Atheist Age

Pharming the community

Recently we looked at the acupressure ‘antisnor ring’ and referenced an open letter from The Australian Skeptics to Pharmacists of Australia. Jason Ball from the Young Australian Skeptics had already referenced this correspondence and also goes into a response from the president of the Pharmacy Board of NSW, Gerard McInerny. Jason goes on to point out the response indicates NSW pharmacists can talk the talk yet with little action.

I’d probably be even more critical of some aspects of the reply. McInerney initially offers not much more than placating semantics. He acknowledges pharmacists are held in “especially high regard” and trusted by the community which relies on their professional advice. He acknowledges this trust may lead consumers to infer professional endorsement thus pharmacists must be “personally and properly persuaded of the safety and effectiveness of medicines” in their pharmacies.

I’m sorry Gerard McInerney, but when you assume you’re held in especially high regard exactly what does personally and properly persuaded actually mean? A durable answer may be gleaned from peer reviewed material but this – according to your reply – is resolved if pharmacists undertake post graduate study and choose Clinical Literature Review as “a module” in the Graduate Diploma of Clinical Pharmacy.

Australian consumer magazine Choice recently evaluated a range of pharmacy diet plans. Given the cost, rapid rise in programme options [competition], claimed success and variation in consultant training this was more than welcome. In short, Choice report:

• Pharmacy diet plans may help to shed extra kilos quickly, but most fail to deal effectively with the complex broader issues around weight loss.
• CHOICE cannot recommend these programs until consultants improve their training and move beyond the “one-size-fits-all” approach.

Tony Ferguson copped a slap on the wrist and his reply, on his own website, beggars belief. “600,000 Australians can’t be wrong but Choice can’t get it right…”, one reads. If such outright insults to a thinking public is indicative of “personal and proper persuasion”, then we can take no comfort from Gerard McInerneys trust in pharmacists.

McInerney continues, The Board recognises that some pharmacists are likely to have a passion and appropriate training for alternative, complementary and natural therapies. Nevertheless, pharmacists must limit their provision of advice about such therapies only to those who voluntarily seek it, and only about therapies for which there is documented evidence of effectiveness.

Pharmacists must especially refrain from intervening inappropriately with prescribed medicine. If an intervention is appropriate, it should be made only through the prescriber.

As Jason points out it is positive that pharmacists have responded to the Australian Skeptics letter. However I find the previous two paragraphs highly subjective and only possible to police by removing unproven, non evidenced based and potentially dangerous items from sale. Nothing motivates pharmacy guilds and bodies like monetary profit. Pharmacy premises are limited in Victoria such that we watch the same shop change hands as the paying community grows around it.

Yet consider the average pharmacy. Even without junk medicine and comfort blanket items, customers must duck and weave through an obstacle course of shelves selling everything from expensive lollies, to dental “miracles”, to desk items such as pen holders, miniature clocks, socks, jewelery, hair products, podiatry items, umbrellas… and so on. In short, massively marked up Bargain Shop items mixed with semi medical stock blocks the journey from the entrance to the ever receding “prescription” or “Dispensary” counter.

Pharmacists can act when necessary. The rapid implementation of restrictions of medicines containing pseudoephedrine and the Guilds interest in proper patient management surrounding the abuse of over the counter medicines containing codeine attest to this.

As an allied health professional myself I confess to many crises of conscience from large hospital wards to overrated exercise physiology labs. I can confirm that when a business must meet overheads, being pedantic about evidence is often a fast track to unpopularity. Perhaps it is how we regulate the human opportunity for profit as much as understand the importance of respecting evidence that matters here.

Finally, it’s worth noting the final paragraphs also collated from Pharmacy Guild of NSW bulletins. They are quite unambiguous in intent, perhaps – as is often the case in Allied Health – reflecting the point at which professionalism meets profit.

NATUROPATHY HOMEOPATHY OTHER ALTERNATIVE
HEALTH CARE AND THE PRACTICE OF PHARMACY
Alternative medical practice or therapies, such as iridology, aromatherapy, reflexology, homeopathy and similar “natural” approaches to health care have apparently found a place in the community, but the Board can see little or no place for them in the practice of pharmacy. Regardless of any pharmacist’s other heath care interests, no pharmacist may ever disregard their standing in the community as a provider of primary health care. Pharmacists have been registered as health care providers after completing a rigorous course of university training followed by an equally rigorous period of practical experience and assessment of their fitness to practice.

Because a recommendation by any pharmacist for a therapy or medicine gives that therapy or medicine special credibility, it is essential that the recommendation is soundly and scientifically based. Pharmacists who recommend alternative therapies or medicines to consumers must be appropriately and properly trained. Additionally, recommendations may be made only according to the principles of evidence based medicine. To assist pharmacists in their evaluation of published papers, the Board recommends completion of a course of critical appraisal of scientific literature as part of proper training.

Associate Professor Louis Roller, Victorian College of Pharmacy makes the following comment in respect of homeopathy, that, at this point in time, there is no evidence pointing towards the efficacy of homeopathic products. Pharmacists would be well advised to apply Professor Roller’s advice to the available evidence relating to other alternative health care procedures or medicines.

Any pharmacist who, after proper training, chooses to practise as a naturopath or other alternative health care provider, must ensure that practise as a pharmacist and the conduct of the alternative health care business is carried out in separate premises. This will ensure that the distinction between practice as a pharmacist and operations as a naturopath, or other alternative health care provider, is so obvious that there will be no question in the mind of the public in respect of the person with whom they are dealing.

Indeed.

Tags: Alternative medicine, Controversy, Medico-legal, Pharmacy, Research, Scam