tag:theconversation.com,2011:/us/topics/pharmacy-review-33225/articlespharmacy review – The Conversation2019-09-15T20:17:14Ztag:theconversation.com,2011:article/1226402019-09-15T20:17:14Z2019-09-15T20:17:14ZA loaf of bread and a packet of pills: how supermarket pharmacies could change the way we shop<figure><img src="https://images.theconversation.com/files/292337/original/file-20190913-190026-w27h4g.jpg?ixlib=rb-1.1.0&rect=7%2C14%2C991%2C651&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Supermarket pharmacies have been around in the US, UK and mainland Europe for years. But will Australia follow?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/shopping-basket-pills-concept-buying-drugs-1289871286?src=-1-2">from www.shutterstock.com</a></span></figcaption></figure><p>On the way home, you wander into the supermarket for a loaf of bread. But before you reach the bread aisle, you drop in your prescription at the supermarket pharmacy. Shopping done, you pick up your pills on the way out.</p>
<p>Across the US, UK and mainland Europe, supermarket pharmacies are becoming the norm. But in Australia, they’re banned.</p>
<p>The Commonwealth government is negotiating the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/New-7th-Community-Pharmacy-Agreement">seventh Community Pharmacy Agreement</a> with pharmacists, which outlines how community pharmacy is delivered over the next five years, who delivers it and where.</p>
<p>So could pharmacies in supermarkets be an option for Australia?</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/explainer-what-is-the-community-pharmacy-agreement-38789">Explainer: what is the Community Pharmacy Agreement?</a>
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<h2>How common are they?</h2>
<p>Overseas, pharmacies have been in supermarkets for decades. In the UK, supermarkets like <a href="https://www.asda.com/about/instore/pharmacy">ASDA</a>, <a href="https://assets.publishing.service.gov.uk/media/56e1a52d40f0b6037900001d/Tesco_hearing_summary.pdf">Tesco</a>, <a href="https://my.morrisons.com/help/information/store-services/pharmacy/">Morrisons</a> and <a href="https://www.sainsburys.co.uk/webapp/wcs/stores/servlet/gb/groceries/get-ideas/our-instore-services/--sainsburys-pharmacy?storeId=10151&langId=44&krypto=3Yh4GQ%2BNdq51nNqI8mxTmkZXe9Ggb9L33GTajzfwdGXhiQftJrJArZAib4hw%2Bs8JTxwLH2HfrQCChmYTBIAbS7BEz2U5FalmUXfV%2FK4wt6OhdFjJrMlhiZMBhuu2s45yNiOQDTkMs%2BONJUT5MWYlSGhWL5pH5YQM9gRqD0wFloM%3D&ddkey=https%3Agb%2Fgroceries%2Fget-ideas%2Four-instore-services%2F--sainsburys-pharmacy">Sainsbury’s</a> have them. And so do <a href="https://www.walmart.com/cp/pharmacy-services/1088604">Walmart</a>, <a href="https://www.kroger.com/topic/pharmacy">Kroger</a> and <a href="http://www.publix.com/pharmacy-wellness/pharmacy/pharmacy-services">Publix</a> in the US.</p>
<p>Canada’s largest supermarket Loblaw <a href="https://www.thestar.com/business/2010/05/04/loblaw_plans_drugstore_expansion.html">announced plans</a> in 2010 to expand more aggressively into the pharmacy business. It later bought pharmacy chain <a href="https://www.newswire.ca/news-releases/loblaw-companies-limited-completes-acquisition-of-shoppers-drug-mart-corporation-514006661.html">Shoppers Drug Mart</a>.</p>
<h2>Arguments against</h2>
<p>The <a href="https://www.guild.org.au/__data/assets/pdf_file/0022/5386/supermarket-pharmacies.pdf">Pharmacy Guild of Australia argues</a> pharmacies in supermarkets means community pharmacies would be unable to compete, supermarkets would put shareholders’ interests ahead of patients, and consumer protection would be lost. Such critics argue supermarkets would push smaller players out of the market, limiting consumer choice and access. </p>
<p>The Guild also suggests it would be hypocritical for supermarkets to run pharmacies when <a href="https://www.guild.org.au/news-events/news/2013/12/19/supermarkets-and-health-care-don-t-mix">they rely on</a> cigarette and alcohol sales.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/relaxing-pharmacy-ownership-rules-could-result-in-more-chemist-chains-and-poorer-care-122628">Relaxing pharmacy ownership rules could result in more chemist chains and poorer care</a>
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<p>Overseas, there is public support for small, independently run community pharmacies over supermarket-owned ones.</p>
<p>For instance, in 2013 <a href="https://www.cheshire-live.co.uk/news/chester-cheshire-news/residents-rallied-behind-helsby-pharmacy-5191264">almost 2,000 people petitioned against</a> supermarket giant Tesco, fearing an existing pharmacy across the road would be “bulldozed” out of business.</p>
<h2>Arguments for</h2>
<p>The main arguments for pharmacies in supermarkets seem to be they would offer the public a <a href="https://www.retailwire.com/discussion/would-you-go-to-walmart-to-see-a-doctor/">cheaper and more convenient service</a>.</p>
