Pharmacists should be looking out for any serious reactions among their customers who are able to buy a growing range of powerful drugs over the counter.

The prestigious medical journal The Lancet is calling on pharmacists to join the yellow card scheme, the drugs monitoring system used by doctors in Britain (The Lancet, 4 June, 1994).

The magazine fears that it is now too easy for consumers to buy powerful drugs that were once available only on prescription. Pharmacists will have to inform their customers of likely side effects and drug interactions (which, if they do, is more than doctors have ever done).

Pharmacists should also learn inter personal skills, says the Lancet. (While they are about it, they might like to invite along their local doctor.)

The move away from prescription only began in 1989 when the UK government's Department of Health wanted to reduce the nation's drugs bill. Drugs that have recently become available over the counter include H2 receptor antagonists for dyspepsia and heartburn, topical acyclovir for herpes cold sores, imidazole antifungals, hydrocortisone cream, sodium cromoglycate eyedrops and some non steroidal anti inflammatories.

The next batch for over the counter status includes chloramphenicol eyedrops, topical antibiotics and anti emetics for migraine.

Once a drug is given over the counter status, it should be subject to new clinical trials, says the Lancet, perhaps checking for its efficacy at lower doses and its interaction with other drugs, and taking into account certain elements of lifestyles of customers, such as smoking, diet and alcohol consumption.

While the Lancet's concerns are justified, their main bone of contention seems more about the doctors losing a patient to the pharmacist. A recent survey among general practitioners revealed that half were worried about this possibility. One estimate has reckoned that up to 150 million consultations a year with general practitioners are, in fact, self treatable.