust cartel, 21/8/23. Teva has total debt of $20.29 billion, September 2023. Teva has had to deal with costly litigation and settlements over its marketing of opiods, in addition to bribery and price fixing charges. Teva was named as the central defendant in a 2019 price fixing case brought by dozens of state attorney generals. Teva settled civil charges for more than $4 billion over marketing of opioids.
Walgreen's Boots Alliance sold the majority of their Alliance Healthcare pharmaceutical wholesale business to AmerisourceBergen, a leading US drug wholesale company for about $6.5 billion in cash and stock ($6.275 billion in cash and 2 million shares of AmerisourceBergen common stock). Walgreens is the single largest shareholder of AmerisourceBergen at 30% of common shares. Both Walgreen and AmerisourceBergen will continue their US distribution agreement until 2029, and Alliance UK with Boots until 2031. One way of interpreting this is the fattening of their "war chest" for expansion. On 30/6/22 Walgreens Boots Alliance sold 6 million shares of AmerisourceBergen common stock with proceeds of $900 million dollars to reform their portfolio and optimize capital allocation.
Almus is partly about creating customer loyalty to Boots which has special status as a trusted brand. If you google : S1.q4cdn.com/343380161/files/doc_downloads/doc_event/WBA-Transcript-2015-04-15T12_00_Day_one_pdf there is an explanation of Almus, Boots branding, how it works and why, supposedly. It is a very secretive answer, and you may not be much the wiser after reading it. Pages 20 and 21 of 80 state "In reality Almus is a very special win-win concept with the manufacturer. It's not a competitor, with the manufacturer, because Almus is a great packaging color and I explained to you before the different advantage for all stakeholders. The partnership with the manufacturer and the work with them is not in competition or doesn't represent the big difficulty in the market with the generic manufacturer. It is the opposite. It's the win-win activity with the generic manufacturer. It is the opposite. It's the win-win activity with the generic manufacturer at the world level." They don't "disintermediate" manufacturers. They "work with them". They like to guarantee their " own sourcing". It is "frequently convenient for the manufacturer to license us their products and sell it through the Almus brand while marketing their proprietary brands side-by-side. " Almus " it allows us as a company , As a Pharmacy-led company to ensure 2 things: much better dispensary discipline through the visibility and habitual use of the packs color- coded for the dispensers , and also the reassurance it gives the patients in terms of seeing that same pack every month in their prescription. BUT IT DOESN'T STOP US FROM PLAYING THE MARKET IN TERMS OF GOING TO THE LOWEST-COST PRODUCER, BECAUSE, OF COURSE, WE ROTATE THE LICENSES AS WE REVIEW THE COST OF GOODS AND THE EFFICIENCY OF OUR PARTNER MANUFACTURER. SO WE GET THE BEST OF BOTH WORLDS WITH ALMUS UNIQUELY." They are in partnership with the manufacturers.
gov.uk/government/news/cma-... is about hydrocortisone tablets where prices rose by over 10,000%. Pharma firms bought off potential rivals to avoid them competing with their own versions of the drug and preserve their ability to increase prices. Advanz Pharma and Waymade were paid off to stay out of the market. It was Actavis who did this, but Teva owned them by the time that litigation came about.
There is also an entry for Levothyroxine sodium 100mcg tablets lactose free Imported Germany. This is obviously Aristo/Vencamil.
Actually, I don't think that is likely! I'd guess L-Thyroxin Henning is more likely - or Aliud Pharma's product. Both have previously been supplied through the NHS. Both are lactose-free.
Wow!Thyroxin Henning looks as if it would have been okay for me, provided the castor oil didn't upset my bowel. So , a question mark on that one suitability wise. Aliud Pharma has corn starch the same as Aristo. Possibly Brexit that put paid to them still being supplied. Your knowledge is second to none!
I think the answer must be that the nhs indicative price and drug tariff price is the same at 69 pence for Almus. For our purposes , there is no such thing as Almus levo, in reality. It is Accord. For Accord, the nhs indicative price is 33pence , but the drug tariff price , which the NHS pay the pharmacy is 69 pence. The owners of Almus must be able to source Accord at 33 pence or less, but are guaranteed more than double this at 69 pence by the tariff price. It must be an accountancy type thing. If sold as Accord they more than double their profit., kind of thing. If they sell it as Almus they break even and don't make a profit or a loss on it, type of thing. Breaking even might also trigger some kind of advantageous tax implication for them, making it worthwhile to repackage Accord as Almus. Most likely legally creative tax accounting to do with what constitutes profit and loss.
