On the third of May, Health Minister Greg Hunt spoke at a conference organised by the Pharmacy Guild of Australia. This is the pharmacy owners association (all pharmacists) which in 2011, notoriously, entered into a deal with the vitamin and supplement provider, Blackmores, to have 5000 pharmacies try and sell a Blackmores’ product to clients picking up prescription medicines. Once revealed the subsequent opprobrium, of course, resulted in the deal being cancelled.
Australian government regulations mandate that retail pharmacies can only be owned by registered pharmacists and their “Guild” is politically powerful. On the occasion in question, Minister Hunt was able to confirm for the Guild that their petition to be able to continue to sell homoeopathic products had been successful. This despite a government-commissioned review by our peak Medical Science organisation, the National Health and Medical Research Council,(NH&MRC) reporting that such products had no medicinal value and the government’s commissioned report on pharmacy regulation and remuneration (The “King report”) urging that pharmacies no longer sell homeopathic “medicines”.
That report states: “All pharmacies dispensing PBS funded medicine should stop selling homoeopathy”, and goes on to emphasise that the products pose an “unacceptable” risk to patients who defer getting effective treatment.Worldwide, leading clinical scientists have issued similar warnings.
Knowing this all too well from his oversight of the Therapeutic Goods Authority (TGA) where the matter has been much debated, the Minister may have been a little embarrassed (well on immediate second thoughts, probably not) as he announced the news, for he is reported to have made the following statement to the assembled pharmacists-
“Professional standards have been designed for use by individual pharmacists to assess their own professional practice. They are intended to serve as guidance for desired standards of practice. However, it is the sole responsibility of the individual pharmacist to determine, in all circumstances, whether a higher standard is required.”
A little confusing in this context? I must admit I’m not sure what he meant. Perhaps he is saying (reading between the lines) OK, we have given into industry pressure as we usually do, but some of you might hold yourself to a higher ethical standard and clear the shelves of these “rip-off” useless products. He could hardly give the thumbs up to homoeopathy and simultaneously remind the pharmacists that as registered health professionals, they are expected to follow the professional and ethical standards demanded by AHPRA and its Pharmacy Board. Inherent in these professional expectations is the imperative that it is not “the sole responsibility of the individual pharmacist to determine, in all circumstances, whether a higher standard is required.”
The Pharmacy Board of Australia’s Code of Conduct for pharmacists states: Good practice involves practising in accordance with the current and accepted evidence base of the health profession, including clinical outcomes.”
“Pharmacists are regarded as role models and are granted certain professional privileges. In return, individual members of the community and the whole of society expect professional behaviour which warrants trust and respect”.
“Consumers place a high level of trust in pharmacists and expect sound and objective advice. Pharmacists should ensure they and their staff are not susceptible to inappropriate marketing influence that may adversely impact on their primary obligation to provide the most appropriate product, care or advice to meet consumer needs.”
How is all that compatible with business models that call for Australians to be sold products they are assured they need but don’t? In this week’s Medical Journal of Australia there is a warning to pregnant women. Too many are taking too many vitamins and supplements and, in so doing could actually harm their baby!. Virtually all products that contain the folic acid that all women need during pregnancy come with a myriad of additional ingredients which they don’t need and could be harmful. Why are they on pharmacy shelves?
Last years sneaky but invaluable “Shadow shop” investigation by CHOICE magazine involved the publications “agents” visiting 240 pharmacies asking for”something” to help with the stress they were feeling. In a distressing number of cases, pharmacists recommended herbal preparations (such as Bach flower), vitamins, various supplements, magnesium and, yes, even homoeopathic preparations, none of which can help relieve stress. As I find is true of a number of colleagues I often challenge pharmacists about the plethora and prominence of alternative and complementary products on sale when I pick up a prescription medicine with the most common responses being, “I just work here, the owner insist on this approach” or “this is what the public wants”!
The King review called for all complementary medicines to be cordoned away from other products in pharmacies, with “appropriate signage” warning of their limitations. Not only was this recommendation ignored (along with 40 of 43 others) the government caved into the “Alternative” medicine industry by softening the requirement that there must be a credible evidence base for therapeutic claims made for a product with that evidence to be supplied by marketers if requested. This honour system needed strengthening not weakening as random audits of these requirements by the TGA found 80-90% non-compliance! After furious industry lobbying, however, the government agreed that for some 1800 products, not associated with evidence of effectiveness, consumers would be adequately informed and protected if they carried a label stating “as used Traditionally”.
In so doing, the government and Its Therapeutic Goods Administration (TGA) have ignored well-reasoned requests by many consumer and health professional organisations to place an advisory statement on homoeopathic and other belief-based complementary medicines along the lines of:
“This product is based on traditional beliefs not supported by modern science”.
Similar recommendations were made by our NH&MRC, the 2016 US Federal Trade Commission’s “Enforcement Policy Statement on marketing claims for over the counter homoeopathic drugs” and the 2017 European Academies Scientific Advisory Council’s report on the subject. I think we should go further and say” credible scientific evidence demonstrates that this product does not provide the claimed benefit” when that is the case, e.g. claims that omega-3-fatty acids can protect you from heart disease.
From July this year, the government will actually remove one regulation that was protecting consumers from misleading claims. No longer will advertisements for alternative and complementary products need to be pre-screened prior to publication for accuracy. This despite random audits by the TGA repeatedly finding that 80-90% of claims made have no satisfactory evidence base. So much for consumer protection.
A few years ago I addressed a Pharmacy Guild meeting as did Marcus Blackmore who told the group “You should capitalise on consumer sentiment” and described the ideal layout for a store to sell his products. Guess which one of us made the most lasting impression?
The evidence, unfortunately, supports the contention that very many pharmacists in Australia have allowed commercial success to diminish their professionalism. Come on you educated men and women of pharmacy; you can do much better than this.
John Dwyer, Emeritus Professor of Medicine at UNSW, is the President of “Friends of Science in Medicine”, an organisation championing the need for credible scientific evidence of effectiveness to underpin health care in Australia.