A question of ethics

Doctors say selling CAMs is a violation of medical ethics

Most doctors believe it is unethical for pharmacists to sell complementary medicines without an established evidence based.

A new poll in the Medical Journal of Australia revealed that 76% of doctors who voted said ‘No, it’s unethical’ in answer to the poll question ‘Should pharmacists sell complementary and alternative medicines with little evidence base’.

Of the 173 respondents to the poll, 22% said ‘Maybe, if they inform their customers of the evidence’.

Only 2% said ‘yes, they’re entitled to make a profit’.

The poll was following on from an earlier MJA InSight article which quoted a Canadian pharmacist, Scott Gavura, who argued pharmacy needs to take a more evidence-based approach, based in part on his own experience working in community pharmacy.

“If it was unorthodox, this store probably sold it,” he said.

“Conventional drug products (the ones I was familiar with) were hidden off in a corner, and the store was otherwise crowded with herbal remedies, homeopathy, and different forms of detox kits and candida cleanses. All of this was unlike anything I’d ever seen or heard about in pharmacy school.”

Gavura argued that selling of complementary and alternative medicine (CAM) violates, not just medical ethics, but even the “relatively permissive” principles of commercial ethics.

In an article in Bioethics, he teamed up with business ethicist Dr Chris MacDonald to make that case, starting off with the identification of some essential ethical principles that underlie commercial transactions.

Two of these are that the product has to work, and that the purchaser has to understand the product and be able to assess whether it will meet their needs (I’m going to call that second one informed consent).

So, a consumer buying a used car is entitled to expect that it is able to be driven. And they should not be misled into believing it can sprout wings to escape traffic jams.

The informed consent principle implies “a general demand for honesty on the part of sellers, and a refusal to profit from the ignorance of consumers”, Gavura and MacDonald write.

So how does the CAM industry fare when measured against these principles of commercial ethics?

It’s pretty much a total fail on the first one, since few CAM products are able to provide quality evidence of efficacy.

“Empirical testing confirms what a priori plausibility suggests: there is little convincing evidence that the overwhelming majority of CAM has any meaningful medicinal effects, and some CAM, like homeopathy, has no effects at all,” the authors write.

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