In light of the recent NPS research into attitudes towards complementary medicines, Pharmacy News asks two industry experts what place the products have in pharmacy.
NO
Dr Ken Harvey, academic, La Trobe University
In 2006, Brian Grogan, then national president of the Pharmaceutical Society of Australia, said, “By selling ‘miracle’ products that offer no evidence for their quasi-therapeutic claims, some pharmacies are undermining the very basis for the profession’s trusted position in the Australian community.”
In practice, the shelves of most pharmacies contain numerous complementary medicines lacking evidence of efficacy. The promotion of these products often overstates their benefits while minimising or even denying known adverse effects and drug interactions.
Not surprisingly, NPS research shows a major disconnect between consumers’ perception of complementary medicines as ‘natural’ and ‘risk-free’ and the reality that they contain pharmacologically active substances capable of producing drug-drug interactions and adverse effects. Consumers also report using these products for conditions where there was no evidence of effect. The use of ineffective complementary medicines not only exposes consumers to unnecessary potential harm but also has a significant adverse effect on consumers’ hip pockets. Such use can also delay or prevent the use of more evidence-based therapy.
NPS research also showed that pharmacists (and GPs) believed they did not have enough access to evidence-based information about CM. As a result they were not confident in discussing these medicines with their patients. Most CM are classified as listed goods by the Therapeutic Goods Administration (TGA). Unlike conventional medicines, they are not evaluated for efficacy or therapeutic equivalence. In addition, complaint procedures are under-resourced, overloaded and the ‘sanctions’ available do not deter repeat offenders.
This ‘risk-based’ regulation has allowed numerous CM with dubious health benefits to enter the market. It also creates the misconception that all CM containing the same ingredients are equally effective. While there is good evidence from clinical trials that some overseas formulations, for example, of glucosamine sulphate or St John’s wort, are effective, there is no certainty that most Australian formulations are equally effective.
I have sympathy for pharmacists who say it is all too hard to sort out which CM are evidence-based and which are not. In addition, if they refuse to stock a CM because it lacks efficacy, they may lose a customer to another pharmacist with less concern about such matters. The current situation represents a failure of Australian Medicines Policy. The challenge for the Federal Government is to overcome industry self-interest, institute the regulatory reforms suggested and assist pharmacists in clearing their shelves of ineffective complementary medicines.
Dr Ken Harvey is an Adjunct Senior Research Fellow at the School of Public Health, La Trobe University.
YES
Gerald Quigley, pharmacist and herbalist
Whether we like it or not, Australians have embraced the philosophy of self-help when their health is challenged. This is reflected in the ongoing and increasing demand for safe, gentle remedies, most of which are available from their trusted local pharmacist. For those pharmacists who embrace these patient needs, they receive ongoing acknowledgement by their patients that they actually 'care'. In this hysteria about our perceptions regarding the relevance of complementary medicines within our area of professional practice, let's not dismiss the expectations of our patients. Upskilling our knowledge in all aspects of treatment regimes is our professional and legal responsibility, and this especially applies to complementary medicines. There are two main aspects of my rationale.
Firstly, we face challenging times ahead if we feel that our current health (or ill-health) system can continue to support the increasing incidence of chronic disease. Proper nutritional support, specific for a particular disease predisposition, is a cost-effective, patient-empowering initiative, providing a 'team' concept between the patient and any health providers involved in their care. Patients feel important, since everybody in that team is helping them take control of their own health outcome. Surely that is a better option than the current taxpayer-funded method of trying to retrieve health from a cascade of events that has led a patient down the illness path. There are many examples - gingko biloba and brahmi for brain health, saw palmetto for prostate health, magnesium and essential fatty acids for asthma, essential fatty acids for eczema, magnesium for tension, and the list goes on.
Secondly, there are many instances of nutrient deficiencies identified as a result of current therapeutic options. This so-called 'integrated' approach allows the patient to discover that many side effects of medicines can be offset by specific nutrient supplementation. Statins deplete co-enzyme Q10, antibiotics destroy beneficial bacteria in the gut. We have the clinical evidence to support supplementation in these instances.
Finally, we have a moral and ethical responsibility to increase our competence and confidence in recommending, advising and reassuring our patients about therapies they may require.
Education is there. If we seek it, it can be found. Let's leave the emotional bleating about questionable weight loss treatments alone, put our inadequacies and prejudice aside and focus our attention on the needs of our patients. The emotional, financial and moral rewards will follow.
Gerald Quigley is a practicing community pharmacist, as well as an accredited herbalist.