To answer this, let’s consider three separate questions.
- What is a pharmacist?
- What is modern pharmacy practice?
- What do you mean, science-based pharmacy?
Let’s start with the term, pharmacist. Among the health professionals, only the pharmacist has medications at the core of his training. Training is university level, and after four to six years of training, graduates emerge with Bachelor or Doctorate degrees. The pharmacy curriculum is rigorous and includes anatomy, physiology, biochemistry, pharmacology, toxicology, and therapeutics. New pharmacists are well trained to prevent, identify, and resolve drug-related problems.
At its heart, modern pharmacy practice is now squarely at the intersection of modern medicine and Main Street. No other health professional is as readily available as a pharmacist. As more and more formerly fatal diseases are fast becoming chronic illnesses due to remarkably innovative new medications (e.g., HIV and cancer therapies), the pharmacist’s role is changing from being simply the dispenser of medicines to a health professional well positioned to help people access and use medications more effectively and rationally. An in some areas, pharmacists are earning limited prescribing privileges.
Pharmacists can work in a variety of settings – not all of them pharmacies: Hospitals, long-term care, insurance companies and government are areas you’ll find pharmacists working. But the vast majority of pharmacists (at least in North America) work in the the “community” or retail pharmacy setting – the local drug store. So for most pharmacists, practicing their profession means being both an entrepreneur as well as a health professional.
Retail pharmacies can vary widely, from a pharmacy counter with almost no “front shop”, to mega-boxes where the pharmacist is hidden at the back behind the cosmetics, milk, and sadly, often lots and lots of unproven, pseudoscientific, questionable products – quackery.
A number of factors have dramatically affected pharmacy practice in the last decade, which have contributed to the rise of quackery at the pharmacy.
- The end of independent pharmacies. Most pharmacies are now owned by corporations, not pharmacists. They may be public companies (e.g., Shoppers Drug Mart in Canada, Walgreens in the U.S.) or privately held (e.g., Katz Group – PharmaPlus, Rexall, etc.). The implication is that product mix is decided centrally and staff pharmacists have no influence over what’s sold. And quackery sells.
- The sqeeze of pharmacy revenue behind the counter. Prescriptions are an increasingly unprofitable proposition for pharmacies. Most insurers do not cover the entire cost of dispensing a prescription (becoming almost a loss leader to get you into the store) and pharmacies typically make up this gap through the sale of other products: the stuff in front of the counter.
- Competition between pharmacies. With independent pharmacies becoming an endangered species, pharmacist-owners changing their product mix away from typical drug store items (where they cannot compete on price) towards more specialized (and often, more questionable) products, including homeopathy, supplements and other types of snake oil.
- Demand: Pharmacists will tell you that even if they don’t believe the products work, consumers are demanding these products, and they need to respond. I question the validity of this response, and will come back to it in a future post.
So what do we mean by science-based pharmacy (SBP)? Our working definition is as follows:
- The provision of professional advice that is science-based. This means providing patients with science- and evidence-based information that is grounded in the best evidence. It is providing professional opinions that are ethically sound through an evaluation of evidence and our judgment as health professionals.
- The provision of products and services that are grounded in science. Science-based pharmacy products have evidence to support their use, and that evidence is consistent with what is know about medicine, drugs, and the human body. There is enough evidence to support the conclusion that the potential benefits outweigh the actual risks. Science-based pharmacies don’t sell questionable products that are implausible or have no evidence of benefit.
- Collaboration with credible health professionals. Science-based pharmacists triage and refer patients as appropriate to other legitimate, licensed health professionals who also practice their profession in a science- and evidence-based way.
Pharmacy is a registered health profession. In exchange for the provision of products and services to patients, pharmacists are granted exclusivity to provide these actions. Unfortunately, these privileges are increasingly being abused through the growing availability of highly questionable and potentially dangerous products and services in pharmacies.
If it looks like pharmacy-based quackery or pseudoscience, we intend to scrutinize it and report on it. We believe pharmacists are compromising the health and welfare of consumers through the sale and promotion of questionable products. Pharmacists need to take responsibility for restoring their own profession to one that relies on science, not mysticism and wishful thinking. We plan to use this blog to advocate for higher standards in pharmacy education and regulation, as well as the overall regulation of drugs and other products sold in pharmacies. There is a clear difference between what some pharmacists and pharmacies do, and what’s in the best interest of patients. This blog will draw that line.