Credibility issues are raised when pharmacies sell low-evidence complementary medicines, according to an ABC Background Briefing report.
And Taree pharmacist Ian Carr, who has spoken out numerous times about issues he sees with unquestioningly accepting complementary medicines, tells the AJP that he agrees.
During the Background Briefing the ABC’s Ann Arnold said that “at a time when pharmacy is fighting a turf war with doctors, with pharmacists wanting to offer more clinical services, their pitch to be taken seriously as health professionals is at risk”.
She spoke to Adelaide pharmacist and advisor to the TGA on medicines safety Adam Phillips and Friends of Science in Medicine’s Ken Harvey; the latter told her that CMs are “a triumph of hype over science… There’s very limited evidence to support the claims that are made.”
The Saxby Pharmacy’s Ian Carr told the AJP that there is little long-term evidence to support the use of CMs, many of which become the subject of fads and thus aren’t taken long-term anyway.
“Chlorophyll was big in the 70s when I came to pharmacy, and it hasn’t been heard from over the last 20 to 30 years until again very recently,” Carr says.
“Every time one of these fads comes along, whether it’s Vitamin E or spirulina or chlorophyll, it’s marketed well before there’s any good clinical evidence – and that makes them, in effect, an experiment on yourself.
“Aside from the placebo effect, you don’t have an endpoint for your experiment. You basically stop that experiment, as most people do, when the next fad comes along.
“Because if we’re talking about a clinical trial, we’re talking about giving 10,000 people this stuff, blinding it, and then 10 years down the track we’ll find out whether or not it does any good.
“Someone might claim Vitamin E is great for your heart health and will extend your life by 20 years, but nobody stays on the damn stuff long enough to find out. That was a fad from the 70s and 80s, and it’s still on the shelf but it’s probably taken by less than 1% of the people who were taking it way back then.”
The Background Briefing saw Arnold ask Phillips about the claims made by a liver detox product, which he said was a “strange concept” as the liver’s role is detoxification.
Carr agrees. “The whole point is that this is what your liver is,” he says. “Your liver is your detox unit. It’s not sitting there storing things up for later, it’s getting rid of them promptly.
“I think that what’s been happening is the marketing aspect is trying to instil fear by alleging that you’re burning the candle at both ends and not eating right, accumulating toxins through alcohol and other agencies like breathing the air, and of course if there’s a problem there’s a solution that can be packaged.
“I’m also convinced there’s a pseudo-religious angle, where these concepts are spread by evangelisation – there’ll be one lady who found that celery seed helped her arthritic knee or something, will talk over the back fence and all of a sudden that recommendation is far more powerful than advertising alone.”
Carr says that rather than simply selling vitamins, minerals and other supplements, pharmacists could reflect on why the patient feels they need them.
“That’s often very revealing. Somebody might come in asking for iron, and if you ask why they think they need it, there’s two answers.
“The first is that the doctor told them to get it. That’s a good answer. The other answer is, ‘I’m feeling a bit tired,’ in which case selling the supplement would not be appropriate without seeking a diagnosis or a second opinion to see if there’s any issues before we get to iron.
“I don’t think there was ever a conscious deception from pharmacy. In the old days, it was simply one way to sell in the front of shop, and then it’s just gone on… and as the various clinical trials have come in their results have not been very impressive. There’s some evidence for a few things like fish oil in high doses for rheumatoid arthritis, not so much osteoarthritis, but there’s a million examples of things that don’t have a basis in science or logic.”
Carr says the Saxby Pharmacy doesn’t stock any unproven CMs. When asked if he takes any supplements himself, he says, “I don’t take a multivitamin. I don’t take a supplement of any sort. But with the money I save, I buy nice ingredients to cook with.”