Skeptics Don’t Like The Drugs You Sell
So we can all admit that not all of the supplements, vitamins, homeopathic, natural, herbal, etc etc products we sell are 100% proven, and things we are likely to recommend to anyone. The Australian Skeptics group have taken it upon themselves to point their finger at pharmacists earlier this year.
The letter released by the skeptics is as follows:
“Australians trust Pharmacies and Chemists’ shops. As pharmacists, you play an important role in the health of the Australian public by functioning as a conduit between doctors and prescription or pharmacy drugs. You also have a respected role as a first resource for medical advice for many people in our community. We are all familiar with the slogan “Ask your Pharmacist”.
When we ask our Pharmacist, what kinds of answers do we want? Not quack products like ear candles that do nothing except pose a hazard. We now ask our Australian pharmacists: What standards do you set for yourselves?
You sell a growing number of products for which there is little or no scientific evidence of efficacy. Calling them “alternative” does not make them work. Examples include homeopathic preparations, magnetic pain relief devices, detox programmes, dodgy weight loss products and ear candles. Such products commonly appear in a “Natural Medicine” section of pharmacies but are sometimes displayed alongside real medicines whose benefits are scientifically proven.”
Now as initially mentioned, yes, not all the stuff in the pharmacy is things we would use on ourselves or recommend. However, the fact is, the majority of pharmacists are up front about the products they sell. If someone comes to me complaining they can’t sleep and they don’t want to touch any harsh chemicals and they’ve heard great stuff about this homeopathic liquid, what do I say? I tell them, scientifically, this product is not proven, and in fact, the dilution is so small, scientifically there is nothing in there. From that point of view, it is not proven, however, it will do no harm, so you may try it if you feel you do not want to take a tablet which has a proven record of working, but come back and chat to me if it doesn’t work, maybe we can discuss alternatives, by the way, why is it that you don’t think you are able to sleep…?
I initially had a problem with some of the items that have been for sale in pharmacies I’ve worked for, but sometimes its the lesser of two evils. Would the skeptics and the community prefer it if we ban all these not 100% proven products, and leave it for the supermarkets and health food stores to sell?
Personally, I prefer having them in an environment where there is a health professional available, such as yours truly, who can say, listen this probably isn’t for you, or, I really think you should see a doctor about this issue. Not all pharmacists are perfect, but I’ve worked with many, and even the competitive owners of the business still seem to be able to keep their ethics in tact. I personally have never been told off for not making a sale (and talking a customer OUT of a purchase). Pharmacists seem to be, for whatever reason, a pretty nice bunch, which is probably what causes us to provide free services to our customers, and not really push sales either. When it comes to health reasoning, the sale is never important.
I think the skeptics are being self righteous as usual, and not really contributing anything useful to the table, but being mildly controversial and annoying an entire profession is a good way to get attention I guess.
Worked for me, I’m writing about them…
Tags: ask your pharmacist, canadian pharmacy, pharmacist, pharmacy, prescription, supplement
December 20th, 2009 at 4:36 pm
Hi AustPharma,
I am one of the authors of the Aust Skeptics letter, “Open Letter to Australian Pharmacists”. I am a scientist not a pharmacist but have done significant leg work recently, visiting pharmacies across the country asking about alt. med. It appears from your blog post that you might be the exception to the rule, at least with the small sample size of “shadow shopping” I have done.
I was particularly interested in asking for advice about ear candles, which is the primary focus of the letter, and homeopathy. I can count the number of times on one hand where there has been a pharmacist available to advise me about products in store. I am pleased to say on the once occasion I did get a pharmacist and asked about ear candles I was told “ they do not work and I would not recommend them to my customers.” However, most of the time there was only an assistant available who would offer responses such as “they might not work but people buy them so what can you do” to blank looks indicating they have quite probably never seen the product, least of all know what it does.
Just last week I had an experience where an assistant told me that homeopathic fever and pain relief for babies works because “they” tell her (meaning customers) and that she had never heard of the placebo effect, that stuff was “over her head”. This certainly does not instill much confidence as a consumer.
