The notorious tendency of pharmacist to behave like shop-keepers when it comes to the sale of bogus remedies has been the subject of this blog many times before. In my view, this is an important subject, and I will therefore continue to report about it.
On the website of the AUSTRALIAN JOURNAL OF PHARMACY (AJP), we find interesting new data on Australian pharmacists’ love affair with bogus alternative medicine. The AJP recently ran a poll asking readers: “Do you stock Complementary Medicines (CMs) in your pharmacy?” The results of this little survey so far show that 54% of all participating pharmacists say they stock CMs, including homeopathic products. About a quarter (28%) of respondents stock CMs but not homeopathic products. And 9% said they “only stock evidence-based CMs”. Three percent completely refuse to stock CMs, while 2% stock them but with clear in-store labels saying that they may not work. One person stated they stock CMs but have recently decided to no longer do so.
The President of the Pharmaceutical Society of Australia (PSA) Joe Demarte commented on these findings: “The latest survey results, showing over 40% of pharmacists are adhering to PSA’s Code of Ethics on complementary medicines, are very encouraging… However it’s disappointing that some pharmacists are still stocking homeopathy products, which are not supported by PSA’s Code of Ethics or our Position Statement on Complementary Medicines… Irrespective of the products stocked in a pharmacy, the important thing is when discussing the use of complementary medicines with consumers, pharmacists must ensure that consumers are provided with the best available information about the current evidence for efficacy, as well as information on any potential side effects, drug interactions and risks of harm… It’s important for pharmacists to provide a fair, honest and balanced view of the current evidence available on all complementary medicines,” Demarte added.
NSW pharmacist Ian Carr, who is a member of the Friends of Science in Medicine group, commented that many pharmacists may not have much choice when it comes to stocking complementary and alternative medicines. “CMs policy is not being filtered through the professional assessment of the pharmacist… It’s basically a business deal with the franchise, and as a pharmacist taking on a franchise you’ve basically got to sign those rights away about what you get to sell. Some of the chains offer basically everything that is available, no questions asked. As an independent pharmacist I am able to make my own decisions about what to stock… We’ve got a ‘de-facto’ corporatisation happening with marketing groups and franchises, and I’m concerned the government will look at this trend and ask, why are we not deregulating the industry to reflect the apparent reality of pharmacy today? We’re only playing into the hands of people who want deregulation… We should be telling people in no uncertain terms that if something is on the shelf it doesn’t mean it’s been assessed or approved by the TGA… There is no doubt that there has been a long-term relationship between the supplement industry and pharmacy. But it was also a few decades ago that researchers started applying the concept of evidence-based medicine to healthcare generally. That should have been the point where we said, ‘we’re not just going to be a conduit for your products without questioning their basis in evidence’. That’s where we lost the plot. The question now is: where do we draw that line? I’m really trying to say to my fellow pharmacists: Please let us reassess the unquestioning support of the CM industry, or we’ll all be tarred with the same brush. I and many others are concerned about – and fighting for – the reputation of the pharmacy profession.”
A BMC Complementary and Alternative Medicine survey by researchers from Alfred Hospital in Melbourne found that 92% thought pharmacists should provide safety information about CMs, while 93% thought it important for pharmacists to be knowledgeable about CMs. This shows a huge divide between what is happening in Australian pharmacy on the one side and ethical demands or public opinion on the other side. What is more, there is little reason to believe that the situation in other countries is fundamentally different.
And did you notice this little gem in the comments above? “…over 40% of pharmacists are adhering to PSA’s Code of Ethics…” – the PSA president finds this ‘VERY ENCOURAGING’.
When I saw this, I almost fell off my chair!
Does the president know that this means that 60% of his members are violating their own code of ethics?
Is that truly VERY ENCOURAGING, I ask myself.
My answer is no, this is VERY WORRYING.
19 Responses to It is “disappointing that some pharmacists are still stocking homeopathy products”
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The UK situation is no better. Neither the General Pharmaceutical Council nor the Royal Pharmaceutical Society is in the least interested in fully applying the principles of evidence based health care:
https://majikthyse.wordpress.com/2016/12/30/not-my-problem-mate/
The RPS appointed a president who is a homeopath!
I know; it’s scandalous, in my view.
