The naturopathy debate


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Do you believe pharmacies should stock naturopathic medicines? Vote in our poll

Concerns have again been raised publicly about pharmacy’s role in supplying naturopathic products and services.

Pharmacist and long-time critic of the stocking of unproven complementary medicines, Ian Carr has reiterated previous calls for the products to be removed from pharmacies, leading to a debate with proponents of CAMs.

How do you believe pharmacy should handle naturopathic medicine?

 

 

 

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14 Comments

  1. Jarrod McMaugh
    26/05/2016

    I voted “other” – No: there’s evidence that they don’t work.

    The first thing I did when I purchased my new pharmacy was to remove all homeopathic products from the shelf. There’s no place for them.

    • darkmatter
      27/05/2016

      I applaud your not succumbing to the profit motive!

    • Peter Archer
      01/06/2016

      Well, the poll is not about homeopathics, and if you do not know the difference bweteen homeopathic and naturopathic, maybe you would be better off doing something other than running a pahramcy!

      • Jarrod McMaugh
        08/06/2016

        True – the reason I posted the way I did is because homeopathy is considered part of naturopathic.

        The problem with a poll like this is that “naturopathic” is way to broad. There are parts that are evidence based and effective, parts that are in great areas on either evidence or effectiveness, and areas that are definitely ineffective.

        I wanted to make a specific point about the area of naturopathic that is proven to be bullshit

  2. BKH
    26/05/2016

    ‘Naturopathic’ is such an ambiguous term that the poll is essentially broken. Are Homeopathics just very expensive sugar an water? Of course they are, and they have no place in pharmacy. What about herbal remedies? Some are legitimate and others pretty useless. How about Glucosamine, fish oil and vitamins? All of these tend to fall under the CAMs banner and most would agree there is enough evidence to support their use. If we’re going to call for the removal of products from pharmacy we need to be a lot more specific than ‘naturopathy’

    • Daniel Roitman
      26/05/2016

      I think the poll should perhaps be reworded to focus on more on the distinction between CAMs that are evidence-based and those that are not.

      Also, glucosamine has been consistently proven in RCT’s and meta-analyses to be no better than placebo. Fish oil has been largely discredited for many uses and most vitamins are either useless or at times harmless. The problem here is two-fold. Firstly, many pharmacists are unaware of the evidence-base (or lack thereof) of many CAMs. Secondly, some do not even care and are just happy to make a buck with their justification lying solely in “customer demand”.

      • Ian Carr
        26/05/2016

        Totally agree, Daniel. When I started practice in 1980, evidence was difficult to access and expensive. We now have — instantly — the resources of the internet. And we must also embrace the concepts of Evidence Based Medicine: to wit, not just ANY evidence, but a measured assessment of the best and latest evidence. Most definitely though: NOT what’s on a CAM label, NOR what the supplement company and its reps tell you.
        I challenge the 30% or so of pharmacists who feel the CAMs they sell are “legitimate” to run a sample of them by Cochrane reviews or one of my favourites http://www.naturaldatabase.com ( subscription required ) .
        CAMs aside, I do not wish to see the pharmacy profession used to legitimize Naturopathy. Many of its concepts are totally indefensible: Iridology, live blood analysis, bio-energy readings, homeopathy, detoxification etc. ALL of these examples of pseudoscientific nonsense are being advertised as available in pharmacies NOW — contrary to the explicit expectations of the Pharmacy Board, in my opinion.
        And what a tragedy for our brilliantly trained young pharmacists to enter a profession sullied by its association with quackery.

        • Daniel Roitman
          27/05/2016

          Thanks Ian. I hadn’t heard of naturaldatabase.com however will start using it myself. up until now I have been using Cochranes, however it doesn’t always have reports on every new fangled (supposedly been used by the Aztecs for thousands of years) herb that suddenly becomes in vogue thanks to A Current Affair!

          And I agree wholeheartedly re: the evidence base. We as pharmacists should not be beholden to anything besides what has been rationally investigated; not profit margins nor manipulative advertising. However, maybe that should be taken out of ours – and the CAM industries – reach by having the TGA also enforce CAMs for efficacy as they do for prescription medications.

        • Ron Batagol
          31/05/2016

          I Couldn’t agree more, Ian!

          Dr. Ken Harvey has written extensively about the lack of assessment and review of the purported efficacy of complementary medicines, some of which I have summarised below.

          I have to also say that, having naturopathists inside pharmacies to give “advice” on a variety of marketed “jungle juice” products does no favours at all in the long term aim to do what is already happening in the U.S, Canada and the U.K- to have pharmacists respected for their knowledge and independence and working alongside doctors to advise on a whole range of primary care and chronic health issues and be recognised, paid and most of all, respected for that professional input. It certainly does no favours for patients seeking advice for health issues such as prostate concerns or an infant respiratory infection, for which the pharmacist may suggest a medical referral.