You say in this post and you also mentioned before on Crikey (http://blogs.crikey.com.au/croakey/2009/10/20/menadue-writes-pharmacy-sector-a-script-for-change/) that you see no problem selling these products as long as they do no harm. There are two ways to address this issue – whilst homeopathy (which you correctly point out) does nothing therefore can do no harm in principle, if used instead of medicine, treatment may be delayed and as such, harm is caused. This was well publicised in the recent case of Gloria Sam (http://www.smh.com.au/national/parents-failed-gloria-jailed-for-cruelty-20090928-g992.html) who was given homeopathy in place of corticosterioids and other treatments and subsequently died. Other such cases of death by delaying treatment and instead using homeopathy can be found here. http://whatstheharm.net/homeopathy.html
Whilst I acknowledge these cases are extreme, the other things to be considered particularly with respect to homeopathy are the ethics of giving a baby homeopathic pain and fever relief in place of kids’ paracetamol. As you would be well aware the Australian Homeopathy Association promotes their products to parents as “Homœopathy can be of benefit for all ages, at any stage including pregnant women, mothers, fathers, babies, young children, teenagers, and the elderly.” (http://www.homeopathyoz.org/WhatIsHomoeopathy.html).
They correctly advise that it is safe for babies since no “effect” means no “side effects”. If I were a parent and was advised that homeopathic pain relief worked then subsequently found out that it didn’t I would be horrified.
We are concerned primarily the with reduction of harm which is why we targeted ear candles as the worst examples of quack products in pharmacies, since these have been demonstrated to do direct harm (See letter an references). I am surprised you didn’t mention these in your blog, perhaps you are sensible enough not to stock them!
The point of this letter was not to “be controversial and annoy an entire profession” rather just get a conversation going about whether something should be done about the infiltration of quack products into pharmacies.
I don’t know if you saw the response to our letter back in May from Gerard McInerney, president of the Pharmacy Board of NSW (See http://archive.i2p.com.au/?page=site/article&id=1274) where he states that “Because a recommendation by any pharmacist for a therapy or medicine gives that therapy or medicine special credibility, it is essential that the recommendation is soundly and scientifically based” and “Alternative medical practice or therapies, such as iridology, aromatherapy, reflexology, homeopathy and similar “natural” approaches to health care have apparently found a place in the community, but the Board can see little or no place for them in the practice of pharmacy.”
Thanks for your comments.
Rachael A. Dunlop, BSc (Hons) PhD.
December 20th, 2009 at 7:12 pm
Surely this is not a case of being self righteous, mildly controversial and annoying an entire profession, it’s about being able to ensure that the largely uneducated public are aware that these products don’t work.
I applaud you for educating your customers, but in my experience you are in the minority. In many pharmacies these products are sold in sections only manned by retail assistants. I used to be a user of such products and had never been warned off them, in fact I’d usually have chats with the assistants about how great they were. I’ve only stopped using them through my own research, and I was shocked that these products were allowed to be sold at all, let alone in reputable pharmacy shops.
Speaking from experience, seeing a product in a pharmacy makes it seem legitimate. I’d never in a million years think that a pharmacy would sell a sham product. I don’t think the items should be left to supermarkets either, I think they should be removed all together, or at least made to carry a warning label.
I’m not commenting here to be self righteous at all and I don’t believe the original letter was intended in this way either. I really truly care about the health of people who take these products, I used to be one of them. What worries me most is that people take these remedies at the expense of real treatment. Because of this it shouldn’t fall to pharmacists to choose whether to sell them at all – it should fall to government. But until then you’re the people who can make real change and even save a life.
I have trouble understanding why pharmacists find these pleas annoying. You’re smart people who’ve worked for many years to be where you are. Why wouldn’t you want to make a stand for science and evidence where you can? Doesn’t the sale of products with no evidence make you angry? I’m not a pharmacist so the best I can do is tell my friends and inform the community. I wish I was in the position to make change that you are.
