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Pharmacists should drop products that aren’t backed by evidence

If you look at the shelves of most Australian community pharmacies or browse the pages of local internet pharmacies, you’ll see numerous examples of products making claims that can’t be supported by scientific…

There’s a conflict between the need for pharmacists to maintain a profitable business and their ethical obligations to the community. Andrew Dubber

If you look at the shelves of most Australian community pharmacies or browse the pages of local internet pharmacies, you’ll see numerous examples of products making claims that can’t be supported by scientific evidence.

These include an increasing proliferation of homeopathic medicines, weight-loss products with names such SensaSlim, Undoit and Fat Blaster Reducta, products to enhance sexual prowess such as Horny Goat Weed (for both him and her) and numerous vitamin and mineral combinations.

But why do pharmacies stock, promote and sell these products when pharmacists are trained scientists? The short answer is that they are profitable. Some pharmacists have told me:

The products are heavily promoted, consequently people want them and if we didn’t stock them customers would simply go elsewhere. In addition, we can provide advice if asked.

Others point out that the decision to stock is often made by the pharmacy owner or group buying chain and has nothing to do with the in-store pharmacist who dispenses scripts and gives advice. Such policies can extend to protocols aimed at up-selling complementary medicines of dubious value to customers getting certain prescriptions filled.

A Pharmacy Guild – Blackmores partnership along these lines was short lived but the practice still appears common. Recent research has shown that pharmacies that recommend the most complementary medicines to customers provide companion sale protocols to their staff.

As one respondent to this research said:

It’s all written down in the [pharmacy group] protocols, so if you work for [pharmacy group] you’re expected to follow this.

Other pharmacies, particularly large discount chains with an internet presence, point out that they stock thousands of, often short-lived, products and they cannot, and should not, be expected to research which ones are evidence-based and which are not. They have said to me:

Sorting out evidence-based products should be the job of the Therapeutic Goods Administration (TGA).

But the listing process of the TGA does not assess the efficacy complementary medicines. In addition, the Therapeutic Goods Advertising Complaint Resolution Panel (CRP) has clearly said that information on retailer websites is the responsibility of the website publisher.

There is clearly a conflict between the need for pharmacists to maintain a profitable business and their ethical obligations to the community.

In 2003 the Pharmacy Board of NSW said:

The community holds pharmacists in especially high regard and places its trust in pharmacists' professional judgment, and relies on pharmacists' professional advice.

Because a recommendation by a pharmacist for any medicine gives that medicine special credibility, it’s essential that the recommendation is based on sound scientific evidence. Indeed, the trust in pharmacists and pharmacies is such that, simply because a medicine is available in a pharmacy, consumers will infer that it carries the pharmacist’s endorsement and recommendation.

So pharmacists must be personally persuaded of the safety and effectiveness of the medicines (and other therapeutic goods) available in their pharmacies.

These principles have been reiterated by the new Pharmacy Board of Australia. Its Code of Conduct for Registered Health Practitioners states that providing good care includes:

Practising in accordance with the current and accepted evidence base of the health profession, including clinical outcomes.

And its Guidelines for Advertising of Regulated Health Services state:

A person (or business) must not advertise a regulated health service in a way that is (a) false, misleading or deceptive or is likely to be misleading or deceptive; or (d) creates an unreasonable expectation of beneficial treatment.

Several complaints have now been submitted to the Pharmacy Board of Australia about pharmacists who continue to make claims about products that had been shown to be false, misleading and deceptive by federal court orders and CRP determinations, even after these products were delisted by the TGA. No response has yet been received.

In October 2011, the Pharmacy Board said:

This being the first year of the National Scheme, the Board has taken a largely educative approach to help practitioners understand the law and the new requirements set down in its advertising guidelines. The coming year will see a more structured approach to addressing concerns about advertising. This will include an escalating series of warnings to practitioners, initially reminding them of their obligations about advertising and ultimately, possible prosecution for non-compliance with the board’s standards.

In June 2012, it reiterated the obligations of pharmacists under the National Law and noted a changing focus from education to compliance. But no change in behaviour has been apparent to date. It’s time pharmacists were prosecuted for non-compliance with their board’s standards.

