If you look at the shelves of most Australian community pharmacies or browse the pages of local internet pharmacies, you'll see numerous examples of products making claims that can't be supported by scientific evidence.
Pharmacy picture from Shutterstock
These include an increasing proliferation of homeopathic medicines, weight-loss products with names such SensaSlim, Undoit and Fat Blaster Reducta, products to enhance sexual prowess such as Horny Goat Weed (for both him and her) and numerous vitamin and mineral combinations.
But why do pharmacies stock, promote and sell these products when pharmacists are trained scientists? The short answer is that they are profitable. Some pharmacists have told me:
The products are heavily promoted, consequently people want them and if we didn't stock them customers would simply go elsewhere. In addition, we can provide advice if asked.
Others point out that the decision to stock is often made by the pharmacy owner or group buying chain and has nothing to do with the in-store pharmacist who dispenses scripts and gives advice. Such policies can extend to protocols aimed at up-selling complementary medicines of dubious value to customers getting certain prescriptions filled.
A Pharmacy Guild – Blackmores partnership along these lines was short lived but the practice still appears common. Recent research has shown that pharmacies that recommend the most complementary medicines to customers provide companion sale protocols to their staff.
As one respondent to this research said:
It's all written down in the [pharmacy group] protocols, so if you work for [pharmacy group] you're expected to follow this.
Other pharmacies, particularly large discount chains with an internet presence, point out that they stock thousands of, often short-lived, products and they cannot, and should not, be expected to research which ones are evidence-based and which are not. They have said to me:
Sorting out evidence-based products should be the job of the Therapeutic Goods Administration (TGA).
But the listing process of the TGA does not assess the efficacy complementary medicines. In addition, the Therapeutic Goods Advertising Complaint Resolution Panel (CRP) has clearly said that information on retailer websites is the responsibility of the website publisher.
There is clearly a conflict between the need for pharmacists to maintain a profitable business and their ethical obligations to the community.
In 2003 the Pharmacy Board of NSW said:
The community holds pharmacists in especially high regard and places its trust in pharmacists' professional judgment, and relies on pharmacists' professional advice.
Because a recommendation by a pharmacist for any medicine gives that medicine special credibility, it's essential that the recommendation is based on sound scientific evidence. Indeed, the trust in pharmacists and pharmacies is such that, simply because a medicine is available in a pharmacy, consumers will infer that it carries the pharmacist's endorsement and recommendation.
So pharmacists must be personally persuaded of the safety and effectiveness of the medicines (and other therapeutic goods) available in their pharmacies.
These principles have been reiterated by the new Pharmacy Board of Australia. Its Code of Conduct for Registered Health Practitioners states that providing good care includes:
Practising in accordance with the current and accepted evidence base of the health profession, including clinical outcomes.
And its Guidelines for Advertising of Regulated Health Services state:
A person (or business) must not advertise a regulated health service in a way that is (a) false, misleading or deceptive or is likely to be misleading or deceptive; or (d) creates an unreasonable expectation of beneficial treatment.
Several complaints have now been submitted to the Pharmacy Board of Australia about pharmacists who continue to make claims about products that had been shown to be false, misleading and deceptive by federal court orders and CRP determinations, even after these products were delisted by the TGA. No response has yet been received.
In October 2011, the Pharmacy Board said:
This being the first year of the National Scheme, the Board has taken a largely educative approach to help practitioners understand the law and the new requirements set down in its advertising guidelines. The coming year will see a more structured approach to addressing concerns about advertising. This will include an escalating series of warnings to practitioners, initially reminding them of their obligations about advertising and ultimately, possible prosecution for non-compliance with the board's standards.
In June 2012, it reiterated the obligations of pharmacists under the National Law and noted a changing focus from education to compliance. But no change in behaviour has been apparent to date. It's time pharmacists were prosecuted for non-compliance with their board's standards.
Dr Ken Harvey is Adjunct Associate Professor of Public Health at La Trobe University. He has collaborated with pharmacists in research, publications and teaching over many years. He been paid by the Pharmaceutical Society of Australia to give CME presentations on Evidence Based Complementary Medicines. He lurks and occasionally contributes to the pharmacist discussion forum: http://auspharmlist.net.au/.