<p>For instance, <a href="https://corporate.walmart.com/newsroom/2005/01/04/wal-mart-unveils-24-hour-pharmacies">Walmart</a> employs more than 10,000 pharmacists across 3,000 retail pharmacies throughout the US and launched a 24 hour pharmacy service over a decade ago. Then it began dispensing generic medications for as <a href="https://corporate.walmart.com/newsroom/2006/09/20/wal-mart-cuts-generic-prescription-medicines-to-4">little as US$4</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/is-pharmacy-the-final-frontier-for-supermarkets-5919">Is pharmacy the final frontier for supermarkets? </a>
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</em>
</p>
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<p>Supermarkets also seem committed to supporting pharmacies in store, despite tough times. In 2019, Tesco, which runs 300 in-store pharmacies, <a href="https://www.chemistanddruggist.co.uk/news/tesco-pharmacy-staff-9000-job-cuts">reported</a> no pharmacy staff positions would be lost when 9,000 store positions became redundant.</p>
<p>There are also <a href="https://www.news.com.au/finance/business/retail/a-chemist-can-own-a-supermarket-but-supermarkets-cant-own-a-pharmacy/news-story/fe97c42c3d2b55bbb613559cbf194cc1">claims of hypocrisy</a>. Why does existing Australian legislation prevent a supermarket from owning a pharmacy, but not a pharmacy from owning a supermarket?</p>
<h2>What might work in Australia?</h2>
<p>If Australia follows international trends, we might consider two models:</p>
<ul>
<li>straight-out ownership, where a supermarket owns a chain of pharmacies and employs pharmacists to run them, or </li>
<li>a strategic alliance, where a pharmacy chain, like Chemist Warehouse, has smaller versions of its stores inside a supermarket. </li>
</ul>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292346/original/file-20190913-35596-1bt65lt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In-store pharmacies might be convenient, but is that enough to convince policy makers they’re right for Australia?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacy-pickup-area-237587">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Examples of straight-out ownership include Sainsbury’s in the UK and Walmart in the US. This arrangement allows them to sell these assets at a later stage. </p>
<p>This is what happened with Sainsbury’s, which <a href="https://www.theguardian.com/business/2015/jul/29/sainsburys-sells-pharmacy-business-celesio-125m">sold its 281-store pharmacy business</a> to Celesio, the owner of the Lloyds Pharmacy chain, for £125m in 2015. Sainsbury’s indicated the move would enable further growth, while extending their pharmacy services to customers.</p>
<p>In an example of a strategic alliance, UK pharmacy chain Boots and supermarket Waitrose <a href="https://www.campaignlive.co.uk/article/experts-weigh-marketing-benefits-waitrose-boot-tie-up/941645?src_site=brandrepublic">agreed in 2009 to stock each other’s products</a>. </p>
<p><a href="https://www.boots.com/stores/6313-lichfield-waitrse-ws13-6rx">Boots supplied</a> health care, pharmaceutical products and services, like flu jabs and medical check-ups to Waitrose, and Waitrose supplied food to Boots. Pharmacies in 13 Waitrose stores were also re-branded “Boots Pharmacy”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-australian-supermarkets-continue-to-look-to-the-uk-for-leadership-71562">Why Australian supermarkets continue to look to the UK for leadership</a>
</strong>
</em>
</p>
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<p>However, existing legislation prevents either option in Australia unless changes are made in the new Community Pharmacy Agreement. This is because <a href="https://www.guild.org.au/news-events/news/forefront/v08n16/ownership-a-foundation-stone">current pharmacy ownership rules</a> prevent supermarkets or anyone (other than a pharmacist) from owning a pharmacy.</p>
<p>If ownership rules were lifted, but <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/DDB409EBB18FCE8FCA257BF0001D3C0C/$File/Pharmacy%20Location%20Rules%20Applicants%20Handbook%20December%202018.pdf">location</a> rules remained, supermarkets would be prevented from operating pharmacies opening within 1.5km of one another. </p>
<p>This means if Coles had an in-store pharmacy, then Woolworths across the road, could not operate one, and vice versa. And if there was already a pharmacy in the neighbourhood, neither could open one, even if ownership rules were relaxed. </p>
<h2>Are we set for regulation or liberalisation?</h2>
<p>The <a href="https://www.guild.org.au/">Pharmacy Guild of Australia</a>, which represents owners of community pharmacies, and the <a href="https://www.psa.org.au/">Pharmaceutical Society of Australia</a>, which represents individual pharmacists, both support current ownership rules — strong regulation over ownership and location.</p>