The cheapest 100mcg levo tablet is Accord with an NHS price of 33p and drug tariff price of 69p. This compares with Aristo and Vencamil , the same products, one generic and one branded, at Nhs Indicative Price of £1.77, but the pharmacies receiving only 69p, being the drug tariff price. Eltroxin branded is also similar at £1.78/69p. The generic of Eltroxin , I assume to be Mercury Pharma, although listed as Advanz Pharma . It is £1.24/69p. Teva is 53p/69p.
This is why pharmacies refuse or are reluctant to provide anything other than what is most financially advantageous to them at any one particular time.
She told me it’s due to 3 major events: Brexit, the war in Ukraine and the incredible greed of the pharmaceutical companies together with low income to dispensers (that make 4 events). She added all the good brands are sold to countries that pay the higher price and the NHS only gets what’s left and often not the best brands.
The pharmacist is parroting the same story that is being parroted (at least) all over geographical Europe and whilst the shortages are real/true, the reasons give are not.
E.G. Brexit took place in 2020 but the shortages have been ongoing since before 2016 (her datum point but e.g. if she wasn't working at that time she wouldn't know the other timeline).
The pharmacist in question is a responsible person with over 20 years experience so she must know what’s happening. With due respect, are you a pharmacist ? Perhaps you could enlighten us. Actually the pharmacists at my local pharmacy have said the same. One cannot escape the fact that big pharma companies are greedy and put profits before people’s wellbeing.
I noticed you live in Greece. Lucky you, at least no shortage of Vitamin D…
No I am not a pharmacist. To be honest (and I know a few pharmacists) they are all responsible people, but it doesn't mean that what they are told regarding x, y, or z is the "reality" of x, y, or z. - they acknowledge that and it is very frustrating for them because they HAVE to tell their customers something. I've recently carried out some extensive questioning (in various pharmacies here) with regard to the total unavailability of Greek produced T3 that until fairly recently, was readily available. Shortage of many medications here (e.g. BP, blood thinners) has been a big issue for people reliant on those, probably since about 2011.
I have relatives in Spain and the story's the same,
I noticed you live in Greece. Lucky you, at least no shortage of Vitamin D
But even so (and despite being out in the sun at appropriate times of the day and not slathering ghastly SPF toxins) for many many years I was low/deficient until I added Gouda cheese as a regular to my diet (Vit K2). I'm (now) a geriatric farmer and have been an outside girl for as long as I can remember - there's always so much more to understand in relation to everything, a small amount of not the most interesting cheese made a big difference for me
Thank you for your reply. Are you a « mature » olive farmer ? How interesting but if that is the case very hard work too.
The VitD question is fascinating… such an important factor for our health, and many others vitamins and minerals too.
Indeed the medication situation is getting rather worrying. One does not know how to manage one’s health issues properly. No doubt most of our health issues(deficiencies) are due to a profound change in lifestyle and soil conditions, depletion etc. as well as pollution. It took a long time for our frail human bodies to evolve in contrast to the fast evolution of farming techniques and others.
Yes I suppose I am that, I've been here for nearly 30 years - I make olive oil, wine (apart from last year which was actually related to events related to the Ukraine war i.e. a small unpleasant explosion causing a "dusting" of unpleasant atmospheric conditions - nobody in my area had any grapes at all.
For me it's not hard work because I love it - hard work was living in London and being confined to working in offices! Physically it can be tiring at certain times of the year.
From my perspective pretty much all our health issues relate to the nutritionally bereft food that is produced - the mid 1960's saw a big shift towards mono culture, fake nutrients for the soil etc. Then add in the nonsense to our world since (say) the turn of last century and here we are now. Sick, stressed and struggling!
One does not know how to manage one’s health issues properly.
I understand what you are saying and there are many aspects to being well apart from what we eat - nutrition for the mind and spirit is also essential.
Making wine and beautiful healthy olive oil… I am envious ! It’s wonderful you found an alternative way of life…. Of course hard demanding work physically but so much healthier than living in London in an office as you say! Officie life eventually can destroy the soul…. Plus all the pollution of a capital city. There’s no real escape allowing for recharging our bodies and minds’ batteries .