Thanks
December 20th, 2009 at 7:47 pm
“I think the skeptics are being self righteous as usual, and not really contributing anything useful to the table…”
I don’t think this is fair. It doesn’t seem like pharmacists do much to educate customers about — or at least communicate — the scientific consensus regarding whether “the drugs that you sell” actually work. If pharmacies sell drugs that aren’t supported by credible research into their effectiveness, then why are they (at least) not advertised as such? Perhaps this passivity of pharmacists has left a vacuum for skeptics to fill.
“Would the skeptics and the community prefer it if we ban all these not 100% proven products, and leave it for the supermarkets and health food stores to sell?”
Crikey. Well, first, nothing is “100% proven”. Second, if pharmacies choose to stock a product, it won’t necessarily affect their availability elsewhere. Third, given that pharmacies don’t advertise products based on their effectiveness, they might as well be sold at a “supermarket or a health food store”.
December 20th, 2009 at 9:12 pm
Thanks for the input from the posts that came though, I’ll try address a few points without extensively repeating myself…I probably will though!
Rachel
Firstly, the comment that you can count on your hand the number of times a pharmacist is available to advise you is puzzling, and does reflect your lack of understanding of pharmacy practice, which is one reason I referred to the skeptics letter in such a negative manner.
At any pharmacy you are you have the right to speak to the pharmacist – however you will need to wait. You cannot expect the pharmacist to drop what they are doing – just give them a couple of minutes. This is a service which requires no appointment, you can wait one, two, and if it’s important enough, even a few minutes. At 100% of pharmacies 100% of the time you can speak to a pharmacist, it is not our fault your are impatient.
Secondly, if you asked an assistant a medical question its your own fault if you don’t get a professional answer. The assistants are there to assist, and yes they have some training. If you ask the assistant to help you pick magnesium because you have cramps and the doctor told you to get some, they can do that. If tell the assistant you ‘think’ you have cramps what can you take, well, you should just ask the pharmacist if you want a valid opinion if it appears to be cramps (or something else) and what is the most appropriate action. Once again, don’t be lazy, have a seat, play with your phone, and the pharmacist will see you as soon as they can. I’ve worked with many pharmacists, we don’t like keeping people waiting, if we haven’t seen you yet, it means we are busy assisting another customer or completing a check on prescriptions. As you said, the only pharmacist you spoke to gave the answer I would give, don’t go jamming candles/wicks in your ear, and if you ear really feels that blocked and if at all painful, let the doctor shine a light in there and have a look. I like you’re comment about the candles particularly highlighting the harm involved, I really hope pharmacy stops stocking them.
Yeah, that assistant sounds like an idiot, but what does that make you for asking someone who is not a medical professional a question – that’s what the pharmacist is for. In an ideal world, yes, I would like to see homeopathy BANNED. Nothing would make me happier. That is unlikely to happen, our hope is that people that might use it, such in that example, might one day decide to get their homeo products from the pharmacy, and maybe ask the pharmacist that this product isn’t working as well as they thought and ask for help….and then we can gently tell them to stop using this useless water. My example of no harm relates to instances where, for example, “I went to the doctor and told him I can’t sleep, she said I was fine and didn’t want to give me anything because I’m pregnant.”, believe it or not, that is an example where the placebo effect may be useful. If I were to give it out, I do warn them that it is unproven and technically just water etc etc (I don’t hold back) and never to use homeopathic products before speaking to a pharmacist or doctor in future (like she had already done in this example). However, if we remove all products, these people will not have the chance to ask this question, and 100% of people buying these products will not have a chance for someone to intervene. Trust me, when I started out as a pharmacist, I was troubled by these products, however, the world is imperfect, it were that easy, the skeptics may have been able to achieve something more than simply commentating on issues. I don’t mean that as a put down, we’re all in the same boat fighting idiocy and red tape to have regulations changed.
I think the tone of the skeptic letter will put pharmacy offside as well as the lack of understanding about the industry in general, which is why I pointed out the shortcomings, it was written in a tone to take a shot at pharmacy rather than be simply constructive. My response was measured with the same tone.