<p>However, pharmacy giant Chemist Warehouse and Ramsay Health Care (which owns pharmacies as well as private hospitals), <a href="http://competitionpolicyreview.gov.au/files/2015/03/Competition-policy-review-report_online.pdf">say</a> ownership rules are redundant and ineffective. And they’re not alone.</p>
<p>Critics of the current Community Pharmacy Agreement <a href="https://grattan.edu.au/wp-content/uploads/2018/05/208-2016-09-23-grattan-institute-submission.pdf">argue</a> over-regulation of pharmacies, particularly surrounding ownership and location, limits competition and growth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-right-prescription-pharmacy-sector-in-dire-need-of-reform-39642">The right prescription: pharmacy sector in dire need of reform</a>
</strong>
</em>
</p>
<hr>
<p>And in 2015 the <a href="http://competitionpolicyreview.gov.au/final-report/">Harper Report</a> into competition policy recommended:</p>
<blockquote>
<p>[…] pharmacy ownership and location rules should be removed in the long-term interests of consumers. They should be replaced with regulations to ensure access to medicines and quality of advice regarding their use that do not unduly restrict competition.</p>
</blockquote>
<p>European countries seem to be moving towards deregulation. In 2017 Italy <a href="https://www.hlregulation.com/2017/08/02/italy-opens-the-door-to-corporate-ownership-of-pharmacies-a-revolution-for-the-italian-pharma-distribution/">passed legislation</a> to allow corporate entities to own a pharmacy business, and also increased the number of pharmacies a proprietor may own.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292339/original/file-20190913-190044-1tczc4s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In the US, in-store pharmacies in supermarkets are common, convenient and can offer cheaper products. But current Australian pharmacy ownership rules ban them.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/shopping-basket-pills-concept-buying-drugs-1289871286?src=-1-2">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>So what are the impacts of deregulation? If we look at <a href="https://www.sciencedirect.com/science/article/abs/pii/S0168851009002875">evidence</a> from Europe, when the UK relaxed ownership and location rules, pharmacies operated more efficiently. Pharmacies also had more freedom to set prices for over-the-counter products and offered a wider range of services. </p>
<p>Yet, the same research also found where there was stronger regulation, such as in Spain, consumer access to pharmacy improved, as new pharmacies were opened based on geographic, demographic or needs-based criteria. Simply, if there was already one pharmacy servicing a neighbourhood, they didn’t need another.</p>
<h2>Is Australia likely to see supermarket pharmacies?</h2>
<p>Whether Australia is likely to see supermarket pharmacies any time soon is open to debate. </p>
<p>In a speech to the Pharmacy Guild’s national conference in 2019, federal health minister Greg Hunt <a href="https://www.guild.org.au/news-events/news/2019/minister-hunt-delivers-support-for-community-pharmacy">said</a> there would be no change to the ban on locating pharmacies within supermarkets.</p>
<p>However, other powerful groups are calling for change. These include the <a href="https://ama.com.au/media/new-working-group-look-pharmacy-agreement">Australian Medical Association</a>, which wants the regulations changed to allow broader ownership of pharmacy businesses.</p>
<p>If supermarkets were to guarantee <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/New-7th-Community-Pharmacy-Agreement">sufficient controls</a> — such as to ensure the safe use of medicines, staff were properly trained and there were safeguards to ensure equitable access for elderly patients, Aboriginal and Torres Strait Islander people, particularly people living in rural and remote areas — it would be hard to argue for existing rules about pharmacy ownership and location.</p>
<hr>
<p><em>Update (Sep 20, 2019): The lead author’s disclosure statement has been updated to reflect his past research in the pharmacy and supermarket sectors, as well as his past employment.</em></p><img src="https://counter.theconversation.com/content/122640/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Mortimer has conducted and published research in the pharmacy and supermarkets sectors, and for the National Retail Association. Before his academic appointment, he was employed for more than 25 years in the retail sector. His consumer behaviour research spans retail channels including supermarkets, pharmacy and off-price retailers.