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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