By Malcolm Brown

The canary in the medicines mine has died. NPA members have voted overwhelmingly for their first industrial action in their history. 

My sociological imagination flew into a daydream. All community pharmacy owners, from the largest chains to the smallest independent, all employed and self-employed pharmacists including locums, all hospital pharmacists and primary care pharmacists working in GP surgeries, simultaneously took industrial action.

My dream, in which pharmacists displayed their power, is unlikely to come to pass. One impediment may be differences of opinion between various levels in managerial hierarchies.

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But, if my reverie came to pass, goodness me. The government and the public would (probably) value pharmacists’ contribution more. The nature and heft of pharmacists' power is worth exploring. 

Note that all pharmacists must consider themselves as one group of "us" rather than "them" (such as government and patients) using the terms of the sociologist Zygmunt Bauman. Only by acting together are there enough pharmacists to exert might.

The perspectives of Karl Marx (1818-1883), a “founding father” sociologist, remain respected, today. Be warned: they are inflammatory. Borrowing and simplifying his ideas, NPA's industrial action is a class struggle, red in tooth and claw.

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Pharmacists and pharmacy owners act together to seek to improve working conditions in which the national owners of capital (government) suck out the extra value of the sweated labour of workers (pharmacists). Put bluntly, government parasitically drains pharmacists’ lifeblood.

Industrial action disrupts the dynamics of power between labour and capital. Pharmacists banding together as comrades strengthens their collective bargaining power allowing them to negotiate better terms.

Pharmacists' potential punch is based on one power and one superpower. Their power is in their intellectual capital as expert professionals curating and practising arcane pharmaceutical knowledge based on long academic study, invested in upfront (before registration), CPD and experience.

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That is so great that any other group would hesitate to dare to challenge. Pharmacists’ superpower is as gatekeepers to the corporeal mass of the medicines: their things.

Crystallised within those medicines is pharmaceutical and other medical knowledge and caring that can work remotely without the healers. For example, in the patient’s home, a stored antihistamine or laxative may be available immediately; taking it gives rapid, reassuring comfort.

Heart-tugging examples are the patient in agony who needs diamorphine or suffering life-threatening septicaemia who requires antibiotics. Pharmacists have a near monopoly on the conduit to prescription medicines; it remains their birthright. 

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The problem is that the possibility of upsetting patients and customers distress pharmacists. Why would pharmacists risk being perceived as bad guys? 

The very name of "Mrs. Doasyouwouldbedoneby”, in a moral fable by Charles Kingsley's The Water Babies (1863), summarises one perspective. An action, in itself, is right or wrong under a series of rules and principles.

Pharmacists cherish their approachable, friendly reputation with patients and do not want to compromise it.  GPs are presently taking industrial action.

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If a patient telephones a GP surgery and hears the recorded message, “You are number 27 in the queue,” that patient may feel like a pawn, a helpless hostage.  Staff who so act would presumably prefer not to receive such a message. Philosophers suggest we have been considering the ethics of  "deontology". 

The alternative philosophical viewpoint is "utilitarianism": broadly the greatest happiness to the greatest number of people. Jeremy Bentham (1748-1832) outlined the “felicific (hedonistic) calculus”, a method of calculating the overall pleasure and pain produced by an act and so the total value of its consequences.

If you are suffering angst over the vote and its consequences and wonder whether deontology or utilitarianism fits your attitude, and your brain feels about to boil, you are not alone. Over the centuries, clever philosophers have hotly debated those viewpoints; they disagreed.

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That is normal; no truly philosophical question has an answer. I suspect pharmacists are more comfortable with utilitarianism: short-term patient inconvenience and irritation will produce, long-term, greater patient safety. Your end justifies your means.

If that is your honourable goal, I urge you to metaphorically stiffen your spine with titanium and get on with assertive industrial action. I would root for you.

Dr Malcolm E. Brown is a retired community, hospital and industrial pharmacist, and is a sociologist and honorary careers mentor at the University of East Anglia.