</span></em></p><p class="fine-print"><em><span>Louise Grimmer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If Australia follows international trends and allows supermarkets to open pharmacies, what are the effects on neighbouring pharmacies? And when does running a business mean health care suffers?Gary Mortimer, Professor of Marketing and Consumer Behaviour, Queensland University of TechnologyLouise Grimmer, Lecturer in Retail Marketing, Tasmanian School of Business and Economics, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/961142018-05-08T06:16:00Z2018-05-08T06:16:00ZGovernment decision not to ban homeopathy sales from pharmacies is a mistake<figure><img src="https://images.theconversation.com/files/218007/original/file-20180508-46356-1fu8iho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Evidence homeopathy works is pretty clear: it doesn't. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Last year <a href="http://www.health.gov.au/pharmacyreview#InterimReport">a review into pharmacy</a> in Australia recommended homeopathic products be banned from sale in chemist shops across the country. This was a sensible recommendation, given pharmacists are trusted scientists in the community and science tells us homeopathic products <a href="https://consultations.nhmrc.gov.au/public_consultations/homeopathy_health">simply don’t work</a>.</p>
<p>In the <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/7E5846EB2D7BA299CA257F5C007C0E21/$File/Pharmacy-Review-Aus-Gov-Response-3-May-2018.pdf">government’s recent response</a> to this review they “noted” the concerns of the reviewer, and have chosen not to adopt it. Here’s why that is a mistake.</p>
<h2>What is homeopathy?</h2>
<p>Homeopathy involves extreme dilution of a compound that is claimed to be therapeutically effective, and uses the concept of “like cures like”. <a href="https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368">For example</a> a fever might be treated with a compound used to induce fevers, in the belief the diluted active ingredient will have the opposite effect and cure the fever.</p>
<p>Products tend to contain the equivalent active ingredient to a single molecule within an Olympic-size swimming pool. Practitioners of fact-based medicine have understandably indicated that any effect of the product could only be attributable to the <a href="https://www.sciencedirect.com/science/article/pii/S0140673605671772">placebo</a> effect (it works because you believe it works) or because the product contains alcohol or a similar <a href="https://publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf">base</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368">No evidence homeopathy is effective: NHMRC review</a>
</strong>
</em>
</p>
<hr>
<p>Most pharmacists probably abhor such treatments lacking evidence, given they go through years of rigorous university training, are heavily regulated and have a strong professional ethic. But it makes the cash registers clang.</p>
<p>These days pharmacies also sell jelly beans, lipstick, energy bars, vitamins, teddy bears and sunglasses – as well as prescription medications. This, unfortunately, is business practice. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/discount-chemists-are-cheapening-the-quality-of-pharmacy-along-with-the-price-68744">Discount chemists are cheapening the quality of pharmacy along with the price</a>
</strong>
</em>
</p>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pharmacists are trusted scientists.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<h2>Business v health care</h2>
<p>Pharmacies have a special status as businesses, along with many actors in the health system. Successive governments have <a href="http://www.pc.gov.au/research/supporting/pharmacy-review">grappled</a> with tensions around service delivery, standards and <a href="https://www.pc.gov.au/inquiries/completed/productivity-review/report/productivity-review.pdf">competition</a>.</p>
<p>They’ve also had to grapple with a very strong industry body, the <a href="https://www.guild.org.au/">Pharmacy Guild</a> (stronger than the Pharmaceutical <a href="https://www.psa.org.au/">Society</a>). Much of the review reflects agreement between them. In responding to the review the government has flicked the homeopathic hot potato to pharmacy owners:</p>
<blockquote>
<p>Professional standards have been designed for use by individual pharmacists to assess their own professional practice. They are intended to serve as guidance for desired standards of practice. However, it is the sole responsibility of the individual pharmacist to determine, in all circumstances, whether a higher standard is required. It is equally their responsibility to meet that standard and ensure that consumers are provided with the best available information about the current evidence for, or lack-of efficacy in, offered treatments and therapies.</p>
</blockquote>