This is the fourth article in our short series about pharmacies. Click on the link below to read the previous instalments:

Part One: Pharmacy gravy train drives up the cost of prescription drugs

Part Two: Online pharmaceuticals: bricks, not clicks, keep us safe

Part Three: Note to pharmacists on how not to sell the morning-after pill

Part Five: Why you have to show ID to buy cold and flu tablets

Join the conversation

61 Comments sorted by

  1. Graham Phelps

    Manager

    Thank you Ken for putting the case so clearly. I believe that pharmacists would generally agree that the community should see them as the experts on medications given their years of formal training and experience and that the community should be able to rely on pharmacists advice and recommendations. By stocking unproven products, pharmacists are giving them a professional stamp of approval that the products don't deserve and that, in time will harm the professional standing of pharmacists. How can pharmacists expect to be respected as discerning professionals if they are willing to stock anything on their shelves?

    In response to the "complimentary medicine" argument, I once heard that there are only two types of medicines; those whose claimed effects have been scientifically tested and those that haven't. It would be good if pharmacists stuck to the former and left the latter to other traders.

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    1. Shane Eagles

      Community Pharmacist | PhD Candidate at University of Sydney

      In reply to Graham Phelps

      A distinction needs to be made between employee-pharmacists (who often don't have the financial means to own, and therefore dictate what happens in, a pharmacy) and pharmacy owners or proprietors.

      As an employee pharmacist, I am completely transparent with regards to the evidence behind (alleged) remedies we sell. Also, as an employee pharmacist, I have no say what-so-ever in what we stock. Therefore, my honesty with customers and the quality of my advice is what brings them back - not these products that are lacking evidence with regards to efficacy.

      I know this doesn't address the problem, but I implore the public to see the distinction between pharmacies and pharmacists. We are at the coal-face and we are all evidence-based-trained scientists with medically proven knowledge and opinions. Our advice is medically-sound (if we're worth our salt) and does matter - please feel free to engage your local pharmacist with queries regarding the evidence behind the things we stock!

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  2. Sue Ieraci

    Public hospital clinician

    Quite apart from questions of efficacy, what about authenticity.

    Many pharmacies sell so-called homeopathic "remedies" - little bottles or "pillules" of supposedly highly diluted "mother tinctures". Paradoxically, the most dilute are considered most "potent" - down to a situation where no single molecule of the original "tincture" might be present.

    Some homeopathic research has shown that there are sometimes molecules of the original substances, but that their concentration bears no relation to the supposed dilutions.

    Does anyone test homeopathic "remedies" for evidence of containing what the label says? How would you ever distinguish the water/alcohol that no longer contains Nat. Mur. from the one that no longer contains arnica? Do they put the labels on at random? IF they switched the labels, how would anyone ever know? Is there such a thing as quality control or authenticity testing in homeopathics?

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    1. Steve Phillips

      Nurse Practitioner

      In reply to Sue Ieraci

      There was recently a major study commissioned in the UK to study and report on the effecacy of 'homopathy'. It concluded that there was none beyond the usual placebo effect.
      I believe theat no matter what the evidence; people will beleive what they want to beleive.
      As long as I dont have to fund it by my taxes, so be it.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Steve Phillips

      Valid points, Steve, but my concerns also include truth in labeling. Should a labeled product be able to be sold with no evidence of the alleged ingredients being present in the product?

      Would we accept a drink labeled "orange juice" that contained no single molecule of orange?

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    3. Martin Male

      Somatic Psychotherapist

      In reply to Sue Ieraci

      One should apply pharmaceutical products also. Most testing is no longer independence or objective .We rely on the corrupt FDA to validate what we allow. Lets be honest on all products

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Martin Male

      "Lets be honest on all products"

      Has somatic psychotherapy been independently tested?

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    5. Martin Male

      Somatic Psychotherapist

      In reply to Sue Ieraci

      Not sure what relevance this question has, nor your intent in the question, but yes it has. It seems you are implying I am not suitable to express my perspective?

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  3. Michael Hunt

    logged in via Twitter

    A few weeks ago I was in a pharmacy and I asked the pharmacist (yes, the actual pharmacist) if they had a specific product.

    She walked me over to the homeopathic section and pointed at a bottle of the homeopathic version of what I asked for. This is the actual, highly educated, pharmacist. I was like, 'You realise this is rubbish, right?.' And she was all like 'I've heard good things about it from people'

    Pharmacists receive competition protection from the Government, they should be held to a higher standard. I think that if pharmacies want to peddle rubbish, they simply stop calling themselves pharmacies and lose their competition protection.

