sarahkeenihan

Day 71. Pharmacies

In October 2012 on October 22, 2012 at 1:12 pm

My local pharmacies are stocked with all manner of products. Prescription-only and regulated medicines increasingly comprise only a small fraction of the total shelf space. This is ok on the whole; I understand they need to make a dollar. Nappies, tissues, health foods, make-up I can handle. In fact, I’ve purchased many of these extraneous products from a pharmacy myself in times of need (dammit, I need a geranium-pink nail polish and I want it now!).

But when a pharmacy staffer tries to forces items of ‘complementary medicine’ down my throat, I get a little testy.

This morning the lady at my local discount chemist was seriously offended when I didn’t want to chat with her at length, and indeed purchase, some ‘oral eczema prevention product’ for my son.

“Is it natropathy?”

I asked.

“Welll…nooo.”

She answered a little hesitantly. Not convincing.

“So, what is the active ingredient?”

I demanded.

“Oh, it’s just a range of ingredients which will support your son’s skin”.

Enough said. I ignored her completely.

Regardless of my attitude, next she started hocking a ‘natural’ cream. I said I’d already tried the specific one she mentioned and that it hadn’t work for us.

“Well, you’d be the only person I’ve ever met who says it doesn’t work”.

she countered.

Judgemental, subjective, anecdotal rubbish.

A few grumpy hours later, I started wondering: are there actually any regulations guiding pharmacies about what they can sell, and how their staff sell it? Is it indeed ethical to sell products which have never been tested by clinical trial almost side by side with proven medicines?

I’ve discovered there is a Pharmaceutical Society of Australia Code of Ethics, but this appears to only address clinical practise, not issues around retail. Also in existence is a Guild Pharmacy Academy, which ‘is the leading provider of vocational and education training for pharmacy and dispensary assistants in Australia’, but again I could find no guidelines offering advice on what can be sold in a ‘chemist shop’, and what sort of information should accompany each sale.

Most interestingly, I did find an article by public health expert Ken Harvey describing a 2011 deal between the Pharmacy Guild of Australia and complementary medicine company Blackmores which featured the following quote:

“From October, pharmacists’ computer systems will prompt them to discuss a Blackmores Companion range product with patients picking up a prescription for one of four popular medications.”

Fortunately, the deal has now been revoked (see article in The Australian), but it does highlight the point I’m trying to make: there needs to be clarity about what pharmacies sell, which products are supported by an evidence base, and who can give advice when sales are made.

I don’t want to be buying medicines and related items from a person whose only training has come from the company sales rep.

Postscript: Since writing the article above, I’ve received advice from a pharmacist that there are no regulations guiding what can be sold in a pharmacy, as long as The Poisons Standard is not breached, and that all products claiming to have a health benefit are registered for an Aust R or an Aust L number. My issues still stands. 

[photo thanks to wrestlingentropy on flickr]

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  1. Sarah, I too have serious concerns around under-educated sales people and healthcare providers. I have qualifications in oriental medicine, remedial massage, lymphatic therapy and worked most recently as a lymphoedema therapist and massage educator, so have seen my fair share of this kind of situation.
    It can be downright dangerous to have uninformed persons suggesting supplements. For example, with lymphoedema it is a high concentration of protein molecules within the fluid in the interstitial spaces that causes most complications and deterioration over time if untreated. If this is not understood then it is generally ‘assumed’ that it is the over abundance of fluid that is the primary issue and alternative remedies such as parsley, juniper oil (both have diuretic properties) as well as pharmaceutical diuretics may be suggested as treatments. This can prove disastrous for the patient as diuretics will strip the fluid, further concentrating the already high levels of protein (the protein attracts more fluid) and compounds the issue, leading to an increase in fluid accumulation. This is a fairly simplistic description of what happens but gives a general idea.
    I would assume also that a sales people do not have an understanding of the full medical history of the patient/customer, and I am sure most healthcare professionals would agree with me that giving advice or suggesting supplements without that understanding is a massive failure in duty of care.
    Sadly there is poor control in this country around training standards, it is getting better, slowly. Associations such as AMT (association of massage therapists) and the ALA (Australasian Lymphology Association) are working hard to improve this by enforcing education standards and ethics amongst their members. One of the main points made the AMT (I have been a member for almost 10 years) is not to treat or advise outside your scope of education. This does not extend to untrained to non-members of course, and only helps to ensure that registered practitioners are of a high standard. Whether the public are aware of this or not is another matter! It is, unfortunately, up to us to ensure we are seeking advice from a registered, properly trained, provider.
    Personally I would not be accepting advice on supplements without 1. researching any clinical trials done on that substance 2. the recommendation of a trained and registered naturopath/herbalist 3. checking with my GP.
    Am I wrong in assuming that had your child taken this supplement and had some serious reaction that the staff member who recommended it would not then be liable?
    You are right to ignore unfounded advice, and it is disappointing that a pharmacy may be encouraging that kind of sales behaviour. Medications all come with product information now, maybe the supplements/creams should also?

  2. Thanks Susan for your comment. I completely agree with you.

    It’s also worrying from a big-picture point of view. We know that our over-burdoned health system must try and distribute some of the management of relatively minor health issues away from doctors/specialists to other layers of the system. I think that’s ok when it’s nurses, pharmacists and others with training (as you are) can step in. But when the advice comes from non-trained sales staff, I get very nervous.

  3. To understand the real difference between Aust L and Aust R, see these articles by Australian Skeptics http://scepticsbook.com/2012/06/03/more-hollow-legislation-from-the-tga/ and http://www.skeptics.com.au/latest/news/tga-effectiveness-questioned/
    (I have no affiliation)

  4. Thanks Michael for those links.

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