<p>So given the government has not banned homeopathic products from pharmacies, we could hope for restriction under Australian Consumer Law. They can, for example, <a href="https://www.accc.gov.au/publications/advertising-selling/advertising-and-selling-guide/avoid-misleading-or-deceptive-claims-or-conduct/misleading-or-deceptive-conduct">prohibit</a> sale of products that lack the purported constituents or qualities. But this has yet to happen with homeopathy, as it’s considered misleading but harmless.</p>
<p>The government is putting the onus on consumers to ask the pharmacist “does this work?”, and only the exceptional customer will ask. </p>
<p>If consumers wish to purchase therapies without a proven effect, they should be able to do so from venues that sell incense sticks and similar “wellness” paraphernalia. </p>
<p>They should not be available for sale in an industry necessarily regulated by government and trusted by the community. </p>
<p>It’s time for the Guild and Society to take a stand and reject sale by their members of products that by definition do not work. If pharmacies want status, they have to skip the junk products dollar. The government should help.</p>
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<a href="https://theconversation.com/pharmacists-are-trusted-medical-professionals-so-they-shouldnt-sell-remedies-that-lack-evidence-65148">Pharmacists are trusted medical professionals, so they shouldn't sell remedies that lack evidence</a>
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<img src="https://counter.theconversation.com/content/96114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A review into pharmacy practices last year recommended pharmacies stop selling ineffective remedies such as homeopathy. The government didn’t support the recommendation.Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/651482017-06-26T20:09:08Z2017-06-26T20:09:08ZPharmacists are trusted medical professionals, so they shouldn’t sell remedies that lack evidence<figure><img src="https://images.theconversation.com/files/175548/original/file-20170626-326-1vucnvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacies are trusted medical professionals, so people trust their products. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>A <a href="http://www.health.gov.au/pharmacyreview#InterimReport">government review</a> has recommended pharmacists explain to consumers the limited evidence for effectiveness of complementary medicines, and keep them in a separate area to regulated medications with proven effectiveness. The review also recommended any pharmacy that receives Commonwealth government approval to dispense PBS medicines should not be able to sell homeopathic medicines.</p>
<p>This review was commissioned by the Commonwealth government to examine the efficiency and value for money of pharmacy services and also the regulations under which pharmacies work.</p>
<p>Complementary and alternative medicines are products such as herbal medicines, dietary supplements and multivitamins, and they’re big business. A <a href="http://www.cmaustralia.org.au/resources/Documents/Reports/CMA%20Industry%20Audit%202014.pdf">2014 survey</a> found the revenue from complementary medicines in Australia exceeded A$3.5 billion and was projected to reach $4.6 billion in 2017-18. Pharmacies are a major player in sales of these products, but the exact percentage of total sales in pharmacies, compared to supermarkets and health food stores, is unclear.</p>
<p>The Pharmaceutical Society of Australia (PSA) issued a <a href="http://www.psa.org.au/downloads/ent/uploads/filebase/policies/position-statement-complementary-medicines.pdf">position statement</a> on complementary medicines in 2015. It highlighted the variable evidence and encourages pharmacists to assist consumers’ decision making by discussing the relevant evidence.</p>
<p>The PSA position statement says they do not support the sale of homeopathic products, but stops short of recommending pharmacists do not sell them. Homeopathic products are different from regular medicines. Homeopathy follows a principal of extreme dilution: a substance is chosen to cure an ill, and then the substance is diluted. The vessel containing the substance is then physically hit against a book or other object. There is no reputable evidence for effect from <a href="http://www.nhmrc.gov.au/guidelines-publications/cam02">these products</a>.</p>
<p>The Royal Australian College of General Practitioners (RACGP) was stronger in their <a href="http://www.racgp.org.au/download/Documents/Policies/Health%20systems/PPI-PositionStatement-Homeopathy-v1.pdf">2015 position statement</a> to their members, which said medical practitioners should not recommend these products and pharmacists should not sell them.</p>