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    1. Monika Merkes

      Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University

      In reply to Michael Hunt

      Michael, I just watched a German documentary on homeopathy: In Germany, 7,000 medical doctors have training in homeopathy (they didn't specify what the training involves), every second German has at some stage used homeopathic products, and in 2011, Germans spent € 400 million on homeopathic products. The doco featured the health minister of Nordrhein-Westfalen expressing her support for homeopathy. They didn't mention pharmacies, but of course pharmacies in Germany stock homeopathic products.
      The doco in German language is online until Thursday 28 Mar, at http://www.zdf.de/ZDFmediathek/#/beitrag/video/1864604/Hom%C3%B6opathie
      I might need to say that I'm not a believer, or rather, I believe in the power of the mind and therefore the power of the placebo.

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    2. Dave Hawkes

      Postdoctoral Researcher (Viral tools and Neuropeptides) at The Florey Institute of Neuroscience and Mental Health

      In reply to Monika Merkes

      Monica,
      Popularity does not equal efficacy, or safety. It is also worth thinking about why doctor's don't prescribe placebo, my understanding is that essentially it comes down to giving a patient something that has no effect but lying to them breaks a couple of concepts like informed consent.

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    3. Monika Merkes

      Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University

      In reply to Dave Hawkes

      Dave,
      "Popularity does not equal efficacy, or safety" - Did I say that? The popularity of placebo treatments prompts me to think about WHY they are so popular, and as this is not a new phenomenon and not likely to change soon, HOW the power of placebos could be used in mainstream medicine. I wrote about this topic about a year ago in The Conversation http://theconversation.com/not-just-smoke-and-mirrors-placebos-place-in-modern-medicine-4587. BTW, the German Medical Association has done some work…

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    4. Monika Merkes

      Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University

      In reply to Darron Wolf

      Darren,
      Well, yes and no. Placebo responses depend in part on the conditions being treated, and I can see a greater role for placebos for chronic conditions such as pain. But this is complex, and I'm not saying that all pain should be treated with placebo.
      In the doco, there was one scene where a woman gave her daughter a few little white pills because the girl had a cold or flu. I thought that, if people have been conditioned to need something tangible like a pill, for a viral infection it's much more appropriate to take homeopathic (i.e. placebo) treatment than antibiotics. If everybody did that, it would be a major step towards addressing widespread inappropriate use of antibiotics. Just a thought though, I know it's not a solution.

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    5. Ken Harvey

      Adjunct Associate Professor, School of Public Health and Preventive Medicine at Monash University

      In reply to Monika Merkes

      See also: "Placebo Use in the United Kingdom: Results from a National Survey of Primary Care Practitioners".

      http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247

      "Placebo use is common in primary care but questions remain about their benefits, harms, costs, and whether they can be delivered ethically. Further research is required to investigate ethically acceptable and cost-effective placebo interventions."

      See also, "The Power of Nothing".

      http://www.newyorker.com/reporting/2011/12/12/111212fa_fact_specter

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Monika Merkes

      I can see some logic in the use of placebo for pain relief, though I'm ambivalent about the ethics of deception.

      I don't agree, however, with using placebo as a "sham" antibiotic. Why not work towards educating consumers that they don't need any sort of tablet for a viral infection, or just to use symptomatic relief? The homeopathic placebo works against this - where a "remedy" is always offered, leaving people with the impression that they always need medicine to survive a self-limited minor illness.

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    7. Monika Merkes

      Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University

      In reply to Sue Ieraci

      Sue, I agree, I wouldn't advocate homeopathic pills as sham antibiotics. What I meant is that in an imperfect world like ours where people feel they HAVE to take some medicine for the slightest feeling of discomfort, a homeopathic pill or another placebo is preferable to antibiotics for a viral infection.
      Yes, people should be educated not to take a pill for a viral infection, indeed not to need and take a pill as the first course of action if they feel slightly unwell.

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    8. Trevor Lowe

      Student nurse

      In reply to Monika Merkes

      The only areas where homeopathy seems to provide benefit via "placebo effect" are sel limiting conditions (head colds, minor viral infections etc) or those with large subjective assessments (pain). To encourage the use of "placebo effect" encourages a person to believe that homeopathy is effective treatment and then also encourages its use when true efficacy is needed from active agents due to serious conditions. It is not better to prescribe "harmless substances" so as a patient feels like they are doing something when the only thing they are doing is facilitating profit. Medicine and healthcare is a serious issue which requires people to take an interest in themselves. Homeopathy is not only ineffective; it's provision is not only unethical but also immoral.

