The New Zealand Pharmacy Council want to change to supply complementary therapies or other healthcare products without evidence of efficacy.
One thing not made clear enough in earlier reporting is that Pharmacy Council is proposing to offer a double standard.
They wish to split one clause covering all of “any medicine, complementary therapy, herbal remedy or other healthcare product”, into two clauses, the first requiring “credible evidence of efficacy” for, “any medicine or herbal remedy”, as they previously did, but exempt a requirement for “credible evidence of efficacy” from “complementary therapy or other healthcare product”, instead offering –
and when sufficient information about the product can be provided in order for the purchaser to make an informed choice with regard to the risks and benefits of all the available treatment options
The full wording of the proposed change can be seen in their consultation document (PDF file) or in Appendix 1, below.
This is applying two standards, one for products that likely have active ingredients and an ‘open’ standard to products that likely have no (sound) active ingredient.
The Pharmacy Council note that they “intend to undertake a full review of the Code of Ethics (2011) in 2016.”
Cynics might suggest this is a pre-emptive move to counter that many (if not most) pharmacies are in breech of this clause at this point in time. Indeed the Stuff reportage could be read as Pharmacy Council chairman Dr Andrew Bary admitting that pharmacies are currently in breech of the existing clause:
But Pharmacy Council chairman Dr Andrew Bary said the rules as they stood were “unworkable” and many pharmacists, including himself, were already selling complementary medicines, even if they didn’t believe their claims.
This is my experience, too; most pharmacies I have visited sell homeopathic remedies. These, by definition, have no active ingredients and can only be placebos. (Earlier articles I have written cover homeopathic remedies in more depth; a list of some of these articles can be found at the end of this article.)
One important point, I think, is that many people likely go to pharmacies under the expectation that everything being sold is effective at some level. (Most people understand that different things have different efficacies.) If they’re not, then the pharmacy is not doing a lot better than the various ‘healthery’ shops with their nonsense remedies.
As just one example, I have previously written about New Zealand company Naturo-Pharm’s ‘Fevamed Relief’, targeted at babies with fever. Consider selling something for fevers in kids that does nothing.
You’d hope that if a baby has fever parent would try determine the cause of the fever and work from that, not give them some placebo remedy and hope for the best. Certainly I can’t see a valid reason for a pharmacy to stock it.
An issue with the “is safe” argument the Pharmacy Council offer is that a product that does nothing is “safe” in and of itself—it does nothing, after all. The unsafeness comes from people using non remedies that allow an illness to continue or get worse, which can then become serious, even untreatable. (An extreme example of this is an iridologist’s ‘treatment’ of a patient with a cancer than invaded her scalp.)
Submissions for this proposal have been extended to 5.00pm, 9 October 2015. A PDF file on the Pharmacy Council website outlines the proposal; instructions how to submit are at the end of the PDF file.
I hope to file a submission. (Note that there is some subtlety over the advisor statements that follow the suggested changes; see Appendix 1.)
Earlier this year the issue of homeopathic remedies was raised in Pharmacy Today tackled sales of homeopathic remedies in pharmacies and with an Australian National Health and Medical Research Council report concluded, in Edzard Ernst’s words,
that there is no scientific basis for homeopathy and no quality evidence of its efficacy
Current wording of clause 6.9:
Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.
Proposed new wording in two parts
6.9a Only supply or promote any medicine or herbal remedy where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.
6.9b Only supply any complementary therapy or other healthcare product where there is no reason to doubt its quality or safety and when sufficient information about the product can be provided in order for the purchaser to make an informed choice with regard to the risks and benefits of all the available treatment options.
You can see how the first part mirrors the previous wording, but singles out only some products, where the second part drops the evidence of efficacy requirement on the remaining products.
The Council’s proposal goes on to say,
It is not Council’s intention to endorse or prohibit the supply of any particular complementary and/or alternative medicine or product. It is the individual pharmacist’s responsibility to ensure they meet their professional obligations in the supply of all products. Pharmacists should be able to advise patients about the general use, current state of evidence, associated effectiveness and any safety issues relating to complementary and/or alternative medicines. This knowledge should provide the basis on which a pharmacist makes a conscious decision on whether or not to supply or promote these types of medicines.
In instances where there is credible evidence to suggest a specific complementary and/or alternative medicine/product lacks efficacy, pharmacists should not promote or recommend its use.
Pharmacists must also respect patients’ rights to freedom of choice or autonomy in relation to their treatment options.
My own (admittedly small-scale) experience is that pharmacists are not good at explaining the nature of these products, not frankly saying what is true of them.
While the final sentence is correct in a proper context, I don’t believe this should be read as opportunity for pharmacies to sell ‘anything’. There should be an expectation that remedies offered in pharmacies are effective to at least some reasonable degree.