AJP poll results show more than half of pharmacists stock complementary medicines, including homeopathic items. But is it out of choice, or have they lost control over what they wish to stock?

With complementary and alternative medicines making headlines across Australia over the past few weeks, AJP ran a poll asking readers: “Do you stock CMs in your pharmacy?”

The poll has received nearly 250 votes so far.

According to the results, 54% pharmacists say they stock CMs including homeopathic products.

About a quarter (28%) of respondents stock CMs but not homeopathic products.

Only 9% said they “only stock evidence-based CMs”.

Three percent completely refuse to stock CMs, while 2% stock them but with clear in-store labels saying that they may not work.

And just one person stated they stock CMs but have recently decided to no longer do so.

“The latest survey results, showing over 40% of pharmacists are adhering to PSA’s Code of Ethics on complementary medicines, are very encouraging,” says PSA National President Joe Demarte.

“However it’s disappointing that some pharmacists are still stocking homeopathy products, which are not supported by PSA’s Code of Ethics or our Position Statement on Complementary Medicines.”

Mr Demarte tells the AJP that pharmacists who sell such products need to make sure they provide patients with the full picture of CMs.

“Irrespective of the products stocked in a pharmacy, the important thing is when discussing the use of complementary medicines with consumers, pharmacists must ensure that consumers are provided with the best available information about the current evidence for efficacy, as well as information on any potential side effects, drug interactions and risks of harm,” stresses Mr Demarte.

“It’s important for pharmacists to provide a fair, honest and balanced view of the current evidence available on all complementary medicines,” he says.

NSW pharmacist Ian Carr, who is a member of the Friends of Science in Medicine group, suggests that many pharmacists may not have much choice when it comes to stocking complementary and alternative medicines.

“CMs policy is not being filtered through the professional assessment of the pharmacist,” Mr Carr says of pharmacists that belong to chains.

“It’s basically a business deal with the franchise, and as a pharmacist taking on a franchise you’ve basically got to sign those rights away about what you get to sell. Some of the chains offer basically everything that is available, no questions asked. As an independent pharmacist I am able to make my own decisions about what to stock.”

While the law demands independent pharmacy ownership, the reality is that much management is in the hands of larger entities including wholesalers, says Mr Carr.

“We’ve got a ‘de-facto’ corporatisation happening with marketing groups and franchises, and I’m concerned the government will look at this trend and ask, why are we not deregulating the industry to reflect the apparent reality of pharmacy today? We’re only playing into the hands of people who want deregulation.”

He suggests all pharmacists should be making a stand for evidence-based medicine.

“We should be telling people in no uncertain terms that if something is on the shelf it doesn’t mean it’s been assessed or approved by the TGA,” says Mr Carr.

“There is no doubt that there has been a long-term relationship between the supplement industry and pharmacy. But it was also a few decades ago that researchers started applying the concept of evidence-based medicine to healthcare generally.

“That should have been the point where we said, ‘we’re not just going to be a conduit for your products without questioning their basis in evidence’. That’s where we lost the plot. The question now is: where do we draw that line?” 

“I’m really trying to say to my fellow pharmacists: Please let us reassess the unquestioning support of the CM industry, or we’ll all be tarred with the same brush. I and many others are concerned about – and fighting for – the reputation of the pharmacy profession,” he says.

Consumer demand

The AJP poll results that show high levels of pharmacist sale of CMs certainly reflect the demand of consumers – a 2010 Australian study of more than 1,100 customers revealed 72% had used CMs within the last year.

The BMC Complementary and Alternative Medicine study, led by researchers from Alfred Hospital in Melbourne, also found the most popular of these products were multivitamins, fish oils, vitamin C, glucosamine, and probiotics.

But it was also important to be informed. Of the survey group, 92% thought pharmacists should provide safety information about CMs, while 93% thought it important for pharmacists to be knowledgeable about CMs.

Mr Demarte suggests pharmacists refer the Australian Pharmaceutical Formulary (APF23) handbook, which he says provides evidence-based information to help pharmacists counsel consumers on the safe, effective and appropriate use of complementary medicines.

Canberra pharmacist Elise Apolloni, who is a managing partner of Capital Chemist Wanniassa in the ACT, explains to the AJP her pharmacy’s approach homeopathic products in order to generate conversation surrounding them.

“We have tagged every CM in our pharmacy saying there’s no evidence for them. There is no mistaking that there are signs in our homeopathic area, and if we do stock them it’s because they’ve been specifically requested by a patient.

“Our pharmacists do not ‘sell’ [homeopathic products]. In a way they’re there to start a conversation about these products, because there are people who genuinely use and believe in them.

“If they came to us with a specific issue – say anxiety – we would talk to them about evidence-based options. But if they approached us holding a specific product such as Rescue Remedy, we would start a conversation with them about it.”

Ms Apolloni says pharmacists can make a difference where they are.

“It’s not that hard to flag what are homeopathic products. Some products aren’t clearly labelled as homeopathy [by the manufacturer], we’re trying to bridge the divide for the consumer and be transparent about them,” she says.

“I don’t think there’s anything wrong with people making an informed choice. As long as it’s not causing any harm – ‘first do no harm’, right? But Australians have obviously voted to use CMs.”