Response to article published in the AJP—The People’s Choice
by Ian Carr
In the AJP February, 2018 [and published online this week], your feature writer asks: “Can we afford not to support the use of complementary medicines?”
Indeed, we can and we must.
As a member of Friends of Science in Medicine and therefore a supporter of the concept of Evidence Based Medicine (which we pharmacists are required to be by the explicit, written ethical standards which govern us), I suggest that we are in danger of consigning our profession to irrelevance if we uncritically support the current state of the complementary medicine industry in this country.
Your article The People’s Choice happily rounds up the usual statistical suspects on behalf of the supplement industry: “two out of three Australians regularly using a natural healthcare product”; “sales… have doubled … to 4.7 billion dollars in just over three years.”
I counter: many Australians have low levels of literacy in science and health, and require thoughtful counselling about their medicines—not the promotion of unproven alternatives of dubious worth.
The problem I and many others have with the supplement industry is that while it loves to trumpet loudly words like “clinically proven” and identify itself with the white coat science brigade, it exists primarily in the spheres of advertising and marketing, exploiting consumer ignorance and generating consumer fear and guilt wherever and whenever it can.
A recent example is the ludicrous claim that a vitamin product is necessary to protect children’s eyes from the light of digital device screens. The marketing to concerned and guilt-filled parents: genius. The science? Nil.
Happily for Nature’s Way, Bioglan and Caruso’s, pharmacy chains have been enthusiastically promoting the products, including the kids’ version supplied as a chewy lolly. Not only is there no evidence of efficacy, there is no evidence that there is a health problem in the first place.
Articles like The People’s Choice, while purporting to be focused on the needs of the patient, are effectively a Trojan horse for the supplement industry. The reassuring phrases of Carl Gibson (“… people investing in their own health and wellness…” and the evidence-averse Gerald Quigley “…it’s all about patient empowerment…” fail to address the profoundly embarrassing situation that Australian pharmacy finds itself in.
The reality is: the shots are called by the supplement industry, and Australian community pharmacy has rarely demonstrated its conformity to the higher standards of Evidence Based Medicine in this area. The Pharmaceutical Society of Australia’s Position Statement on Complementary Medicines says pharmacists “must ensure consumers are provided with the best available information about the current evidence for efficacy…”
Consumer group Choice’s 2017 “mystery shop” for advice on stress found that a large majority of pharmacies—around 75%—recommended complementary products with little or no basis in evidence.
For all the hopeful reassurances that pharmacists might have a role in helping consumers evaluate the worth of complementary medicines, its value is completely overshadowed by incessant in-store, online and catalogue promotion of remedies, supplements and concepts that are unscientific, anti-scientific, pseudoscientific and outright fraud.
Ian J Carr, B. Pharm., MPS
Friends of Science in Medicine