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    9. Monika Merkes

      Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University

      In reply to Trevor Lowe

      Trevor, all I'm saying is that given a choice between a homeopathic pill and antibiotics for a minor viral infection, the homeopathic pill is preferable; it's the better of two bad choices.
      As to homeopathy: I do not advocate it, I do not use it, but I do not demonise it. I try to understand why so many people choose to use it.

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    10. Ken Harvey

      Adjunct Associate Professor, School of Public Health and Preventive Medicine at Monash University

      In reply to Monika Merkes

      While antibiotics are certainly not appropriate for viral URTI's there are much better choices from pharmacies than the homoeopathic placebos currently being promoted, see: https://theconversation.com/kids-smarts-dumb-ads-consumers-complain-of-misleading-claims-9989.

      For example, decongestants can provide relief for running noses and paracetamol or ibuprofen can help with the fever and aches and pains of influenza. See:

      http://www.nps.org.au/conditions-and-topics/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/medicines-and-treatments

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Monika Merkes

      Monika - I take a different approach towards homeopathy as opposed to some other "complementary" therapies for several reasons:

      1. A single type of "therapy" is alleged to heal all manner of illnesses and injuries

      2. The 'therapy" is based on de-bunked principles and not consistent with well-demonstrated physiological and chemical principles

      3. There is no evidence that what is sold to you on the label is actually present in the substance

      4. The "remedies" are sold at huge mark-up for…

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    12. Sue Ieraci

      Public hospital clinician

      In reply to Sue Ieraci

      Also meant to add: at least some "complimentary" therapies - like remedial massage or aromatherapy - actually offer something tangible that is comforting and not sold as a "cure" for all manner of illness.

      The danger of practices like homeopathy, offered as an alternative to medical care, is that crucial diagnoses can be missed and people can be convinced to abandon effective medical care.

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  4. Darron Wolf
    Darron Wolf is a Friend of The Conversation.

    Analyst

    Good morning, Professor Harvey.

    Thank you for another fine work challenging pseudo-science in medicine.

    As has been pointed out, pharmacists enjoy a privileged position within the health system. They are trusted and respected but this trust and respect comes with the obligation to act in the best interests of the patient and especially as pharmacists are often medical science’s final point of contact for the patient.

    Considered so, the pharmacist’s obligation to act as an intelligent…

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    1. Thomas Duff

      Postdoctoral Fellow, Forest and Ecosystem Science at University of Melbourne

      In reply to Darron Wolf

      Arguably, considering that a pharmacist has far greater training in drugs and their effects than doctors, they should be held in far higher esteem in relation to prescriptions and treatments. Maybe they're undermining their own reputations by giving placebos the same apparent value as tested medicines?

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    2. Trevor McGrath

      uneducated twit

      In reply to Thomas Duff

      Hi Thomas. A lot of the time a placebo would be a better alternative than some of the stuff Drs prescribe so that they can move their patients on. A little while ago there was as small stink in the USA. A major drug company wanted to remove the placebo part out of of their drug trials, I wonder why that would be. Cheers

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Trevor McGrath

      Trevor - the community no longer considers it ethical for mainstream medicine to intentionally prescribe placebo medication - why would it be ethical for anyone else.

      I doubt your story about "A major drug company wanted to remove the placebo part out of of their drug trials", as a product would not be accepted as efficacious if it were no more effective than placebo.

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    4. Trevor McGrath

      uneducated twit

      In reply to Sue Ieraci

      Thats why the company wanted to do a trail without the placebo, as you would know most over the counter cold and flu products are only marginally better than placebo in clinical trials. I'm sure that if you have time you would be able to find the story about the attempted removal of placebos from trials.. The FDA does already approve drugs without randomised trials. This is not the article I was looking for but it backs up my point some what
      http://www.lymphomainfo.net/lifestyle/non-hodgkins/b-cell/biovaxid-and-the-fdas-recent-cancer-drug-approval-record
      Cheers

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Trevor McGrath

      Trevor - you cite an article that questions why the FDA wanted another round of trialing before approving a drug for lymphoma.
      How is that evidence of drug companies wanting to test drugs without placebo?