Rachel, I sincerely hope the government puts restrictions on irido/aroma/reflex/homeopathy AND ESPECIALLY NATUROPATHY (excuse the loud font, that one really gets on my nerves) both for pharmacy and the community in general.
Geoffery
I agree with the skeptics letter getting the message out to be cautious of these dodgy products, I am referring to the tone it took to the profession, not fully appreciating all the issues of the healthcare industry, the current legislation on these issues, and by ignoring these, making pharmacists look like charlatans. I’m sure there are a few bad ones like any profession, but we’re an alright bunch, and will normally steer you aware from ‘natural medicine’, especially if the cause of a person’s complaint has not been medically investigated.
Thank you for acknowledgment that I attempt to educate customers, I am not special and most of my peers do the same, however, like Rachel you miss a big, big point – ASSISTANTS ARE NOT MEDICAL PROFESSIONALS. Excuse the capitalization, that was more for the benefit of the lazy folk skimming these replies from you and I, it’s an important distinction to make if you want safe advice. Assistants are there to assist the pharmacist, and help out on the shop floor. See my reply to Rachel above, you both seem to be confused that an assistant’s advice is a good replacement for the pharmacist’s. You didn’t need to do any research to find out to stop using them, you only had to wait a couple or a few minutes, ask the pharmacist who would have told you that it’s not the way to go.
Yes, Geoffery, I’d be thrilled to see all those products dumped, see my response to Rachel. The warning label is actually not a bad idea, “NO PROVEN THERAPEUTIC EFFECT” or we could put those products in the ‘Pharmacist Only’ (Schedule 3) category, which is a category of products where the pharmacist much physically hand it to the customer and ensure it is being used appropriately. I like that. I suppose they’d all then go to the supermarkets/health food stores once they catch on that we won’t give any out 99% of the time!
I agree with you there, Geoffery, the government needs to intervene and shut this stuff down. It comes down to the issue that if us pharmacists band together and stop selling it, maybe it will be good that we will show we have no confidence in these products, or maybe it will be bad that we will no longer have the chance to talk people out of these.
We don’t find these pleas annoying, we feel the same way in general about alternative therapies, however we don’t like the unrealistic black and white stance and accusatory tone that we sometimes receive, no offense, but especially from people not in the profession/qualifed – but we take on feedback from anyone (even our customers! We’re not snobs…). As Rachel said, because the pharmacist couldn’t see her straightaway, she deemed that meant a pharmacist was not available to her. This is way, way off. A pharmacist will ALWAYS speak to you – ALWAYS. However, we are busy counseling other patients, on the phone to doctor’s clinics or hospital, checking medication for people that are also waiting and directing our staff. We will get to you, but you have to understand, most pharmacies, there is only one pharmacist, and even in stores were there may be a couple, the reason there are two is only if it is an extremely busy pharmacy (so the same issue applies). Be patient, we will speak to you and we will be happy to help you, and we do not charge for our advice. I have spent two minutes, sometimes five, sometimes ten or more with a customer depending on how long was necessary, many times they walk out the store with nothing because there was not a suitable product or I advised them not to buy anything and get checked by the doctor first. My fellow pharmacists do this too (including the business owner or manager, also pharmacists of course), and occasionally have had people with injuries, severe bleeds, and other stumble in and collapse in a pharmacy and had to attend to them, we will drop everything in those cases. They, and I, do this all happily, but I won’t rush checking a prescription or advising someone else to get to you quicker. Rushing leads to mistakes, we work briskly, but safely.
Thank you for your comments Geoffrey, somethings that occur in the healthcare industry make me angry too.
David:
David you’re comments are sort of like the others, sort of not…but that’s okay, thanks for commenting and hopefully the above relates to what you are asking and stating. I’ll just say there are things 100% proven, penicillin does kill certain types of bacteria, and iron tablets will increase the iron level in your body. I don’t mean to be a smart alec, but it’s not all doom and gloom when it comes to drugs.