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<a href="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The review has recommended alternative medicines be kept separate to regulated medicines so consumers know there’s a difference.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<h2>What these mean for consumers</h2>
<p>The review’s recommendations should increase the information available to consumers to assist them in making an informed purchase. The changes should also educate consumers about the process by which complementary medicine products are assessed by the Therapeutics Goods Administration (TGA) before they can be sold on the Australian market.</p>
<p>Just like any other medicine, consumers should ask at the point of purchase about the evidence for the claims made and any potential side effects and interactions. If these questions cannot be answered (or there is no one to ask), go to another store where they are willing to provide answers and even written information to support those answers.</p>
<p>A ban on homeopathic products would be a positive change for the pharmacy profession. For too long pharmacists have claimed “health professional” status while functioning more like shopkeepers, primarily chasing profits. Some people claim homeopathic products are an expensive placebo and do no harm. But if the person taking the homeopathic remedy delays treatment, they can be causing harm and increasing medical costs if the condition progresses while being “treated”.</p>
<p>The PSA has not been strong enough on homeopathic products, perhaps because it is are a member-based organisation and some of its members would sell these. </p>
<p>If a product is sold by a health professional it means consumers have faith it will work. These products don’t deserve this trust, and health professionals who endorse them are putting profit before reputation. Pharmacists should only stock products with a strong evidence base.</p>
<p>Other review recommendations include:</p>
<ul>
<li><p>removing the $1 allowable discount on the PBS patient co-payment, increasing equity in PBS prices for consumers no matter where they live</p></li>
<li><p>changing the current paper Safety Net scheme (where patients have to collect a sticker for every script) into an automatic electronic recording and alert system.</p></li>
</ul>
<p>It’s important to note the review is not yet finalised – this release is an interim report and is <a href="http://www.health.gov.au/pharmacyreview#InterimReport">available for public comment</a> until 23 July 2017. There are almost 50 “options” on which comments are sought.</p><img src="https://counter.theconversation.com/content/65148/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A review has recommended separating pharmacists from complementary and homeopathic products.Greg Kyle, Professor of Pharmacy, Queensland University of TechnologyKatherine Browne, Associate Lecturer, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/687442016-11-17T03:25:04Z2016-11-17T03:25:04ZDiscount chemists are cheapening the quality of pharmacy along with the price<p>Every day, more discount pharmacy stores and chains are opening and assaulting health-care consumers with the “we are cheaper” message. But is price the best way to achieve positive health-care outcomes?</p>
<p>Community pharmacists are the only Australian health-care professionals to practise in a retail environment. When a patient “buys” a medication, it is easy to see how they can think they are purchasing a commodity. This perception is further fuelled by the retail and price-promotion focus by many (if not most) pharmacies.</p>
<p>Multiple times each week, I receive a pharmacy sale catalogue in my mailbox. Yes, it has the vitamins and complementary medicines, the perfumes and general retail lines like soaps and so on, but it also contains an array of medicines that are promoted as cheaply priced.</p>
<p>There’s a tension between the three major players in this space: consumers, pharmacy owners, and the health system.</p>
<h2>Consumers</h2>
<p>From a consumer perspective, anything that reduces the cost of an item is good. Cost of living is increasing, and everyone is looking for the next bargain. Price can be a huge motivator in driving purchasing behaviour and just about every retail outlet knows this and uses it to attract customers.</p>
<p>Many discount chains have large amounts of signage dedicated to giving the perception they are the cheapest, and if not, they will beat any competitor. This can attract customers for specific products they are seeking – usually products for a specific need, or high use items.</p>
<h2>Pharmacy owners</h2>
<p>Pharmacy owners are in business, and they need to make a profit or their business will fail and close. The profit they extract from each sale provides all the business costs (rent, electricity, staff, wholesale cost of products) and also a return for the owner. </p>
