An article in the Australian Journal of Pharmacy seems well worth mentioning on this blog. It throws some light on what is happening in Australia regarding an issue that I have repeatedly written about: the sale of homeopathic remedies by pharmacists.
Pharmaceutical Society of Australia have apparently published a ‘Complementary Medicines Position Paper’ which states that complementary medicines may be used as an adjunctive therapy with conventional medicines, provided there is evidence to support their use. The president of the PSA, Joe Demarte, says that the PSA is committed to supporting pharmacists help consumers make informed decisions regarding complementary medicines and continued to advocate strongly for a partnership approach with consumers to promote the Quality Use of Medicines and responsible self-medication. “This is a partnership between the pharmacist and the consumer where the pharmacist as the medicines expert can advise on the appropriate use of complementary medicines the consumer may be considering,” Demarte is quoted saying. He continues: “There is a wealth of information available about complementary medicines which can be confusing and the pharmacist can assist in ensuring 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. In the event that a consumer chooses to use a product with limited evidence, the pharmacist must advise the consumer on the risks of rejecting or delaying treatments for which there is good evidence for safety and effectiveness. PSA strongly encourages all consumers considering taking complementary medicines to first consult their pharmacist for sound, evidence-based advice.”
So far so good – but what about disproven treatments such as homeopathy, I wonder.
Demarte says the PSA endorses the NHMRC report, released in March 2015, which found there were no health conditions for which there was reliable evidence that homeopathy was effective. And he states that the PSA does not support the sale of homeopathy products in pharmacies: “Our position is that pharmacists must use their professional judgement to prevent the supply of products with evidence of no effect.”
This surely is good news for all who stand up for evidence-based medicine and foremost for patients. It comes only a few months after the RPS Chief Scientist of the UK Royal Pharmaceutical Society, Professor Jayne Lawrence stated very similar things: “The public have a right to expect pharmacists and other health professionals to be open and honest about the effectiveness and limitations of treatments. Surely it is now the time for pharmacists to cast homeopathy from the shelves and focus on scientifically based treatments backed by clear clinical evidence.”
Now that we are (almost) all in perfect agreement, we only need one thing: adequate action by pharmacists!
A quote from the British Homeopathic Association (web page entitled ‘The Evidence for Homeopathy): “A homeopathic prescription is based not only on the symptoms of disease in the patient but also on a host of other factors that are particular to that patient, including lifestyle, emotional health, personality, eating habits and medical history. The “efficacy” of an individualised homeopathic intervention is thus a complex blend of the prescribed medicine together with the other facets of the in-depth consultation and integrated health advice provided by the practitioner…”. Does any over-the-counter pharmacist offer an in-depth consultation and health advice? (Homeopaths charge from £20 to £80 for the privilege, according to NHS Choices.) Or do they just suggest any random pick from the little bottles they have stacked up on their shelves, knowing full well that the customer is too [stupid/gullible/scientifically illiterate/suffused with spirituality-based disbelief in reason] to matter?
Perhaps it should become a criminal offence for pharmacies to display homeopathic medicines and allow customers to choose their own. The finesse required for their prescription dictates these should be behind-the-counter products, available only with a valid written authority from a properly qualified homeopath.
“Surely it is now the time for pharmacists to cast homeopathy from the shelves and focus on scientifically based treatments backed by clear clinical evidence”
Being properly trained health professionals, I have a suspicion that pharmacists as a profession might be only too glad to sweep their shelves clean of ‘woo’ (& homeopathy in particular).
However, unless a pharmacist owns his or her own business, are they actually in a position to dictate what is or is not stocked by the shop part of the pharmacy?
So is it pharmacists you need to convince, or actually those managerial folk who hold the commercial purse-strings, and who make purely commercial decisions on whether selling homeopathic ‘remedies’ is profitable for the business?
I suspect it is the ‘bean-counters’ at the top that need the ethical pressure applied to them! So a call to action, yes absolutely, but think carefully about the target/s!
That is a common refrain, but many, many pharmacists work for themselves in small pharmacies so do have complete control over what they sell, yet many still do.
What I don’t know is how many are and how many have no say in what is displayed outside the pharmacy area in larger shops. I understand the owners of Boots, etc are simply out to be as profitable as possible and sell the sugar pellets because there’s ‘a consumer demand for them‘ but it is hoped that those pharmacists are at least trying to persuade them that they are undermining the pharmacist – who else is going to persuade the bean counters?
There is an element of truth in what you say about independent pharmacies owned by a pharmacist…but I suspect that ‘speaking truth to power’ in a large commercial pharmacy about unethical expensive placebos might not be a palatable prospect.
Presenting uncomfortable truths to management is rarely a recipe for career advancement.
insisting on ethical standards is often very difficult and sometimes even risks career advancements. this is, however, rarely a good reason for not doing it. ethical standards are not optional and ethical codes have to be adhered to.
In principle yes, but to effect change, I’d be thinking about a strategy of naming and shaming the top people ie the directors of chains flogging homeopathy ‘remedies’ not the (relatively uninfluential) pharmacists employed by them.
Top down change might be more achievable than bottom up (if you excuse the metaphor).
my point is that action is needed; whatever action!
just sating “I cannot do anything about it” is not ethical.
A lively and informative discussion between Ms. Stillman-Lowe and Dr. Ernst, making the same points I was going to post. Here in the US, the vast majority of pharmacies are large and corporate with buyers who operate on a huge scale–and one in particular, retired from Walmart, who is singing the praises of quackery. (see ScienceBasedMedicine post last week). The independents are sometimes so-caled “compounding pharmacies”, many of which are heavy into the woo of fanciful lab testing, bioidentical hormones, homeopathy and more. They will do well if the large chains are ever make to give up the “complementary” potions.
Across the Tasman, in New Zealand, there’s some stuff happening about homeopathy in pharmacies as well. The regulatory body for pharmacists, the Pharmacy Council, has proposed a change to the part of their code of ethics which requires that only healthcare products with credible evidence of efficacy can be promoted or sold in pharmacies.
Sadly, that section of the code of ethics has been largely ignored and completely unenforced even in the face of formal complaints. At the Society for Science Based Healthcare we have prepared a submission on the proposed change. We’re hoping we can turn it into the best consumer protection tool it can be: http://sbh.nz/submissions/pharmacy-council-code-of-ethics-proposal