Why do pharmacies sell CMs?


pharmacy deregulation: shopping trolley full of pills

We need to know how (and why) complementary medicines are being sold in Australian pharmacies, writes Ian J Carr

Australian pharmacies sell a lot of vitamins. Bucketloads – and, seemingly, in increasing quantities and dollar values, with no sign that the health of this particular golden goose is under threat.

Recent figures show a supplement market worth $4.7 billion, with pharmacies’ share $2.5 billion and rising. By comparison, our increasingly “unaffordable” PBS costs Australia merely twice what we are willing to spend on vitamins, chlorophyll, olive leaf, Vita Gummies and Horny Goat Weed.

As a supporter of evidence based medicine, and member of Friends of Science in Medicine, I find these statistics disappointing. I have a niggling suspicion that Complementary Medicine (CM) sales in pharmacy would not be so robust if we pharmacists were adhering closely to the PSA’s advice in its CM Position Statement: “…pharmacists must ensure consumers are provided with the best available information about the current evidence for efficacy…”

Why has the profession of pharmacy failed to bring its best qualities to the consideration of CMs? Why has it overlooked the principles of evidence based medicine as developed since the 1980s? Why has it supported so wholeheartedly and unquestioningly a supplement industry which is largely built on hype and the marketing of fear and guilt to the worried well. 

I will hazard a few guesses.

It’s historic: we’ve always sold vitamins, and VITAMIN equals A GOOD THING, surely?

It’s easy. The vitamin rep sorts out a nice display, trains the staff and doesn’t ask me to choose what my pharmacy displays – let alone have me cast a professional eye over his/her choice. Or, my marketing group allocates a ton of the stuff, and I have little say.

It’s not my problem: CM customers generally get their information from family, friends, internet or the health food store. It’s easier to sell what they want than disabuse them of nonsensical ideas.

It’s really not my problem: I allow an in-house naturopath to introduce my patients to concepts like Iridology and live blood analysis… but sales are up!

It’s because PBS dollars are being squeezed. So, does your local GP seek extra work offering Reiki or rolfing when his or her Medicare dollars fail to roll in?

There’s little chance of harm: except that the harm is done not so much by the product, but by the encouragement of poor thinking when it comes to important health choices. If only those billions of dollars were being spent on better diet, sport and exercise!

Before I am dismissed as an “extremist” skeptic, dear pharmacist reader, may I assure you (as if you don’t already know) that the great majority of your GP allies in health are dismayed that pharmacies today sell a lot of dubious, unevidenced garbage.

Despite the swift negative public reaction which caused the Guild to drop its notorious Blackmore’s “Coke and fries” deal in 2011, I have heard that some pharmacies (groups?) are still doing exactly that, contrary to the best evidence.

May I therefore announce: Pharmacy CAM Leaks.

I have set up an email pharmacy.CAM.leaks@gmail.com where pharmacy workers may share their stories.

The idea is simply to gather stories and data about how Complementary Medicines are being managed in Australian pharmacies today.

I invite employee pharmacists, group managers, staff, ex-employees, industry whistleblowers, patients or carers to tell Friends of Science what may be going on at the pharmacy “coal face”.

I would like to invite anyone who is concerned that the highest ethical standards are not being met.

For example, who conducts the training for the vitamin section? The company rep? The pharmacy owner/manager?

Is there pressure on staff to “sell up” or “companion sell” — perhaps to prescription customers? Are you given a computer “prompt” by the pharmacy’s point-of-sale?

Pharmacy managers, is the CM department stocked and controlled by retail management or the “group”?

Are sales targets set, regardless of how suitable CMs might actually be?

Does your pharmacy employ a naturopath, or other advisor who consults about CM issues?

All comments will be treated with complete confidentiality. (However, ideally we would like contributors’ contact details, if we have to confirm facts.)

I would like to hear of any situations where poor advice about CMs has led to bad outcomes; also where CMs have been offered instead of evidence-based therapies.

We must not allow Australian pharmacy to turn its back on best practice, evidence-based medicine, or we will be continuing to contribute to the public’s poor scientific literacy and confusion when making the best choices for their health.

Ian J Carr, B.Pharm., MPS, from Saxby’s Pharmacy in Taree, NSW, is a member of Friends of Science in Medicine.

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8 Comments

  1. A great initiative! It could also link into our 2017 Monash, “Whack-a-mole” project where we ask medical and bio-med science students to evaluate the evidence for questionable claims made about therapeutic goods and services and, if appropriate, submit a complaint to the appropriate regulator.

    Feel free to submit questionable claims to: http://www.medreach.com.au/?p=2073

  2. Daniel Roitman
    14/06/2017

    Bravo, a fantastic initiative.

