Given their visibility in the pharmacy, a recurring topic of this blog are the category of products deemed “natural health products”. My philosophy towards their uses has changed over the years, and what was an “evidence-based” approach is now firmly a “science-based” approach. A central principle to science-based medicine or pharmacy is that all health interventions and treatments should be evaluated based on a single, scientific standard. One of the biggest successes of the alternative medicine industry, worldwide, has been the embedding of different regulatory standards for the evaluation and approval of so-called “non-drug” products such as supplements, herbal products, and non-scientific treatment systems like homeopathy or traditional Chinese medicine (TCM). The implications cannot be overstated: this different and lower standard is now so firmly entrenched in most health systems that few seem to question its rationale, or consider the consequences. As a practicing pharmacist I spent the first decade of my career working within this regulatory framework without ever stepping back to question why we regulate some products differently. Comparing two countries illustrates my point: Continue reading
Today’s post is a guest contribution from a Canadian pharmacist who is writing under the pseudonym Sara Russell:
For several years after graduating from pharmacy school, when I’d answer the question “What do you do for a living?”, it would be met with responses like “Good for you!”, “You must be so smart!” or simply “Wow!”. After a decade-long absence from a role in direct patient-care, I returned to pharmacy. I noticed that my response to that same question was met with much less enthusiasm, with some people even having trouble hiding their disappointment. How did this happen? When did being a pharmacist have less caché than saying you worked in a health-food store? Continue reading
Thanks to Andy Lewis of the excellent Le Canard Noir who flagged this pharmacist opportunity: The Royal London Hospital for Integrated Medicine is hiring a pharmacist. Normally pharmacist positions don’t justify blog posts – but this is a unique pharmacy. Until recently, this was the Royal London Homeopathic Hospital. Yes, the United Kingdom’s National Health Service (NHS) funds homeopathy and homeopathic hospitals, yet it changed the name of the hospital in 2010, possibly because the idea of a publicly-funded homeopathic hospital was becoming untenable. Now it’s an “integrated” hospital; “integrative” being a preferred term for alternative medicine these days. Continue reading
Is the best medicine no medicine at all? Sometimes. My past posts have emphasized that the appropriateness of any drug depends on an evaluation of benefits and risks. There are no completely safe interventions, and no drug is free of any side effects. Our choice is ideally informed by high-quality data like randomized controlled trials, with lots of real-world experience so we understand a drug’s true toxicity. But when it comes down to a single patient, treatment decisions are personalized: we must consider individual patient characteristics to understand the expected benefits and potential harms. And in a world with perfect prescribing and drug use, harms wouldn’t be eliminated, but they would be minimized. Unfortunately, we’re not there yet. There is ample evidence to show that the way in which prescription drugs are currently used causes avoidable harms to patients. It’s an opportunity to dramatically improve care and health outcomes that continues to be largely missed by the pharmacy profession.
The art and science of medicine is a series of interventions to improve health. In making these treatment decisions, we strive to minimize iatrogenic harm — that is, harms caused by the intervention itself. High up on the list of of avoidable harms are adverse events related to drug treatments. Audits of adverse events are astonishing and shameful. Studies suggest 28% of events are avoidable in the community setting, and 42% are avoidable in long-term care settings. That’s a tremendous amount of possible harm resulting from treatments that were prescribed to help. And the group that is harmed the most? The elderly. Continue reading