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THE scrapped deal between the Pharmacy Guild and Blackmores highlights the need for improved regulation of Australia’s complementary medicines industry, according to a public health expert.
Under the dumped deal pharmacists would have been prompted by their computer software to recommend specific Blackmores supplements as “companions” to four common classes of prescription medicine. The plan drew widespread media attention after the companion products were described as the ‘Coke and fries’ that pharmacists could offer with prescription medicines.
The deal drew criticism from the AMA, the National Prescribing Service (NPS), the Pharmaceutical Society of Australia and individual doctors and pharmacists, before being abandoned last Wednesday.
Blackmores said it would also remove its Gold Cross endorsement from the four companion products.
Many of the concerns centred on the potential conflicts of interest and the lack of evidence for the companion supplements, as detailed in an evidence review conducted by the NPS.
Dr Ken Harvey, from the school of public health at La Trobe University, said the incident reinforced the need for greater transparency in the way complementary and alternative medicines were regulated.
He said there were a number of evidence-based complementary therapies, some of which were even registered, rather than just listed, on the Australian Register of Therapeutic Goods (ARTG).
“There are research-based complementary products and some that have even gone through the registration process, and that’s something that doctors should know about”, he said.
Unfortunately there was no function on the ARTG website to search for complementary products that were registered rather than listed. Among the registered products it was not possible to determine which had just been ‘grandfathered’ in and which had gone through the proper checks for quality, safety and efficacy, Dr Harvey said.
Dr Harvey called on the Therapeutic Goods Administration to include a specific list of properly evaluated, registered complementary medicines on its website to help consumers and doctors separate the “little bit of wheat from so much chaff”.
Although he was pleased the Pharmacy Guild–Blackmores deal had fallen through, Dr Harvey said he was disappointed with the Guild’s response, which failed to acknowledge the error of the scheme itself.
In a statement, the Pharmacy Guild said: “The mutual decision has been taken in view of the strong level of public concern about the proposal, based on some media reporting of the endorsement which was ill-informed and inflammatory”.
But Dr Harvey said, “it was the deal that was ill-informed. They still don’t seem to quite get it which is a pity”.
The Association of Professional Engineers, Scientists and Managers Australia (APESMA), a professional association which represents pharmacists, also welcomed the decision to scrap the deal, but criticised the Guild’s response.
“The Pharmacy owners Guild has been dragged kicking and screaming to the decision and still will not take responsibility”, said APESMA CEO Chris Walton.
– Sophie McNamara
Posted 10 October 2011
Michelle – I agree with you that there are certainly ethical pharmacists out there – but surely it is the profession’s responsibility to regulate those who work outside best practice. It appears that the Blackmores deal was a widespread practice (not just a few renegades), so it is important for ethical pharmacists and your academic and regulatory authorities to come out strongly against this practice. I don’t think anyone here believes that all pharmacists are unethical. However, a credible health care profession needs to be seen to be regulating the practice of the profession.
In reference to: “Posted by:Anonymous 10/10/2011 3:15 pm”…For the record… I am a pharmacist/pharmacy owner in a small town pharmacy. I do everything I can to ensure the customers/patients who visit my pharmacy are provided with evidence-based non-prescription medicines that are appropriate to their condition (hence our complementary section is not that big). To make this happen, I read widely and regularly, I ensure I have a good understanding of research trial data interpretation, and I take account of current guidelines such as TGs, AMH, NPS, Chochrane reviews etc. I also communicate with our local GPs when providing these products so that they are aware of the full complement (pardon the pun) of medicines their patient is taking and have an opportunity to give their opinion on the specific medicine in question (and, no, I don’t ring them incessantly). The end result being that the patient gets the best possible outcome AND there is no professional bickering because effective, positive and patient-centered communication is happening. So PLEASE don’t judge a whole profession from the actions of a few … I am well aware of MANY PROFESSIONAL pharmacists who have the same professional ethic as myself and are embarrassed by this deal and fully realise that it undermines our efforts to work as a true professional rather than a shop owner. So perhaps rather than using this issue to “bag-out” the pharmacy profession (which I agree, the issue begs itself to do just that), do your patients and the current health care system a favour and seek out a pharmacist in your local area that IS interested and dedicated to collaborative, professional, ethical and patient-centered health care because certainly there are many out there doing just this.
So when will there be good evidence which shows the benefits of ubiquinone especially when this substance is found to be low in humans who take a statin drug, I wonder.
“Why is it unethical to advise CoQ10 when a statin drug is prescribed?”
Because there is no good evidence that shows any benefit from this combination. The downside is that it unnecessarily adds to the “medication burden” experienced by many patients taking multiple drugs; this includes compliance difficulties, cost and potential drug interactions. See:
http://www.nps.org.au/topics/companion_products/Q10_and_vitamin_D3_with_…
Dr Ken Harvey sums up this issue correctly — it is the deal that Blackmores are offering the pharmacists, and not anything else that has been mentioned. For example, why is it unethical to advise CoQ10 when a statin drug is prescribed? Is it because the word ubiquinone is not understood as yet?
When the TGA asked for evidence of effectiveness on 11 complementary medicines in the latter half of 2010, only 2 of these had such evidence. See http://www.tga.gov.au/industry/cm-post-listing-compliance-reviews.htm
This is an area where people may claim anything that they like and self-certify it and only occasionally will somebody officially question their claims.
In 2000, Helen Chryssides, a journalist writing in the Readers’ Digest visited 35 naturopaths around Australia and got 35 different diagnoses and 35 different treatments. See http://www.hotheads.com.au/naturopaths.htm
The whole area seems to me to be a sort of enchanted forest where anything can be true if you just believe it.
What are complementary or “companion” medicines complementary to? Medications which have been rigourously tested to work?
I continue to be astounded by the polls that show that pharmacists are the most respected profession! These are the same people who hawk “snake oil” remedies alongside their dispensaries. The Guild should be ashamed of itself. It continues to put the interests of its members ahead of the wider population. They continue to expand their scope of practice into a number of health professions and the government appears to aid and abet them as they do so!!
A quick way to check for evidence of safety and effectiveness of any given therapy is to go to the search line on PubMed at http://www.ncbi.nlm.nih.gov/ and type in the name of the therapy and the word Cochrane. This will list not only the Cochrane reviews but in fact any serious systematic reviews of safety and effectiveness on the therapy.
It would be helpful for Blackmores to circulate the ‘evidence’ supporting the complementary products they were proposing to match with specific pharmaceutical products.
It would also be helpful for pharmacists’ professional standing if they got rid of their prominent displays of products for which there is little evidence of efficacy – for example, ‘detox’ products. Could they also dispense with fridges displaying ‘vitamin waters’ – in effect, sugary cordials containing a few vitamins not known to be lacking in Australia.