  3. Tony Pal
    14/06/2017

    I fully appreciate the white coat giving CMs legitimacy argument but I still think that for customers determined or desperate enough to get CMs it is better from a pharmacy than a health food store. Divesting pharmacy 100% from CMs means going back to the dark ages where pharmacists knew nothing to very little about CMs. I would prefer to be informed rather than uninformed about CMs when people come in asking questions about all the possible therapies, proven or unproven. I don’t want the local Health Food Store becoming the local go to health source because customers wanting a product that gives them a little extra control, whether placebo or not, see me as hostile to their needs and falling asleep when CMs come up in conversation. All EBMs were dubious when first developed. No EBM is 100% effective in all circumstances same as CMs. It is not impossible with enough use and study for a CM to become an EBM, the problem is there is no money in doing the EBM research.
    I have used CMs myself, many have failed but I am very grateful for the ones that turned out to work. If the EBM version existed logically I would take that in preference to a CM. CMs have a place in the market because if a EBM version existed then why would not take the EBM version. If the CM market disappeared overnight, not available anywhere from anyone, people would invent it because when you are desperate you have no choice but to clutch straws. this may look pathetic to an outsider, but it gives hope to keep going on. There are no shortage of people with terminal or debilitating diseases/illnesses who have lost hope and all they want to do is end it. It doesn’t authorise legitimising or providing false hope but if I was desperate or determined to purchase something for good reason, I would prefer to get reliable balanced advice from a health professional rather than Health Food Store sales slick. (PS: I am sure there are good Health Food Stores, so I hope you know what I mean.) It is wonderful to have a crystal ball that guarantees which CM or EBM will be saving lives until something better comes along. Until then, if you don’t which is real medicine or not you have to give it a try. Even EBMs get taken off the market eg Vioxx because no one knew in advance the risk-benefit ratio. Dipyridamol comes and goes as a EBM that may or may not work. I thought Glucosamine would go the way of buggy whips once the craze was over but it is still here. The Head of the TGA should be so wise and then our drug market could be leaner and meaner instead of wasting money on me-too’s that are only half as good as the gold standard drug. Or should we allow for diversity and diversity in response. I have no objections to pharmacy not wanting to sell CMs but it is like walking into a pharmacy that will not supply ECs on moral grounds, the decision for the customer has already been made and the customer will have no choice but to go elsewhere, where supply of what they want is reliable. Not having the product available means you have no opportunity to counsel and no opportunity to upsell them to an EBM if the EBM exists, or giving them good and fair advice regarding their expectations with the CM eg someone came in for Glucosamine Cream for knee OA and I sold them Dencorub with methylsalicylate. They came back a week later and asked why I sold them rubbish when the Glucosaamine they bought elsewhere works so well

    • Robyn Johns
      14/06/2017

      Finally some balance to the augument.

    • Ronky
      23/06/2017

      A very illogical and unprofessional list of emotive empty slogans and false arguments.
      “going back to the dark ages” – oh the irony. Unproven medicines belong in the dark ages and should be left there.
      Surely you know that osteoarthritis is one of the classic remitting-relapsing incurable diseases. The ignorant will thank that whatever he happened to be using when it remits “worked” and whatever he happened to be using when it relapses “didn’t work”. Health professionals should not encourage this puerile idea.
      Yes there are some remedies that are in a grey area between proven and unproven, but you can’t just pretend that proven and unproven medicines are equivalent and can be treated just like different brands.
      It’s unprofessional to sell someone something that’s unproven on the basis of “yeah it’s unproven but it just might possibly work”. If you want to conduct an experiment, do so through a proper trial whose results will actually have some meaning.
      Yes some people are desperate and want to “try anything”. It’s our job as educated professionals who truly care for their health (and their finances) to honestly admit to these people, “Look there are some diseases in some people for which we can’t sell you a pill that will help you. You’ll have to learn to live with your condition and cope with it as best you can without pills.”

  4. Jarrod McMaugh
    14/06/2017

    Ian can I ask the threshold of evidence that is being used here to determine what is CAM and what is EBM?

    I ask this because I have several issues with how the terminology is thrown around without any specified distinction, especially by members of FSiM.

    I also have specific issues with the behaviour of a few notable members of FSiM who behave in an extremely unethical and unprofessional manner when they criticise wholesale the entire profession of pharmacists without supporting evidence in what amounts to a breach of the founding principles of this group.

    I would also direct every medical professional to apply the same standards to allopathic medicine, and observe that a large number of scheduled medicines and medical interventions (including major surgeries) do not meet the level of evidence that is considered “gold standard”.

    There is much discussion about CAM and EBM, and unfortunately very little of it recognises that there isn’t a black and white divide between the two – there are only shades of grey. I personally find FSiM’s approach to this topic to be extremely hypocritical, since many of the statements and generalisations that come from some vocal members of the group are unfounded, generalised garbage…. Ironic!

    Personally, I have a very critical eye for evidence, and I operate under the best evidence we have….. Which is not always the gold standard (ie RCTs etc). I do apply it e enly though, and I expect to this to be the same for all HCPs.

    I think it’s also relevant to mention that whether our “GP Allies” are proud or disappointed in pharmacists is the most completely irrelevant point to make in such an article. After all, RACGP actually has a standing committee on integrative medicine (something pharmacists don’t have) and a quick Google of “naturopath in GP surgery” returns a large number of hits….. And I know of a number of GPs in Melbourne who sell ranges of CAMs from their rooms. Basically, any GP who wants to criticise the entire profession of pharmacists for the actions of any one of us needs to watch for broken glass…

    Lastly, I think any collection of information like this about the practice methods of any health professional is exttemely cynical, and I can only assume that the intent is for it to be used against the pharmacy profession as a whole… Something FSiM has been only too willing to do in the past. While I think non-EBM practice is indefensible, I think this particular undertaking is reprehensible and I hope it fails

    • Robyn Johns
      14/06/2017

      Thank you for a balanced view point.

  5. bernardlou1
    15/06/2017

    Thank you Jarrod.

    Ian are you going to follow the same principle on health food stores, supermarkets and the major discounters?
    Or are you simply targeting community pharmacy who actually give advice and spent time with the patients.

    Please don’t be hypocrite. Have an balanced approach.

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