      Testing against placebo occurs for new drugs or new classes of drug. Many new formulations are not tested against placebo, but against existing therapy - as it would be unethical to leave a group untreated when there is an effective therapy available.

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    6. Trevor McGrath

      uneducated twit

      In reply to Sue Ieraci

      As I said that was not the article was really after.

      And just a small point. I'm not in the habbit of lying on any forum. let alone one which will be viewed by professionals from all walks of life. Cheers
      "I doubt your story about "A major drug company wanted to remove the placebo part out of of their drug trials", as a product would not be accepted as efficacious if it were no more effective than placebo".
      That's the point, they must have done some work on some product they were trying to develop and realised that fact. Cheers

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Trevor McGrath

      Trevor McGrath - it hadn't occurred to me that you might be lying - but you're likely to be mistaken.

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    8. Trevor McGrath

      uneducated twit

      In reply to Sue Ieraci

      So far only red fish or whatever they call them or the straw donkey or whatever ... Big pharma who no doubt will be monitoring this will be inviting you to a conference at a venue of your choice. Ps I’m in the middle of a paper about the global thermohaline circulation, so no more time to chat about the indefensible. Cheers

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    9. Sue Ieraci

      Public hospital clinician

      In reply to Trevor McGrath

      No, Trevor - I rarely encounter pharmaceutical representatives. Unlike yourself, I imagine. Why not write papers within your area of expertise, rather than in your "hobby". I suspect there are enough hobbyists in the climate change discourse already.

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    10. Trevor McGrath

      uneducated twit

      In reply to Sue Ieraci

      On reflection I'm sorry that I ever responded to your post. What you said was of course true. How silly ever to question big pharma. After they are just like every other chemical company in the world. Cheers

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    11. Trevor Lowe

      Student nurse

      In reply to Trevor McGrath

      Sounds more like a dummy spit, Trevor McGrath, than a rational contribution to a conversation? Why should readers take any of your claims with seriousness in the bsence of evidence but with the presence of slurs?

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    12. Sue Ieraci

      Public hospital clinician

      In reply to Trevor McGrath

      "How silly ever to question big pharma"

      Trevor - aren't you a pharmacist?

      I suspect you spend a lot more time collaborating with "Big Pharma" than I do - I don't always prescribe as a solution to every problem.

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  5. John Doyle
    John Doyle is a Friend of The Conversation.

    architect

    This could be a slippery slope. The word "evidence" is a loaded term because a lot of nutritional advice is promoted without evidence but can sound like there is evidence behind it, for example it might have a heart tick. A lot of scientific research is not impartial or it might have been impartial initially but then is found to be flawed, but too late to stop the industrial juggernaut from changing tack.
    So lets not throw out the baby with the bathwater. We need at least a way of selling controversial products where there is evidence both ways. So few people do their research but just spout received wisdom, and that doesn't exclude pharmacists or medical practitioners.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      John Doyle - what do you think about pharmacists selling homeopathic drops or "pillules" (lactose or sucrose tablets) without detectable levels of any therapeutic product?

      Shouldn't a pharmacy product be at least scientifically feasible to have some effect, and also demonstrably contain what it is labelled as containing?

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  6. Dave Hawkes

    Postdoctoral Researcher (Viral tools and Neuropeptides) at The Florey Institute of Neuroscience and Mental Health

    Thanks Ken. As pointed out by homeopathy there is a difference between something labelled as homeopathy and the classical idea of homeopathy which states that the more diluted the stronger the dose. I have seen homeopathic products in pharmacies with dilutions of 1X (1 in 10). Surely we need safety information on these products? If I were to sell arsenic 1X this would endanger peoples health but simply by labelling it "homeopathic" I can get away with it? If someone wants to promote a product as having medicinal health benefits they should be asked to prove two things, firstly that it is safe and secondly that it does what it claims to do.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Dave Hawkes

      Dave - I would add a third: it should be demonstrable that it contains what it is labelled as containing.

      If something is labelled as 30X Nat.Mur. it should be labelled as "no detectable molecules of sodium or chloride".