We are in agreement regarding that not only the body needs healthy reparative nutrition but also the spirit, the soul (or are they one and only?) need the same nutrients, conditions. In fact…. we humans are destroying our species… yet, we’re supposed to be intelligent and to have become somewhat a tad more sophisticated…. but are we really?
I am concerned we are trapped in a mad rush endangering our civilisation, ´pushed’ by so-called progress…. I am in my late 70s and I worry about the future my children and grandchildren (ranging from 18 to 28) will have to endure and for how long.
Sorry do not intend to depress anyone but the way the world is at the moment (and has been for quite a while) is not reassuring. The world is on fire, in more ways than one.
Nevertheless one must keep hope that we can still change the course of events and destruction of our beautiful earth.
The initial steps towards getting the trial going were some time ago.
There has long been a determination to reduce levothyroxine prescribing - whether the dose an individual gets or the number of individuals. Some of this is right and proper - people should not be taking medicines that are of no benefit. But sometimes it appears to have become an end in its own right.
There has been no higher imperative driving this though sadly just financial. I said on the other post if they actually did a full panel instead of the laughable TSH (what is your pituitary doing test), the misdiagnosis would be no where near the magnitude it is and actually more of the people who should be on thyroid hormone replacement and are missed because of the TSH (what is your pituitary doing test) could be identified.
It must be a false economy though, given the myriad other complaints and symptoms caused by being hypothyroid. Leaving aside the impact on people's lives... I suppose that someone(s) is/are making little or less money from T4... It's a sad old world sometimes
Trouble is the real cost and losses to NHS AND the country as a whole are held in different accounting columns and the connections are never made despite the research that is out there.
Quality of life is paid ‘lip service’ to, but if it is a toss up between that or keeping the numbers looking ‘good’ in a blood test we all know which consideration wins.
Well let’s be honest. The simplest measure is always cash. Anything else is too much bother and less clear. Our governments seem to be so easily ‘convinced’.
If one were cynical, one might think there are some dots that definitely need joining up. As per usual unless it is lining someone's pockets they will do all they can to increase the income stream. So obviously it must depend on whoever is getting the bung. the only reason to want to appear to be cost cutting is to have more money available to embezzle. Double sided sword, reduce costs by undertreating, undertreating leads to various other treatable conditions so more profit.
If it was really about cost cutting they would treat effectively , monitor effectively and all would be well and cost effective. 🤯
So as a Brucey Bonus , if people stop Levo, then lose free prescriptions think how much money they could save , and maybe reduce waiting lists at the same time.
This was also covered in the Tonight programme, not only are pharmacists struggling to get meds with many it leaves them out of pocket as they cost more than the NHS will reimburse... I think it was 6 pharmacies a week going out of business
And then ultimately the prescribing will become controlled and dispensed from a centralised administration - remote warehouses where we are little more than a number. Choice is being removed by manipulation of market forces.
They are going to have to do something to safeguard the pharmacies as they are more and more reliant on them taking some of the load off the Surgeries by dealing with jabs, health check ups and even minor prescribing etc which are being forced onto them....
You wouldn't expect a shop to last long if it stocked milk that costs them £2 and we pay £1 only huge supermarkets can run that sort of racket...🤔
Not so much that, but the complete dismantling of the NHS. They will make it so inefficient we will eventually beg for a solution - a bit like a man begging to have his gangrenous foot chopped off before the infection reaches the knee.
Helvella Thank you for another Great post. Being that I am totally dependent on my thyroid meds. My thyroid now come from a bottle. I constantly fear of not getting thyroid meds. Shortages. It's so unbelievable that this day and age there should be thyroid meds or any other meds shortages. We should not have to have the stress if our thyroid meds will be available to us. We have enough worries . We are not looking for more.
Well I pay a lot for my thyroid meds, so I hope I'll keep getting them. I do best on Armour Thyroid + slow release T3 (for reasons I am not going to go into here, but this is what I had been on for over a decade in the US, before I moved to the UK). The NHS only prescribes synthetic T4, so I have to go private. In the US even without any medical insurance, I can get Armour Thyroid for around 30% of the price I pay in the UK. If I had US insurance I would have paid about 2% of the UK price out of pocket, about the same as the NHS charge if you don't have an exemption (I do but it took some time to convince the NHS to let me have one, as they aren't treating me for hypothyroidism). When the NHS isn't involved in bargaining, or for unlicensed drugs in the UK, I guess drug companies/pharmacies can charge what they want to charge!