____
I do appreciate all your feedback (and I will have a read of those links posted in the comments), I started this blog as a way to highlight the good and the bad in the industry (as I have been horrified by some of the issues occurring in the USA which I hope NEVER happens here), as well as have some fun highlighting the odd and strange things that occur in this profession, that most pharmacists can relate to, and non-pharmacists can still be entertained reading (hopefully). This feedback makes the effort of setting up this pharmacy blog more worthwhile, and I welcome more discussion.
AustralianPharma.
December 20th, 2009 at 11:25 pm
AustralianPharma
Thanks for the honest reply. I think there’s a general view in the community that Pharmacists are there to talk about/manage prescriptions and have important things to do behind the counter. Whenever I’ve been in to a pharmacy for minor ailments I’ve not wanted to bother the Pharmacist because I knew I could get products off the shelf and choose them simply by reading the boxes. At the end of the day, I assume that if something is on the shelf, it does what it says on the box. Surely it does or it’d be illegal! You must agree that people have trust in the government and the pharmacy that products work if they’re for sale.
Anyway I guess that’s a bigger problem with the community and the even the communication from pharmacy stores/pharmacists in general.
I completely understand that there is much in your industry that non-medical professionals don’t know, and I’d feel as insulted if someone tried to tell me how my industry should change. However I think that the original letter was not intended to be flippant. Reading it as a non medical professional it expresses my frustrations as a lay-person very well. The language is simple, and pointed but please don’t mistake that for being arrogant or accusatory as I’m positive it was not intended in that way.
Now that we understand the sides better, skeptics and medical professionals must be able to work together – we want the same thing, we must simply learn to communicate better. I’m glad that this has resulted in constructive conversation rather than a snarky brawl as these things so often do.
Cheers
December 20th, 2009 at 11:42 pm
Certainly, the medicines should do what they say and for what conditions stated in the box, but regardless, feel free to bother us if you’re not really sure what you’re trying to treat or if its appropriate/first time using it. For example, a common one we see is people confuse heartburn/reflux pain with angina (heart pain) if they’ve never had a heart issue before, so especially if it’s the first time you’ve had a symptom and if it’s out of the ordinary it’s a great idea to ask. Even common issues people don’t necessarily do the best thing for their body. Customers also tend to grab antidiarrhoeals when they get the ‘runs’ because they think stopping it will make them feel better, when in reality, if you’re at home or somewhere close to a bathroom, its much healthier to let the body flush itself and try keep yourself hydrated, rather than buying capsules to stop it.
While what we do behind the counter mostly out of public view is important, we feel what we do in front talking directly to people is also important – feel free to bother us/ask the assistant you want to speak with us!
I agree completely, Geoffery, if groups such as skeptics and pharmacy organizations collaborate, we might find it easier to lobby for more sensible legislation and clampdowns on alternative medicine.
AustralianPharma.
December 20th, 2009 at 11:56 pm
Now hopefully people will read the comments section of the post and not just skim the first paragraph… the skeptics are just trying to do good for the community and overcoming the arrogant cynic label is a very important step.
Cheers
December 21st, 2009 at 2:57 pm
“I like you’re comment about the candles particularly highlighting the harm involved, I really hope pharmacy stops stocking them.”
“Rachel, I sincerely hope the government puts restrictions on irido/aroma/reflex/homeopathy AND ESPECIALLY NATUROPATHY (excuse the loud font, that one really gets on my nerves) both for pharmacy and the community in general.”
“The warning label is actually not a bad idea, “NO PROVEN THERAPEUTIC EFFECT” or we could put those products in the ‘Pharmacist Only’ (Schedule 3) category, which is a category of products where the pharmacist much physically hand it to the customer and ensure it is being used appropriately. I like that.”
I don’t understand. If you share all the same sentiments towards alternative medicine as the skeptics do, then what exactly do you have against them? If anything, shouldn’t you be supporting them? After all, they share your beliefs exactly, so why not take this as an opportunity to side with the skeptics in order to achieve a common goal?
