Mystery shoppers reveal pharmacy’s issue with CMs

A CHOICE study published on Monday reveals what happened after the consumer advocacy group deployed mystery shoppers to the prescription counters of 240 pharmacies across Australia

CHOICE commissioned a mystery shop to check out the advice being dispensed in 240 pharmacies across Australia, including Priceline, Chemist Warehouse and Terry White Chemmart.

Each shopper was asked to approach the prescription dispensing counter and ask for advice from a pharmacist, stating, “I’ve been feeling really stressed lately, is there something you can recommend?”

“Guidelines for treatment emphasise self-management techniques and lifestyle changes (such as a healthier diet, more exercise and relaxation), as well as various psychological therapies such as cognitive behavioural therapy (CBT) or counselling,” explains CHOICE investigator Karina Bray.

“There’s no mention of vitamins, herbal medicines and other over-the-counter products as a first line of treatment for stress. Yet most pharmacies are chock full of products that claim to treat stress and related symptoms, like insomnia.

“Since pharmacists are considered to be medicines experts and are often the first port of call for advice before seeing a GP, we thought it would be interesting to see what they would suggest for stress management. Would they recommend the best-practice guidelines mentioned above? Or instead try to sell unproven pills and remedies from the shelves in their store?”

After speaking to the pharmacist:

  • Three per cent of the shoppers were told to see their doctor, while 1% were simply directed to the vitamin section.
  • Among the shoppers who were recommended a product, 46% were recommended products containing a mixture of B vitamins and possibly other vitamins, minerals and herbs.
  • Twenty-six per cent of shoppers were recommended Bach flower remedies such as Rescue Remedy, about which CHOICE says “there is no scientific evidence they’re effective, and some evidence they’re not effective at all”.
  • As a standalone herbal remedy, St John’s Wort was recommended to 12% of shoppers. “There’s strong evidence St John’s Wort is useful for mild to moderate depression, but no evidence it helps stress or anxiety, so it’s not an appropriate recommendation,” says CHOICE.
  • A further 3% were recommended homeopathic remedies for their stress symptoms. CHOICE points out that the National Health and Medical Research Council (NHMRC) says “there are no health conditions for which there is reliable evidence that homeopathy is effective”. Furthermore, it cautioned, “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious”.
  • Thirteen percent of pharmacists recommended an antihistamine (doxylamine) “which has a sedative effect and can help with insomnia that may result from stress.”
  • One product a mystery shopper was recommended, “Metabolic Maintenance MetaCalm”, wasn’t listed on the Australian Register of Therapeutic Goods, which CHOICE reported to the TGA.

“To be fair to the pharmacists, they were confronted with a customer prepared to purchase something to help them – it could be argued that by directing the customer to a product that the pharmacist believes might help, or at least do no harm, the customer would be better off than if they’d chosen a random product themselves,” Bray writes.

“On the other hand, there’s no excuse for recommending products with little or no evidence to support their efficacy when better products are available. Giving additional advice for healthy lifestyle practices and other evidence-based techniques would also be appropriate.

“This mystery shop raises genuine issues around conflict of interest when it comes to the range of products on sale and what is being recommended. A massive 97% of the pharmacies visited stood to gain financially from their treatment advice while only three percent of our shoppers were told to see a doctor instead of being offered a product.”

Professor Bastian Seidel, President of the RACGP, argues that there is no role for vitamin/mineral and herbal supplements in the management of stress.

He says that not only are people wasting time with these products when they should be trying more effective strategies to deal with stress, they’re wasting money on products that make unsubstantiated claims with limited evidence of effectiveness.

Furthermore they can do harm – it’s possible to take too much of certain vitamins (A, E and some B vitamins), and many herbal medicines have side effects or interactions with other medicines.

The PSA has expressed concern about these CHOICE survey results revealing that a significant portion of pharmacists are recommending non-evidence based complementary medicines to patients.

“This practice, as claimed by CHOICE and the ABC, is not supported by PSA’s recently revised Code of Ethics or our Position Statement on Complementary Medicines,” says PSA National President Joe Demarte.

“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.”

The PSA still recommends that consumers consult pharmacists before taking any complementary medicines.

“Pharmacists – as healthcare professionals – are best placed to assist consumers in making informed, evidence-based decisions regarding complementary medicines and many pharmacists in Australia already adhere to PSA’s Code of Ethics principles and position statement on this issue.

“PSA strongly recommends that all consumers considering taking complementary medicines consult with pharmacists who adhere to PSA’s Code of Ethics and provide evidence-based advice.”

The Pharmacy Guild of Australia agrees that the best place to obtain objective, informed advice about complementary medicines is at a community pharmacy.

“The Guild believes that pharmacists, as highly trusted health professionals, have a duty of care to be aware of available clinical evidence that supports the therapeutic and marketing claims made about products sold in their pharmacies,” says National President George Tambassis.

“A range of complementary medicines are available through most community pharmacies in Australia, where pharmacists and pharmacy staff play an important role in providing advice to consumers about these products, and about any interactions that may occur with other medicines they may be taking,” says a Guild spokesperson.

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