Issue 37 / 4 October 2011

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

14 thoughts on “Jane McCredie: Pharmacy faux pas

  1. Dr Ken Harvey says:

    A pharmacist said, “Prescribing software is full of advertising from pharmaceutical companies”. That used to be so but is true no longer. Health professionals and consumers raised concern about this practice, see:

    Subsequently, Medicines Australian Code of Conduct was changed to include clause 2.5, “Prescribing software.
    Advertisements for prescription products must not be placed in any section of prescribing software packages.”

  2. Pharmacist says:

    Medical practitioners must be careful not to throw stones in glass houses. Prescribing software is full of advertising from pharmaceutical companies. Doctors also willingly accept and supply pharmaceutical samples. There are also many doctors recommending supplements to their patients and some even sell these products directly. I personally do not support the “Fries and Coke” Blackmores deal (which has not been withdrawn) and I belive that it is important not to tarnish the majority of the profession who are not pharmacy owners and thus are not implicated in these practices.

  3. loretta says:

    Good news that the Guild has backed down from this outrageous arrangement.

    The retraction on the Pharmacy Guild website states that “Blackmores products are well-established, and marketed by one of the best known and respected names in evidence-based complementary medicine (CM).”

    ‘Evidence-based complementary medicine’????

    The TG Act allows ‘evidence’ that is traditional or scientific – in that order – and even when CMs continually fail when tested (eg Glucosamine Hydrochloride, Red Clover and Saw Palmetto), sponsors are still able to promote them as having evidence, without explaining that it is not based on clinical trials.

    Blackmores claimed the companion supplements were proven to address nutrient deficiencies, however, the NPS conducted a literature search on them and concluded that the evidence was either inconclusive, had conflicting results, was uncertain or should be only recommended on a case by case basis.

    One can only wonder how many other Blackmores ‘companion’ products (with so-called traditional evidence) were in the pipeline ready to roll out for other prescription drugs and how many hundreds of them remain stacked on pharmacy shelves.

  4. Sue Ieraci says:

    Why is it that people who use the disparaging term “Big Pharma” to criticise the ethics and motives of the therapeutic drugs industry don’t include companies like these – who are not only huge multinationals but also sell “remedies” of dubious benefit?

  5. Confusion reigns says:

    As someone who works with the elderly in the community, this can only add to the confusion surrounding their medication, its bad enough they stay on medications for years without review, but to add more to the already large quantity of drugs some already take will lead to more adverse reactions and hospitalisations. The elderly see the pharmacist as an expert and don’t question the advice, they hurt in the hip pocket but the health consequenses could be far worse.

  6. Anonymous says:

    As an accredited, consultant pharmacist I will only recommend medication that has appropriate levels of evidence. May I say that I know some GPs who recommend supplements for their patients.

  7. Colin Crighton says:

    re Practising herbalist-nutritionist’s statement that the side effects of natural supplements are virtually non-existent.
    Bunkum.Try telling that to my 2 patients who have experienced strokes because one added ginger to her tea,the other given ginko,both supplements recommended to “improve their memory.”
    They were taking Warfarin. The hebalist gave
    appalling advice based on ignorance.

  8. ClinicalPharmacist says:

    Totally agree with the gist of the commentary. Please don’t paint all pharmacists with the same brush selling meal replacements and unnecessary vitamins.The Guild is just as the name implies- a body of Pharmacy (shop) owners and not a professional body, such as the Pharmaceutical Society of the Society of Hospital Pharmacists. Our new graduates are being trained as knowledgible health carers- perhaps it will be a generational thing until we see change in all community pharmacies. See the newly formed Pharmacists Coalition for Health Reform>

  9. Adam says:

    Pharmacists selling homeopathic ‘medicines’ makes me sick. By supporting the illusion that these substances actually derive some therapeutic benefit, they are positioning themselves as lying, dishonest members of their profession, that are profiting directly from the ignorance of their customers. Closer regulation of the behaviour of private pharmacists is certainly required.

  10. Practising herbalist-nutritionist, researcher says:

    How appropriate your POLL Q is “Are medical researchers partly responsible for the quality of medical news reporting? Yes (90%)”. Medical researchers and the media are contributing to the worldwide consumer confusion over natural supplements. Seems like pharmacists suffer equally. How many doctors or pharmacists are trained in the use of natural supplements? Pharmacists have fallen out of their tree but at least side effects of natural supplements are virtually non-existent. Some pharmacists have discredited their profession. PITY

  11. RayT says:

    It all sounds rather unethical to me, and makes me feel rather negative about Pharmacists giving advice. I’m having lunch with an old school friend, who someone else told me is now on the new Pharmacy Board, soon so I’ll ask him for his view…

  12. Donald Runcie says:

    Will pharmacists taking part in this need more insurance cover? If not, why not.

  13. yvonne says:

    No David, we shouldn’t be suprised. It is already going on. A while ago, a reasonable wealthy lady aged about 60, with IDDM, taking about 10 medications, came to see me about going to Fiji. She had decided to get all her medications put into Webster packs for her trip, which she thought would be easier for her to manage. I agreed.
    “But”, she then asked me, ” what do I do about all the others?”
    “What others? I asked.
    “All the other things he (our friendly local pharmacist) says I have to take” she replied.
    “Why don’t you bring them in to show me?” I asked.
    The next week, she came back, with a plastic shopping bag, full of alternative medications, all of which had been recommended to her by the pharmacist.
    There was Vitamin B12 tablets to take with her Pariet, Co- Enzyme Q10 to take with her Lipitor, B-group multivitamins, etc etc.
    I counted 24 bottles, of which probably only 2 were necessary (Vitamin D and a calcium supplement). I told her to toss them all in the bin, and not to buy others unless she checked with me first to see if she really needed them.
    Other elderly people have told me the same story.
    Some of them have been pensioners on health care cards, who could not aford to waste their money on such unscrupulous practises! I suppose it helps the pahrmacist pay off his mortgage!
    This needs to be stopped!!!

  14. David Gillespie says:

    Should we really be surprised? This is the same profession that actively sells meal replacement shakes which are up to a quarter fructose; a substance that has been repeatedly shown to materially increase heart disease and type II diabetes risk in humans.

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