MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

This study by Australian pharmacists, assessed the quality and relevance of community pharmacists’ information gathering (questioning), counselling and product selection when interacting with customers requesting a s0-called alternative medicine (SCAM) product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for ‘pharmacy only’ (S2) and ‘pharmacist only’ (S3) medicines.

A covert simulated patient (SP) was used to investigate the response of pharmacists to a request for a natural product for stress. The SP documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature.

Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product.

The authors concluded that the pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending SCAMs.

This paper offers a host of interesting information. For instance, it reveals that almost all pharmacists recommended at least one product for sale, about half of them recommended more than one. Considering that the evidence for most of the products in question is weak (to say the least), this seems concerning.

The second most recommended product, the ‘Bach Rescue Remedy‘, is perhaps a good case in point. There is no evidence that it has any effect on stress or any other condition. As the product contains no active ingredient, it is also implausible to assume it might work beyond placebo. Yet, many pharmacists are happy not only to sell it to the unsuspecting public, but even to recommend it to a customer who seeks out their advice.

I find this quite intolerable.

The paper thus confirms the point I have made repeatedly on this blog and elsewhere: community pharmacists seem to behave like commercially motivated shopkeepers, yet they are healthcare professionals who have to abide by an ethical code. When confronted with this overt conflict of interest, their vast majority seem to opt for violating their professional ethics in favour of profit.

I fail to understand why, despite these facts being well-known for so long, the professional organisations of pharmacists are doing do very little to rectify this appalling situation.

17 Responses to Community pharmacists: shopkeepers or healthcare professionals?

  • Medical care has always been a *for profit business*. Another wasted effort, but nice try.

  • Ernst,

    You actually think that a pharmacist should only sell evidence-based drugs..
    In this way, the customers will find Internet ways to get their alternative meds.
    Is that what you really want, then there is no connection with the customer at all?

    Everyone knows that almost all alternative medicines are not evidence-based.
    Only large pharmaceutical companies and perhaps one or two homeopathic companies can afford such expensive research. The choice of alternative meds is based on experience. I’m thinking of folk medicine, which works the same way ..
    Everyone should have the right to make their own choice, especially if the complaints are not serious.
    If more serious complaints are suspected, the pharmacist or his staff can play a guiding role with good advice..

    I would be more concerned about all the regular analgesics people can buy without a prescription.
    Isn’t that much more harmful ..
    Try to put things in perspective…

    • they actually RECOMMENDED alt med that was unproven and implausible.
      do you think an ethical code is something to frame and hang on the wall – and then forget about it?

  • Eelco_G:
    ” The choice of alternative meds is based on experience”.

    I’m not sure what that means, or how wise such a policy might be.
    ‘Experience’ being a metaphysical concept.

    That is why most of us do our best to seek evidence on a more rational basis – and when we consult with pharmacists (and doctors) we surely expect ethics to be complied with.

    How can a pharmacist (or doctor) ‘play a guiding role with good advice’ if patients are gullible and irrational?

    I know some doctors (and pharmacists) have ‘lost their way’ and have interests in vitalism, the occult, the supernatural, even deliberate crime – but they should not do so.

  • @Lenny

    Surely, you’re not that obtuse. I stated: “Medical care has always been a *for profit business* I made no specific reference to the NHS. However, as an entity, the NHS employs health care practitioners. They pay them. The practitioners profit from their expertise in providing health care services. Since your practice is private, you enjoy more profit. And, more importantly, you don’t need to meet certain Units of Dental Activity quotas imposed on dentists employed within the NHS. They profit too, but to a lesser degree. For NHS dentists, money they can afford for family holidays is less. More about the situation with NHS dentists here:

    https://www.theguardian.com/society/2007/feb/21/health.comment

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