All the medicines I need that I have to self-pay for here (believe you me I'd get the NHS to pay if I could, and I am still trying to jump through hoops to get another of my meds covered) cost more than I would have paid for medical insurance in the US, even if I had expensive self-employed medical insurance. And that insurance covers pre-existing and chronic conditions. (So much for the US system being so bad .. it is the hospitals that usually end up bankrupting people in the US, I found regular care on insurance to be pretty good).
Can you not get a referral to a consultant endocrinologist who supports prescribing Armour? I struggled for years on synthetic thyroxine in the U.K. but found a consultant who was willing to prescribe Armour . He wrote to my GP basically “ticking him off” and told him that he could prescribe Armour on a “green pad” prescription as it’s approved by the EMA. It used to cost the NHS £137 for 100 tablets which lasted me a month . The endo advised I could take up to 3 a day and vary the dose based on how I felt so long as I didn’t exceed it . That worked far better for me as I’ve Hashimoto’s.
Sadly Armour is “illegal” in France where I now live . It is neither prescribable nor available and it is not allowed in if you order it from elsewhere. So I’m back on the synthetics (Euthyral) and haven’t been well since having to swap - maybe coincidence or Covid (although blood test for antibodies for that were negative).
It's the same in Australia. My HRT patches (I can't take the pills or pessaries/creams) were out of stock for 4 months, until i was finally able to get a single box, 2 weeks ago. I've had to wait on my Liothyronin for weeks at a time, several times in the past year. With no thyroid and intolerant of high doses of thyroxine, yes, it's a very big concern when the pharmacist says that they can't keep many life dependant medications in stock due to global shortages.
This is really, really depressing. It's hard enough to have this all-encompassing disease and the constant sense of vulnerability it brings, without having to deal with the idea that we might not be able to get the meds/hormones we need to combat it. I'm feeling very sad today for everyone of us (including Michael Rosen) who feels so at risk. Stress like this is the last thing we all need....
Brexit has had the biggest negative impact on imports and almost all of our medicines are imported from the EU. We are now bottom of the list when it comes to supply because we are the hardest country to send the medication too. The export/import rules have put us below everyone else. As a business who exported to the EU I have been on the coalface of this ridiculous disaster from day one. Shortages of medicines are really annoying, but not unexpected to me. It's the same with the fruit and veg. We get the dregs, which is often what it looks like on the shelves these days.
We did it to ourselves. On top of that there does seem to be a global shortage of some medications. I haven't been able to fulfil a prescription for an injectable medication I use for most of a year. I have limped on, getting the odd batch here and there if I sleuth for it. I have 4 pens left now and then I have no clue where to go. So I'm going to be going cold turkey off that in about 7 weeks time. Joy.
I daren't get started over here. But Brexit took my once prosperous business and decimated it. To the extent that I worked last year for nothing. Just to try to keep going in the hope that something will change and improve. I don't have any of my bigger EU customers anymore. They buy direct from the US now. Everything I worked hard for and gave up my time for has gone. Now I'm left with ill health, poor care, bills for testing, medications and consultants and no income. I don't have enough money left to spend this year the same as last. But I'm too tired and also I have caring duties now, to go out and get a "job" for someone else. Brexit broke me. If it steels my medications too, there is nothing left I can do about it.
I only heard a snippet whilst getting lunch, but I heard several callers explain the problems they'd had and yes, not good at all. What a state we have got into!
These shortages are really annoying/ troubling. I had not heard of shortages of thyroid hormones but I have twice been subject to no availability of diabetic medication. Annoyingly my husband was signed up through the NHS to be part of a drug trial for semaglutide + an additional component making it more effective in weight loss. At the same time diabetics who are dependent on the medication to be well could not access this or any similar injectable. I am prescribed Dulaglutide, which is similar but doesn’t cause loss of appetite/ weight loss for all patients in the manner Semaglutide known as Wegovny or Ozempic does. It seems money talk and supplies are readily available for those who are happy to pay for weight loss even if they do not need it. The drug manufacturers appear to concentrate on supplying the more lucrative market, hardly surprising as a business model, sadly lacks empathy for those this class of drugs was originally developed to help. Like others on here I’d be concerned if I was unable to have thyroid hormone prescriptions dispensed. A short term availability of these will at least be less disruptive to my health than the ongoing diabetic medication shortages I am undergoing. However I might feel differently if both become unavailable at the same time.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.