Jane McCredie: Pharmacy faux pas

PHARMACISTS have long felt like the poor relations in the broader family of health professionals when it comes to status and respect, if not monetary reward.

In recent years, their representative bodies have lobbied for expanded prescribing rights, for recognition of their role as front-line “clinicians” and against allowing pharmacies in supermarkets for fear this would undermine the quality of health care provided.

It’s going to be a lot harder to make those arguments convincingly in the wake of the spectacularly ill advised deal between the Pharmacy Guild and Blackmores that created such a media furore last week.

The deal — due to launch this month unless wiser heads prevail — would see pharmacy computer software prompt pharmacists to recommend specific Blackmores’ supplements to customers as “companions” to four common classes of prescription medicine.

Customers could find themselves being advised to address alleged side effects of their medication by taking a Blackmores’ probiotic with their antibiotic, a zinc supplement with their antihypertensive, coenzyme Q10 and vitamin D3 with their statin, or magnesium with their proton pump inhibitor.

Pharmacy Guild president Kos Sclavos could hardly contain his excitement, writing in Pharmacy News that he was “personally thrilled” about the deal, which could see the products being companion-sold with more than 58 million PBS prescriptions per year.

In a quote that created headlines around the country, Blackmores CEO Christine Holgate told the publication the products represented the “Coke and fries” that pharmacists could offer as an accompaniment to the staple meal provided by their prescription medication.

There are so many problems with this deal it’s hard to know where to start.

The National Prescribing Service, the AMA and individual doctors raised a number of them last week, questioning the evidence for the products and warning about the risks of polypharmacy as well as the obvious potential conflict of interest faced by pharmacists.

The NPS last week found there was not enough evidence to support routine supplementation with these products when taking prescription medicines.

Professor Paul Glasziou, director of Bond University’s centre for research in evidence-based practice, called on Blackmores to make their data public, telling ABC radio that if routine supplementation of this kind did turn out to be supported by evidence it should be included in clinical guidelines rather than being left to the discretion of individual pharmacists.

It wasn’t just doctors. Some pharmacists have publicly disassociated themselves from the deal and the profession’s peak body, the Pharmaceutical Society of Australia (PSA), said it was “appalled” at any suggestion pharmacies might become “McDonald’s style” businesses. It later called on Ms Holgate to apologise for her “damaging and denigrating comments”.

In some ways, the whole unedifying spectacle was not a bad thing. It did at least provoke public debate about the ethical dimensions of contemporary pharmaceutical practice.

Pharmacists play an important role in primary care, advising customers on minor ailments and — you would hope — suggesting they seek medical treatment when necessary.

But unlike most doctors, they also sell the remedies they advocate, creating a potential conflict of interest that is always going to be tricky to manage, especially when the evidence base for those products is less than rock-solid.

The PSA is due to release a new code of ethics for its members — along with a vision for the profession’s future — at its annual conference later this week. It would be nice to think that code might require pharmacists to disclose the level of evidence for any non-prescription medication they sell — hardly an unreasonable demand of people who want to be recognised as clinicians.

I’m imagining the conversations now if this code is implemented. Pharmacists selling homoeopathic remedies will be required to tell each and every customer: “There’s not a skerrick of evidence this works, but if you want to throw your money away…”

POSTSCRIPT — The Pharmacy Guild and Blackmores have since decided to abandon their proposed deal. 

Jane McCredie is a Sydney-based science and medicine writer.

Posted 4 October 2011