Addressing pharmacy’s ethical dilemma

The Review of Pharmacy Remuneration and Regulation should address concerns over the possible conflict of interest between pharmacy’s retail and health care roles, bioethicists believe.

In an article entitled ‘Health professionals as vendors: the commercial erosion of evidence and ethics’, the three experts take issue with media reports claiming Pharmacy Guild of Australia national president George Tambassis had said attempts to limit or otherwise disincentivise front of shop activities were ideologically-driven and would dismantle a good system – “which he defined on the basis of positive customer satisfaction surveys and the high level of trust in pharmacy professionals,” they said.

The bioethicists argue this view is wrong “on a number of counts”.

 “First, simply labelling an argument as ‘ideological’ is not a sufficient basis for its refutation. Indeed, complaints that arguments are “ideological” are usually themselves ideological,” they said.

“Second, the fact that there are high levels of trust in a particular professional group does not mean that the trust is informed or valid (i.e. reflective of the fact that pharmacists genuinely have their customers’ best interests at heart) – or that this trust cannot be eroded.

Third, while customer satisfaction may be a valid measure of commercial or professional transactions these ratings do not necessarily reflect the quality of professional care or the impact of transactions on health and wellbeing.”

They believe the Guild view misses “the moral anxiety that underpins the questions posed in the Discussion Paper—that commercial activities of pharmacists and pharmacies might ultimately undermine both their professional standing and their contribution to public goods”.

However not only pharmacy is the target of the ire, with the group also criticising doctors who “frequently engage with, and benefit financially from, their interactions with industry in both research and clinical settings.

The most obvious example of this—and the one that has attracted the greatest attention—is the relationships that medical professionals have with the pharmaceutical industry. Another example is the growing number of doctors practising “integrative medicine”, some of whom also sell supplements and various other kinds of complementary and alternative medicines (CAMs)”.

The Pharmacy Guild of Australia did not wish to comment on the Croakey article

The article was published on health website Croakey

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  1. Jarrod McMaugh

    I’d like Dr Wendy Lipworth, Dr Christopher Mayes and Professor Ian Kerridge to explain the difference between using your professional reputation to sell a product, and using your professional reputation to sell a course of action.

    My Lawyer provides me with very few physical products, but the different courses of action that she recommends cost me different amounts, and also earn her different amounts.

    I am in discussions with a surgeon at the moment, and depending on the particular process I agree to, each surgery has a different cost and subsequent profit for the surgeon.

    My financial adviser offers me purely cognitive services, and the different courses of action have different costs for me and profits for her.

    The definition of a professional is someone who puts the interests of their patient (or client in two of the cases i describe above) above their own financial benefit, while still benefiting from that transaction financially.

    Perhaps that’s the difference – pharmacists often provide advice that may prevent a sale… therefore we don’t always benefit from the transaction financially.

    I think its all too easy for people who don’t actually know what they are talking about to accuse pharmacists of a conflict of interest based purely on the fact that our advice is often linked to the sale of a product.

    If pharmacists truly had a conflict of interest in this area, we would stock something innocuous like bottled water, and sell it to every person, no matter the complaint. Whats the point of having a pharmacy filled with product if I could just recommend water for everything?

    • Peter Crothers

      Well said Jarrod. The argument is simplistic and not grounded in ordinary peoples’ lived experience. Couple of things to add. First, as we know, the community pharmacy business model is all about relationship, to an extent outsiders and commentators will never realise. Whereas, say doctors have a powerful motivation in the MBS and can influence their own income without the patient necessarily bearing the cost, we have no such power. Instead we are motivated by the need to maintain and build ongoing relationships with hundreds and hundreds of patients and customers. Whereas surgeons and lawyers might collect $1000 or more ‘per transaction’, we keep the myriad small but precious care relationships ticking over and pick up a dollar profit this time, nothing the next three times but maybe $20 the time after that. It’s the lifetime value of the relationship that pays the bills. Second, health care is astonishingly complex and confusing and we at least know enough to help people navigate through it without riding roughshod over their independence and right to disagree with us. Community pharmacies have thus come to occupy that unique place in the health care spectrum where self-care collides with primary care and where patients’ right to exercise their own beliefs and care for their own health, and the claims of product sponsors and advertisers, collides with evidence: evidence that is changing all the time. If we don’t do a consistently good and honest job of guiding people through that complexity, uncertainty and ambiguity, we would never gain their trust and be able to build the lifetime patient relationships on which our businesses increasingly depend.

    • PharmOwner

      “Whats the point of having a pharmacy filled with product if I could just recommend water for everything?” Oh, but Jarrod, you could do just that. In fact, some people ARE doing just that. It’s called homeopathy

      • Jarrod McMaugh

        Nice to see someone got the point…

  2. Ethical pharmacist

    As a practicing pharmacist, I agree with the bioethicists. Pharmacists, as health professionals, should be reimbursed according to the services they provide and not through the products that they sell. Ideally, pharmacies should all be deprivatised (as seen with the new 24-hour super pharmacies which are now operating in Victoria).

    • Anthony Tassone

      Ethical pharmacist

      Just by way of clarification the ‘deprivatised… 24-hour super pharmacies which are now operating in Victoria’ are existing community pharmacies that applied by way of a tender application to have co-funding from the Victorian Government for extension of their trading hours to 24 hours, 7 days per week.

      Not sure if you were inferring these 24 hour pharmacies were not owned by pharmacists and had deregulation of ownership.

      All five as part of the first stage of the 24 hour pharmacy policy are existing pharmacies – one of them is an existing Friendly Society pharmacy as part of the UFS Group in Ballarat and the others are owned by pharmacists as required by the Victorian Pharmacy Regulation Act 2010.

      More information about the ‘Victorian Supercare pharmacy’ policy can be accessed from below.

      I hope this provides some clarity.

      Anthony Tassone
      President, Pharmacy Guild of Australia (Victoria Branch)

  3. pagophilus

    Finally someone’s thinking!!!!

  4. everyone is in it for the mone

    How ethical are 6 minute consults? How is charging a patient $37 for a repeat without a consult ethical? “either pay up or don’t have access to your required medicine”. If doctors are these supreme beings of ethics then why do studies show a $20 dinner influences prescribing practices? Why do doctors claim that generics are not as effective as originators? These comments are not evidence based and cost the taxpayer. Why do doctors with financial interests in vaccination clinics argue against scientific evidence and public benefit? Why do specialists demand million dollar salaries and rush through consultations and take 2 hour lunch breaks?

    • PharmOwner

      Let’s not forget the GP’s who refuse to prescribe repeats for stable patients so they can see them more often and charge another MBS consulting fee…

  5. Ralph

    Fine – if these smarty-pants’es can get the government to pay us a viable amount for PBS medicines, we’ll dump the stuffed toys. Until then, we have to sell all the extra junk to pay the bills – so we can keep the doors open, and actually provide medicines to public. Until then, the clever-clogs can keep their ivory tower comments to themselves.

  6. Nicholas Logan

    How do I become a “bioethicist”? lol

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