Health Professionals or Retailers? Pharmacists, your customers are wondering
Recently, Australian Skeptics published an open letter to the pharmacists of Australia, asking consumers to take it to their “university trained seller of snake oil”. Click on the link to see the full-sized PDF.
Their letter makes several important points:
“As pharmacists, you play an important role in the health of the Australian public by functioning as a conduit between doctors and prescription or pharmacy drugs. You also have a respected role as a first resource for medical advice for many people in our community. We are all familiar with the slogan ‘Ask your Pharmacist’”.
“We now ask our Australian pharmacists: What standards do you set for yourselves? … You sell a growing number of products for which there is little or no scientific evidence of efficacy.”
“Your customers rely on you and anyone in a professional capacity within your store to provide sound medical advice and products. We fear that in some cases they are receiving what amounts to little more than magical sugar pills and spurious health advice.”
“Pharmacies need to make a profit, but this should not be done through quack products and bad advice. To regain the status a pharmacy should have – a place to get sound advice and effective medicine, supported by scientific and clinical evidence – we implore our pharmacists to stick to worthy products sold by knowledgeable staff.”
Australian Skeptics succinctly echo my position, that the pharmacy profession is increasingly being discredited as community pharmacies embrace the sale of pseudoscience, quackery, and other non-evidence-based products. And pharmacies seem to be increasingly aligning themselves with dubious practitioners of quackery, like homeopaths, naturopaths, and related promoters of woo.
The letter points out correctly that Health Canada has banned ear candles. However, I can assure you that they continue to be sold in Canada - I’ve even seen them for sale in a pharmacy. I’m not going to review the ear candle in this blog, because an excellent post has already been done by Dr. Rachael Dunlop. It’s actually quite astonishing that efforts have to be made to debunk this type of quackery. Why would anyone seriously believe that sticking a burning candle in your ear could be anything but harmful?
The open letter has gained some attention. Phil Plait, the “Bad Astronomer,” blogged about the open letter, and about the homeopathy lining the walls that he observed in Australian pharmacies. Skimming through the 99 (and counting) responses to his post, you can sense the frustration and disappointment people have with the apathy of the pharmacy profession to act like, well, science-based health professionals.
“The community holds pharmacists in especially high regard and places its trust in pharmacists’ professional judgment, and relies on pharmacists’ professional advice. Because a recommendation by any pharmacist for any medicine gives that medicine special credibility, it is essential that the recommendation is soundly and scientifically based. The trust in pharmacists and pharmacies is such that simply because a medicine is available in a pharmacy, consumers will infer that the medicine carries the pharmacist’s endorsement and recommendation. Therefore, pharmacists must be personally and properly persuaded of the safety and effectiveness of the medicines available in their pharmacies.”
“Alternative medical practice or therapies, such as iridology, aromatherapy, reflexology, homeopathy and similar “natural” approaches to health care have apparently found a place in the community, but the Board can see little or no place for them in the practice of pharmacy. Regardless of any pharmacist’s other heath care interests, no pharmacist may ever disregard their standing in the community as a provider of primary health care.”
“Because a recommendation by any pharmacist for a therapy or medicine gives that therapy or medicine special credibility, it is essential that the recommendation is soundly and scientifically based.”
The pharmacy profession has been granted a privileged and exclusive right in the provision of health care: certain health products (both prescription and non-prescription) are only available through pharmacies. Why? Because pharmacist consultation has been deemed necessary to maximize the safe use of these products. It’s a right that is vigorously defended by the pharmacy profession, for both patient care and business reasons. So when pharmacies take advantage of this privilege, and start selling ridiculous treatments like oil of oregano, homeopathy and detoxification kits, they’re abusing this privilege – and behaving like retailers – not providers of health care.
The calls are growing on pharmacists to act like health professionals. In the United Kingdom, Edzard Ernst, co-author of the book Trick or Treatment, has called on pharmacists to disclose to patients that homeopathy is a placebo therapy:
“The Royal Pharmaceutical Society’s code of ethics state that if pharmacists sell homeopathic or herbal medicines, or other complementary therapies, they must assist patients in making informed decisions by providing them with necessary and relevant information. Pharmacists should, therefore, inform their customers that a homeopathy remedy is devoid of any biologically active material and it has not been shown to have relevant health effects beyond placebo.”
In New Zealand, physicians are going even further, calling on pharmacists to stop selling homeopathy:
“Pharmacists are scientists, and I urge them not to sell products that are proven to be ineffective” says Dr. Shaun Holt.
This is a tremendous time of change in health care, with pharmacists finally gaining an opportunity for an expanded scope of practice. But with physicians voicing concerns about pharmacist prescribing rights, the continued sale of unproven pseudoscience, like homeopathy, does not distinguish pharmacists as health professionals with much professional judgment.
Pharmacy owners (whether pharmacists or not), seem so enamored by the revenues from quackery products that they fail to see the inherent contradiction in selling “pharmacist professional services” alongside homeopathy. Pharmacists that continue to work for pharmacies that put profits before evidence-based care are, through their inaction, moving the profession firmly into the role of a retailer. Consumer demand can help, but real change will not come until pharmacists take responsibility for their own profession.
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Tags: ear candles, ear candling, homeopathy, pharmacy, pharmacy practice, pharmacy regulation