Ian Carr: Peddling homeopathy

IF you visit most Australian pharmacies these days you are likely to be confronted by a slough of highly suspect supplements and therapies.

From detoxing to fat burning to immune boosting, it appears that no claim is too outlandish to be chanced upon a credulous public. That our government regulators and pharmacy bodies have been sitting quietly on their hands over this is unfortunate and distressing.

Recently the NHMRC published a draft information paper of the evidence on homeopathy, finding that it cannot be proven to be more effective than placebo. Submissions on the review closed last week.

While homeopaths are likely to dismiss the findings of the review, we supporters of science in medicine should only regret that it was necessary for this august body to expend time, energy and funding to lay to rest a pseudoscience which had had no basis for plausibility.

So why do pharmacies sell homeopathic medicines?

First, there are a (very) few pharmacists who have training in homeopathy, specialise in it, or are convinced by its claims.

I have no problem with allowing anyone their delusion of choice, as long as it is an informed choice. However, these pharmacists should separate their homeopathic practices from their jobs in community pharmacy.

Second, there have been major changes in the retail management of pharmacies in the past 20 years or so. Previously, most pharmacies had been independent businesses, albeit sometimes branded with the logo of a marketing group.

Recent years have seen a rise in retail management, which means more emphasis on discounting, advertising, online sales and closer ties to major brands. With this change, many pharmacies have introduced the retail manager, an expert in business, retailing and merchandising, whose role is to run the “front of shop”, leaving qualified pharmacists free — in theory — to concentrate on their professional duties.

In practice, these arrangements appear to have resulted in pharmacies stocking their shelves with anything that sells. And therein lies a challenge to the profession.

As an independent pharmacist proprietor, I do not stock homeopathic medicines, diet pills or ear candles. I am free to recommend therapies where I am convinced of an evidence base.

However, were I an employee pharmacist in a discount chain, would I have the same opportunity to exercise my professional discretion and conscience? Or would I be encouraged to companion sell and recommend the chain’s favoured brands? Could I tell the truth and expect to keep my job?

An answer might lie in the recent newsletter from the Pharmacy Board of Australia, which warns: “Action by non-pharmacists (such as managerial staff) which impinges on the ability of pharmacists to meet their legal and ethical responsibilities may be subject to action under the Health Practitioner Regulation National Law”.

Another category of pharmacist which allows for the profusion of nonsense products is the uninvolved pharmacist, who sees no need to interfere with what goes on in the front of shop. Staff training is handed over to any company that offers it, with no oversight of quality or ethics.

Given the multimillion dollar advertising by vitamin and supplement companies, the exponential growth of complementary and alternative medicines and folk cures, and the extreme level of science and health illiteracy in the populace, this laissez faire approach is not acceptable.

Pharmacists are well placed to be at the forefront of science-based medicine, trained and ready to counsel, explain and teach our clients, and help give them informed control of their health.

My call to fellow pharmacists is stop being seen as tarrying with the dark art of homeopathy. Let’s declare our intention to treat our patients based on the best evidence, and honesty.
 

Mr Ian Carr has been a community pharmacist for 35 years. He is a supporter of evidence-based medicine and is a member of Friends of Science in Medicine. His pharmacy does not sell homeopathy, detox regimens or fat burners.