Why Dr. Oz will not save pharmacy practice

Retail pharmacy is a competitive business, and these are tough economic times. And as I’ve pointed out before, retail pharmacies are increasingly selling ethically questionable products like homeopathy, positioning them as alternatives to real medicine. So I guess I should not have been surprised when a blog reader, (who is also a very prominent Canadian pharmacy leader) passed on the following to me from Pharmacy Development Services – a program to profile and promote products recommended by Dr. Oz: Continue reading

Season’s Greetings to pharmacies that sell homeopathy

From the  Nightingale Collaboration, a UK-based group that is challenging misleading claims in healthcare advertising:

We know from what our supporters tell us that there are more than a few pharmacists up and down the country who still either aren’t sure what homeopathy is and even recommend it to some of their customers in the mistaken belief that it is a proven, efficacious alternative medicine.  We thought we’d seize the opportunity of this time of year to try to raise awareness among high street pharmacists and their staff about homeopathy. We have sent greetings cards to the pharmacists and staff of nearly 2,000 Boots pharmacy stores up and down the country.

You can download and send your own homeopathic greeting to pharmacists here.

The campaign highlights an important difference in homeopathy regulation between countries. In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) recently ordered pharmacies to stop providing point-of-sale information on homeopathy products. That is, the regulator is prohibiting medical claims for products with no active ingredients.  The opposite occurs in Canada, where Health Canada approves homeopathic products, many with specific “recommended uses”, and also deems these products to be “safe and effective”.

Homeopathy in pharmacies is an embarrassment to the profession of pharmacy, and an abuse of the trust our patients place in us. Kudos to the Nightingale Collaboration for politely asking the profession to do the right thing for patient care.

Hypothyroidism: The facts, the controversies, and the pseudoscience

As glands go, we don’t give the butterfly-shaped thyroid that straddles our trachea too much thought — until it stops working properly. The thyroid is a bit like your home’s thermostat: turn it high, and you’re hyperthyroid: heat intolerant, a high heart rate, and maybe some diarrhea. Turn it down, and you’re hypothyroid: cold, tired, constipated, and possibly even depressed. Both conditions are associated with a long list of more serious health consequences. Between the two however, hypothyroidism is far more prevalent. The mainstay drug that treats it, levothyroxine (Synthroid), is one of the most prescribed in the world.

One of my more memorable pharmacy experiences involved levothyroxine. The store had recently changed its prescription labelling standards: It switched from listing the brand name, to only including the generic name (with the manufacturer in parentheses). Few patients noticed. But one elderly patient, taking Synthroid, was furious, and accused me of making a dispensing error. I assured her that levothyroxine was the active ingredient in Synthroid, and she was getting the exact same product as her last visit — but she would have none of it. Her symptoms had worsened, she said, because the medication wasn’t the same. “I want Synthroid — this levothyroxine stuff does not work,” she screamed at me across the counter. No amount of reassurance would satisfy her — I think we eventually resorted to custom, typewritten labels.

I mention this anecdote not to dismiss the symptoms of hypothyroidism as sensitive to placebo effects — hypothyroidism is a real condition with objective monitoring criteria. But this episode was one of my earliest lessons in understanding how perceptions can shape expectations of effectiveness — something that I’ll come back to, when we look at the controversies of this common condition. Any the treatment of hypothyroidism is not without its controversies – most of which occur outside the realm of medicine, and can more accurately be labelled pseudoscience. Continue reading

Point of Inquiry: Dispensing Skepticism

For those interested, I recently spoke with Karen Stollznow for the Point of Inquiry podcast.  What is Point of Inquiry?

Point of Inquiry is the premier podcast of the Center for Inquiry, drawing on CFI’s relationship with the leading minds of the day including Nobel Prize-winning scientists, public intellectuals, social critics and thinkers, and renowned entertainers. Each episode combines incisive interviews, features and commentary focusing on CFI’s issues: religion, human values and the borderlands of science.

This discussion focused on the role of the pharmacist and the need for science-based pharmacy practice. We touched on a lot of issues including the changing role of the pharmacist, the ethical responsibilities of pharmacists when it comes to products like homeopathy, what compounding pharmacies do, what generic drugs are, what an expiry date means, what pharmacists think about vitamins and other supplements, and more. You can listen to the podcast here.

Vitamin B12 – The Energy Panacea?

It even looks like red blood cells!

Having spent many hours working in close proximity to a wall of vitamins, I’ve answered a lot of vitamin questions, and given a lot of recommendations. Before I can make a recommendation, I need to ask some questions of my own. My first is almost always, “Why do you want to take a vitamin?” The most common response I’m given is “insurance” – which usually means supplementation in the absence of any symptom or medical need. Running a close second is “I need more energy.” With some digging, the situation usually boils down to a perceived lack of energy compared to some prior period: last week, last year, or a decade ago. While I may identify possible medical issues as a result of these interviews (these are referred to a physician), I’m often faced with a patient with mild and non-specific descriptions of fatigue. And more often than not, they’ve already decided that they’re going to buy a multivitamin supplement. When it comes to boosting the energy levels, they’re often interested in a specific one: Vitamin B12 (cobalamin). So why does vitamin B12, among all the vitamins, have a halo of benefit for fatigue and energy levels? The answer is part science and a whole lot of marketing. Continue reading