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    2. Dave Hawkes

      Postdoctoral Researcher (Viral tools and Neuropeptides) at The Florey Institute of Neuroscience and Mental Health

      In reply to Sue Ieraci

      Absolutely. Surely knowing what you are putting into your body is necessary as part of informed consent for any medical treatment. To give you an idea of what homeopathic remedy labels look like check out;
      http://www.brauer.com.au/products/hayfever/hay-fever-tablet-60/

      "Contains ingredients traditionally used in homeopathic medicine for the relief of the symptoms of hay fever, including sneezing, itchy, watery eyes and runny nose."

      Homeopathy was first described in print 200 years ago (1807…

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Dave Hawkes

      And not to mention, Dave, that the title of that list actually says "ACTIVE ingredients" (my capitalisation) - false advertising in itself!

      Also, does the "250mcg" refer to the amount of "ingredient", or to the amount of DILUTED ingredient - ie water and/or alcohol with onion or arsenic in it?

      As far as cost and profit goes, a well-known Australian homeopath sells little dropper bottles of "remedy" at a whopping $18 for a tiny 20 ml dropper bottle - that works out at $900 per litre! And, funnily enough, all the various dilutions cost the same. What does that tell you?

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  7. Russell Hamilton

    Librarian

    "These include an increasing proliferation of homeopathic medicines, weight-loss products with names such SensaSlim, Undoit and Fat Blaster Reducta, products to enhance sexual prowess such as Horny Goat Weed (for both him and her) and numerous vitamin and mineral combinations"

    I don't think you should group all those things together. There are plenty of doctors that prescribe (recommend?) vitamins to their patients - that being the case, why wouldn't pharmacies stock them?

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  8. Margo Saunders

    Public Health Policy Researcher

    I believe that some of these products will feature on tonight's new tv program, 'Checkout' (8pm ABC1).

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    1. Trevor Kerr

      ISTP

      In reply to Margo Saunders

      Excellent research backing up the Checkout segment, great presentation. Made TGA look weak.

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  9. Luke Weston

    Physicist / electronic engineer

    "In addition, we can provide advice if asked."

    What sort of advice?

    Some "alternative medicines" do contain actual pharmacologically active chemcials at meaningful concentrations, with potential for dangerous adverse interactions with other drugs. St. John's Wort is a well-known example of this. If pharmacies are going to be selling this, for example, they have a responsibility to understand what they're selling and provide appropriate advice to ensure it's safe, particularly with regards to…

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  10. Michel Syna Rahme

    logged in via email @hotmail.com

    That was a god interesting article thank you. To add, the consumer also should look into what and why they are purchasing some of these products and what evidence there is behind them.

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  11. Trevor McGrath

    uneducated twit

    Hi Dr Harvey. I do read your articles in our journal. But we must remind the readers that the punters are voting with their wallets…. which big Pharma and the medical profession does not like. I'm sure your figures are more accurate than mine, but I believe that about/over one third of the health dollar in this country is spent on alternate products and therapies of all kinds. This very large amount of money is not money coming out of the public purse (good for the tax payer) or going either to the drug companies or Drs pockets (not good, so therefore must be stopped). Evidence based medicine is a moving feast. The vastly over prescribing of antibiotics, and the "gett'em outta my face in 10 minutes" model of medical practice is proof of that. Cheers

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    1. Dave Hawkes

      Postdoctoral Researcher (Viral tools and Neuropeptides) at The Florey Institute of Neuroscience and Mental Health

      In reply to Trevor McGrath

      Trevor, companies like Brauer or Boiron (both manufacturers of homeopathic products) can make profits in the hundred's of millions of dollars so I am not sure that there is much difference between unproven remedies and safety and efficacy tested pharmaceuticals. A number of large private health insurance companies subsidize homeopathy etc so with federal tax support for health insurance we the public are in fact paying for them. The issue that a lot of people have is that if there are no benefits to taking a medication (and there is no strong clinical evidence that homeopathy works) then all that is left is risk. I am sure you will talk about the placebo effect at some point so just remember that medical doctors don't use placebo because it is considered unethical to lie to patients.