I’ve always thought to myself, as a layman, that some group of well meaning skeptics would *never* be enough to persuade the government to do something. There would need to be a strong backing by the people actually working in the industry itself before we get the attention of the government. With this in mind; If what you’ve said about most pharmacists is true (ie. sharing the same sentiments that you do to alternative medicine), then why isn’t something being done? You make it sound like it’s a hopeless endeavor and that the battles already lost, but has there actually been an effort by the pharmaceutical industry to do something about it (that’s an honest question, as I wouldn’t know)?
December 21st, 2009 at 3:53 pm
Hi Hez. As I mentioned in my lengthy reply (…longer than my initial post) the basic idea of the skeptics letter, “alternative medicine is usually not good”, well, that it in simplest terms, is something pharmacists mostly agree with.
However, the letter didn’t take into account the issues I mentioned and took a very black and white attitude without considering the complexity of removing such products from pharmacy if they are still publicly available elsewhere, and how this will impact the public and access to professional health advice being available when persons consider these items. Essentially, it framed pharmacists in a negative light as if we get kicks from selling terrible things because it’s good for business. As this was a public letter, like any profession, we do not appreciate being unfairly spoken of in the media, even if its a skeptics letter. This further propagates an ill informed opinion to the public.
Generic brand medication is a perfect example of this, and a topic I’ll cover soon. Even some doctors do not have a clear understanding of what these are, and they will tell the customer “don’t let the pharmacist give you those terrible generics” without there being a sound reason for it (such as allergy to color or gluten etc). This person will then tell their family this, who might tell their friends, and presto, you’ve got a little bunch of misinformed people. While the pharmacy will give whatever brand the customer wants if it is in stock, the problem is that these misconceptions get in the way of customers listening to sound advice.
I do find the skeptics attitude is inflammatory in nature as I stated in the post, which may be a tool to get more attention to their cause/publications, but may get possible allies on the wrong side. The skeptics take an arrogant tone in many cases, have a read of some articles on their website, and often this is not the best way to go about gaining support for a cause.
I have customers tell me that they think antibiotics aren’t good for their kids to take and its poisoning their system. If the kid has a severe ear infection to the point that the doctor told them it may burst if untreated, and this mother or father STILL thinks they shouldn’t give their kid these ‘harsh chemicals’, I want to THROW the antibiotic syrup bottle at them for bad parenting! However, I don’t turn around and, to use a quote I read from an article on the Australian skeptics website “blind them with science”, but I explain to them in a manner I think will most likely have an outcome to reassure them to seek medical help and sometimes antibiotics are appropriate, and leaving an infection untreated can have bad consequences. I don’t hide the truth, I often and very blunt, I make the consequences of their action (or inaction) very clear, and I tell them if I feel they are making a mistake, but I do not seek out to put them down or make the situation worse, because this is more likely to make them ignore my advice.
Hez, it’s not a hopeless endeavor, and there is talk about changing the schedule or registration system for items to ensure there is better control, I haven’t heard of anything definite yet as lately the focus has been on opioid (strong painkiller, codeine) usage/addiction and rescheduling of some of these items that are available without a prescription, but yes, I support the basic argument of the skeptics in this case, but I don’t support the manner in which they communicated this in their letter. Thanks for your comment.
January 4th, 2010 at 8:38 am
Unfortunately, the general public cannot really have any confidence in the genuineness of the Pharmacists’ concern re the efficacy of “alternative therapies” such as herbal treatments and homeopathy when this website is obviously funded in part by advertising for such services! For example, ads currently displayed as I type are for studying herbal medicine, and not one but TWO ads for homeopathy “clinics” – one in Brisbane and one that offers treatment via telephone or online! Promoting these services via this website makes your comments such as “I’d be thrilled to see all those products dumped” rather hollow, don’t you think?
Cheers
January 4th, 2010 at 9:36 am
Hi Alan, thanks for the heads up. This site does have advertising on it, but it is generated based on the content of the page, so because we are discussing homeopathy it looks like it has started generated those related ads in the box.
Unfortunately the only way to pull these is once they appear and you can target the URLs and request they are removed, which I shall do. If anyone notices any inappropriate ads let me know, I’m trying to filter it down to useful ads such as pharmacist employment, education, conferences and resources etc. This is a small independent site, we do the best we can to remove these as they come.