          Btw- to summarise the key points of Harvey’s articles, as follows:

          1. Don’t believe the hype – your complementary medicines are unlikely
          to deliver.

          December14, 2015 5.32pm AED

          “Therapeutic Goods Administration (TGA), does not assess the
          claims of the vast majority of complementary medicines (labelled AUST L) before
          they go to market. Rather, the company simply promises that it holds evidence
          to support any health claims it makes”.

          He refers to The Review of Medicines and Medical Devices Regulation – Stage
          Two Report on the regulatory frameworks for complementary medicines and
          advertising of therapeutic goods.

          (Link:https://www.health.gov.au/internet/main/publishing.nsf/Content/8ADFA9CC3204463DCA257D74000EF5A0/%24File/Review%20of%20Medicines%20and%20Medical%20Devices_Stage%20Two%20Report_Accessible.pdf)

          He notes that, First, it recommends
          eliminating the free text option in the listing process that allows companies
          to creatively add their own product indications such as CoQ10, “supports a healthy cardiovascular system”, and probiotics, “help improve general well-being”.

          Instead, the TGA should establish a limited list of evidence-based “permitted indications” which companies can use. An example might be, “glucosamine sulphate may relieve
          joint pain”.

          Second, the review panel wants companies to publish the evidence they hold to support the indications made. And where the company has made its own assessment of the evidence for their product, the panel wants a prominent disclaimer to be added to all promotional materials that states: “efficacy claims for the product have not been independently assessed”.

          Third, the panel recommends increasing the number of post-marketing reviews and making them more transparent; and that the complaint process be revamped and current investigative and enforcement powers be broadened.

          2. In a further article in MJA Insight 27/4/15-
          Ken Harvey: The right touch (Link: https://www.mja.com.au/insight/2015/15/ken-harvey-right-touch) he notes that, “without independent assessment
          of the effectiveness of these products (and their side effects and
          interactions), how can consumers and health professionals make appropriate
          assessments of risk and benefit? Approved and consistent consumer medicine
          information (CMI) for complementary medicines is needed.”

          He suggests that “complementary medicine sponsors should provide a summary of the evidence they use to self-certify the indications and claims for their product to the Australian Register of Therapeutic Goods. This public summary document should also be available on the sponsor’s website with the CMI for the product. This would help the TGA to conduct post-marketing reviews, allow third parties such as consumer organisations and health activists to more readily check the information provided, and educate consumers about the product’s risks
          and benefits”.

          He notes that consumer organisations have suggested in many submissions that Australian product labels and promotions should be required to show a disclaimer similar to that used in the US. For example: “The claims made for this product have not been evaluated by Australian health authorities”.

          He suggests that a similar large sign should also be compulsory in pharmacies and health food stores- sounds like good health advice to me!!

    • Roger Matthews
      26/05/2016

      The key phrase here is “there is enough evidence to support their use”, if so there is no reason why they should not be sold. Selling products where there is no evidence is just fraud.

  3. Tim Bangsund
    26/05/2016

    Poor choice of wording..
    Answer: Yes, only if there is evidence of efficacy.
    Homeopathic medicines should not be stocked. Natural medicines with supporting evidence should be stocked and sold only if the pharmacists selling them are comfortable with their knowledge in order to provide proper counselling and patient care.

  4. Simon O'Halloran
    26/05/2016

    Surely this debate doesn’t suggest that if an item is scheduled or written on a prescription it must be evidence based, and if it belongs in the natural medicines category it is useless? Have we stopped supplying paracetamol (prescription or OTC) for acute lower back pain and began questioning its usefulness for osteoarthritis….I consider a published meta-analysis to be pretty robust evidence. But then again to quote Homer Simpson: “People can use statistics to prove anything….40% of all people know that”.

    • Daniel Roitman
      27/05/2016

      The evidence may shift as to whether something is as effective as we once thought it was…and that should be welcomed. CAMs on the other hand have either not been proven to work, or actively proven not to work. Reminds me of the old Tim Minchin joke: do you know what they call alternative medicine that’s been proven to work? Medicine.”

  5. Ian Carr
    30/05/2016

    Here’s one to be proud of. The Amcal website puts the advice of the Naturopath BEFORE the advice of the Pharmacist
    http://www.amcal.com.au//StaticContent?storeId=10154&url=healthhub_amcal%2Farticle%2F2275_PaininChildren.html&urlLangId=-1&urlRequestType=Base&langId=&catalogId=10051

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