<p>Therefore, the owner will try to maximise profit at every opportunity. This can be achieved by reducing costs or increasing selling prices of goods. This is true for any pharmacy owner, not just discounters. However, discount pharmacies generate the perception they are cheaper, so something has to give.</p>
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<span class="caption">Medicines shouldn’t be a commodity.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/fran001/15670055963/">Francisco Anzola/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Some of the things targeted for cost reduction by pharmacies can be:</p>
<ul>
<li><p><strong>Staff</strong>: pharmacists cost more per hour than pharmacy assistants, so minimising pharmacists and using pharmacy assistants can increase profits. Getting pharmacy assistants to do some of the tasks usually left up to pharmacists, such as providing patient information and answering questions, can also cut costs.</p></li>
<li><p><strong>“Non-billable” time</strong>: every time an employee is talking with a customer, that time has a cost (wages), but no direct return. If a product is sold, the hope is that the profit generated will reimburse the pharmacy for the time spent generating that sale. To address this, pharmacies can reduce the need for expensive staff to be involved in every purchase. Information is usually given with prescription and over-the-counter medicines. While private questions and information would be ideally shared in a private consulting room, this increases time per transaction. Whereas using a predominantly open segregated counter can reduce the questions asked and information sought – again reducing time.</p></li>
<li><p><strong>Low-priced common items</strong>: consumers do not remember the price of every item, but they know the prices of things they buy commonly. Many discount pharmacies will determine these products and have their “top list” of 100, 150 or 200 items. These will be regarded as “loss leaders” and will be very competitively priced, whereas other products will have higher margins to subsidise the loss leader price reductions. If a consumer does happen to notice this, a price reduction on a single sale does not jeopardise the profit on the other sales made off that product.</p></li>
</ul>
<h2>Health system perspective</h2>
<p>The health system aims to provide a high level of care for the most people possible at an affordable cost. Pharmacy owners will say the system doesn’t pay them enough to perform a variety of tasks. Consumers will say they pay too much out of pocket and the system should pay more. The system tries to maintain a balance between the two.</p>
<p>Discount pharmacies are driving down prices for a variety of non-prescription medicines and the government de-listed some medications it used to subsidise, saying their cost was the same or lower without a prescription. This makes price a factor and further leads to medicines having a perceived value in the consumer’s mind.</p>
<p>The health system deals with more than 200,000 hospital admissions each year (<a href="https://safetyandquality.gov.au/wp-content/uploads/2013/08/Literature-Review-Medication-Safety-in-Australia-2013.pdf">costing over A$1 billion</a>), and <a href="https://safetyandquality.gov.au/wp-content/uploads/2013/08/Literature-Review-Medication-Safety-in-Australia-2013.pdf">at least half are preventable</a>. </p>
<p>Medicines are the most cost effective and easiest to administer health intervention. Therefore the health system wants to ensure the Australian policy on quality use of medicines is followed to maximise the benefits for the patient and the budget, and minimise the harms.</p>
<h2>Race to the bottom in price and quality</h2>
<p>Our pharmacy system is built around a retail entity where the income is derived from selling a product, not advice. Today’s pharmacy retail model is becoming a “race to the bottom” on price. </p>
<p>Pharmacies that give advice when selling a product, and have appropriate staffing levels to maximise health-care outcomes, are becoming rare as consumers follow the price to the bottom. </p>
<p>The problem with such medication consumerism is it increases the risk of medicines-related harm. Consumers should always ask questions about their medicines regardless of the type of pharmacy where they buy them. If your pharmacist doesn’t answer your questions to your satisfaction – go to a pharmacy that will.</p><img src="https://counter.theconversation.com/content/68744/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Greg Kyle is a member of the Pharmaceutical Society of Australia. </span></em></p>Every day, more discount pharmacy stores and chains are opening and assaulting health-care consumers with the “we are cheaper” message.Greg Kyle, Professor of Pharmacy, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.