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    2. Trevor McGrath

      uneducated twit

      In reply to Dave Hawkes

      Hi Dave. The people who seek out Homeopathic products are in my experience not the main stream who is by passing the medical profession by default. The people who seek these things do so because they believe that they work, they know about the history of the practice and they know that modern science dismisses it (as do I by the way) so there is no deception going on. Others who seek it out are often at the last resort after a long struggle with their illness or complaint and are willing to try anything to try to find relief. In my practice I never recommend such things. My boss employees 4 year trained Naturopaths to handle that side of the “wellness industry” (notice that I did not use the words “Health Industry”) Cheers

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Trevor McGrath

      Trevor - are you a registered pharmacist? Do you think it is within the AHPRA code of conduct to sell "remedies" that don't contain anything beyond water and/or alcohol?

      The reasons so many people buy these things is that people generally like simple answers, and that they are sold alongside effective medicines in pharmacies.

      It is disingenuous to say that "there is no deception going on".

      Isn't this just about profit? It seems hypocritical to criticise so-called Big Pharma, an industry that his not perfect but does invest millions into research, when a homeopathic manufacturer can sell little bottles of water and/or alcohol with no R&D at all - let alone any active ingredient.

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  12. Trevor Lowe

    Student nurse

    Why is it that when the issue of evidence and "alternative medicine" I have yet to see an proponent of this modality say or write, "here is the evidence, here are the links and here are the trials and paper." instead their responses amount to variants of: this is just an attack on choice, wfhat about Big Pharma, what reward do you get for your posts? There is an attempt to shift the issue from one of evidence to claims of corruption, slurs against character and assorted other assertions. Interestingly enough, again, with this line of attack, evidence is lacking. Modus operandi: smoke, mirrors but not facts.

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  13. Colin MacGillivray

    Architect, retired, Sarawak

    Perhaps above the shelves containing unproven products that fact could be displayed in large lettering:
    "Unproven products, read the instructions carefully, check here for further information." A computer with the google search page on the screen could be located by the shelving.
    It probably wouldn't deter many buyers and would clear the pharmacist to some extent. Don't forget many retailers blithely sell and promote stuff that's positively harmful.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Colin MacGillivray

      Good suggestion, Colin. The shelves could be organised according to sections:
      - stuff we know works
      - stuff there is mixed evidence on; and
      - stuff that has no basis at all, but we think you'll buy anyway.

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  14. Martin Male

    Somatic Psychotherapist

    My background included Psychiatric nursing and a BSc in Humans Sciences and Psychology. I am also an informed and active user of some of the products identified in this article. I also agree that there are many products that are simply quackery. It is also interesting to note that the major pharmaceutical companies have been buying the very companies that produce some of these products.
    I would argue that while there is some factual basis to this article, it also contain some significant bias.The…

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    1. Darron Wolf
      Darron Wolf is a Friend of The Conversation.

      Analyst

      In reply to Martin Male

      I respect that this discussion has been running for some time and that there may be very little to be gained by replying to Mr Male’s post, but I also recognise that it cannot go unanswered even by one with no formal medical training or qualifications.

      To tease out Mr Male’s main points:

      It may be true that big pharmaceutical companies are buying into big pseudo-science companies. The business model of big pseudo is relatively sound and low-risk, as the products have no identifiable active…

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    2. Martin Male

      Somatic Psychotherapist

      In reply to Darron Wolf

      Hi Damon ,not sure what your need is to address me as Mr Male? I don't believe in " pseudo-scientific nonsense'. My choice as I stated previously is" I am also an informed and active user of some of the products identified in this article. I also agree that there are many products that are simply quackery." I am also acutely aware of the placebo effect! I also see the place for allopathic treatments, maybe in by previous past this was not stated clearly?
      Not sure what the inference is to the ad…

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    3. Darron Wolf
      Darron Wolf is a Friend of The Conversation.

      Analyst

      In reply to Martin Male

      Hi, Marty.

      To respectfully address your most recent post in (rough) order of presentation.

      If you didn’t feel that you were subjected to an ad hominem argument, then I am happy that I have succeeded in avoiding same. No offence was meant and no offence delivered. Very good.

      An active and informed user of pseudo-science is still using pseudo-science. Objectively, nonsense remains nonsense whether one is aware of it or not. The mission of science and rational scepticism is to inform the…

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  15. Monika Merkes

    Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University

    A recent article in the International Journal of Pharmacy Practice might also be of interest to the readers of this article: "Consumer-pharmacist interactions around complementary medicines: agreement between pharmacist and consumer expectations, satisfaction and pharmacist influence" https://www.ncbi.nlm.nih.gov/pubmed/23517229. A small study by researchers at the University of South Australia.

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