In an ideal world, all pharmacists would stick firmly to their ethical principles and would simply not stock CAM products. But in the real world only a few would go this far — they risk losing business, not only from sales of medically worthless products, but from sales of all the other stuff they stock. Let’s face the fact that there’s a demand for complementary and alternative medicines, even though scientifically they don’t work (by definition: medicines that do work are not included under the heading ‘complementary and alternative’).
Perhaps the situation could be addressed by governments taking a leaf out of their own anti-smoking strategies. If, by law, CAM products were obliged to come in packaging displaying a standard form of health warning, users might at least be obliged to think about the medical value of their purchases.
In fact, the more I think about this, the more attractive the idea becomes. Anybody fancy joining me in setting up a company to market ‘e-homeopathy’ products?
“In an ideal world, all pharmacists would stick firmly to their ethical principles and would simply not stock CAM products. But in the real world only a few would go this far — they risk losing business, not only from sales of medically worthless products, but from sales of all the other stuff they stock. Let’s face the fact that there’s a demand for complementary and alternative medicines…,” you stated.
I agree, Frank. Most pharmacists work in large retail stores and are not decision-makers as to what their stores carry.
why do they have an ethical code then?
Good question!
Most, practically all, pharmacists have no say as to whether CAM products are stocked. Pharmacists generally are employees and the corporate or franchised retailers they work for know all too well that if they don’t stock the products, consumers will drive to the nearest WalMart to purchase them.
true, but if they are forced to violate their ethics, they should change the system.
Agreed!
doctors working in ‘chain hospitals’ can also not use this as an excuse for disregarding medical ethics.
You’ll have to educate me regarding hospital chains. Do pharmacies within them actually carry homeopathics and other alt-med products? If so, I’m surprised.
not sure – but I meant physicians working in hospital chains still have to adhere to their ethics and not those of the chain.
I understand and agree.
‘However, if a patient approaches a pharmacist for advice on homeopathy, the pharmacist should be able to advise on the lack of evidence on the efficacy of homeopathic products, discuss the formulation and composition of the product, and provide other pertinent advice. ‘
So a patient wants some homeopathic remedy. Well they are not going to be convinced that easily by a Pharmacist who then tries to sell them the stuff ‘with evidence’ that was tried before but didn’t work.
This is one way of getting more and more people to go to Health Food Shops.
Hi Dr. Ernst,
There is a CAM school in Florida that runs a company called Jin Tang. This company puts out a variety of herbal combination products used to treat a variety of conditions. I looked into on product called Body Sore. http://ac5574ede10d289dbec4-8c4b1935d1a53de6c3c0c3d833432803.r27.cf2.rackcdn.com/7fd6144d36774f178c8a3c51c03f9591.pdf
The label lists a large number of herbs but gives no indication of the quantity of each ingredient in the formulation essentially making it a “secret” proprietary formula. When I called the company to ask for a breakdown of the amounts of product in the remedy the customer service rep said she couldn’t do that as Dr. Xie the owner of the company does not want to reveal this information. What is up with that. Could you address “secret” formulations in one of your blog posts….Thank you
secret formulas do not deserve a whole post, in my view. all I want to say is TO THE BEST OF MY KNOWLEDGE, THEY ARE ILLEGAL.
That’s a product for animals. I can’t comment on what it contains, but I’m sure this information on it will be very helpful…
“That’s a product for animals”
Yes I know , I am a veterinarian confronting multiple problems with TCM, and CAM in my profession. thank you for the comments.
As to the secret proprietary blends being illegal, I don’t think that is the case. Practitioners are simply expected to take the “oracles” recommendations on faith.
INTERESTING NEW ARTICLE ON THE SUBJECT:
My view is that honesty is the best policy, and therefore practicing evidence-based medicine directed by consensus guidelines is the best way to go. Best for patients that is.
The profession has already made a stand against homeopathy due to a lack of evidence of efficacy.
Perhaps it’s time to consider the overall evidence based benefit vs potential harms of the remainder of the over the counter remedies.
Why stop at homeopathy? I would propose that this could be painful commercially in the short term, but will serve our patients and our profession better in the long run.
https://pharmacyinpractice.scot/2018/02/02/pip-respiratory-series-are-cough-bottles-the-new-homeopathy/