Australasian Science: Australia's authority on science since 1938

Eye of Newt and Toe of Frog

By John Dwyer

Modern pharmacology is among the most rigorous of sciences. After all, the health of millions depends on pharmacologists getting it right, but what has happened to those who dispense those products – the men and woman of modern pharmacy?

In my neighbourhood pharmacy, a large window display explains the amazing benefits of a “DETOX” preparation that will cleanse all the impurities from your body and give you a fresh start “for a healthier you”. Previous marketing there assured arthritis sufferers (pictured in a wheelchair) that glucosamine, combined with chondroitin, would soon have them back on the golf course despite abundant evidence that such preparations have no more than placebo value.

Fraudulent claims for this or that product providing remarkable weight loss also commonly grace these windows. This pharmacy provides free consultations with a visiting iridologist on Tuesday mornings.

How could this be? Are not the pharmacists involved graduates of a science-based program emphasising critical thinking and the need for an evidence-based approach to therapeutics? Well, yes, but you would have to conclude that commercial opportunism has these university principles safely obscured behind that shelf sagging under the weight of vitamin preparations promising to neutralise an unhealthy lifestyle.

A few years ago I shared presentations to a Pharmacy Guild meeting with a captain of the “alternative and complementary” medicines industry. He urged the assembled pharmacists to “capitalise on consumer sentiment”. He advised on store layout and even advocated a division so that all “alternative” products were displayed prominently at the front of the store.

Many pharmacists with whom I discuss these issues say that they must provide what consumers want for their business to be profitable, and that they could not survive with only their reimbursements from the Pharmaceutical Benefits Scheme (PBS). I don’t doubt that service is generally satisfactory at the “back of the store” where they fill prescriptions and answer questions, and I sympathise with the frustration caused by arguably inadequate remuneration and the increasing amount of paperwork the PBS demands, but that surely does not justify their promotion of so many products offering few, if any, health benefits.

I am sure that many consumers in Australia, as in other countries where TV advertising for non-prescription medicines is so prominent, want the $90-per-month vitamin fix that their screens promise will provide all that energy and freedom from stress, but the conundrum for our pharmacists is clear. They want to become far more heavily involved in primary health care and expand their educational role in helping to improve the health of the community. We would expect them, then, to avoid being hypocritical by telling their customers the truth about the lack of reliable evidence for the claims of the popular “alternative” products they sell.

Survey after survey reveals that nurses and pharmacists are the professionals who consumers most trust. There is therefore real potential for pharmacists to be valuable partners with other health professionals in moving our health system from a sickness-centric one to one emphasising prevention, but to do so they must become champions of the need for good science to provide confidence in the medicines they supply.

They would be helped in this if our Therapeutic Goods Administration (TGA), like the Food and Drug Administration in America, insisted that small labels be attached to the shelf where specific products are placed, indicating that each product’s claims have not been reviewed by the TGA, which therefore does not endorse them. As all therapeutic goods are meant to carry the TGA’s L number (“L” for listing), many consumers mistakenly believe that this listing means approval, an error compounded by many providers of such preparations who actually claim that this is so.

With the electronic health record slowly but assuredly coming online, pharmacists will find it easier to integrate their services with those of other health professionals and act as team members in a patient-focused way. To be trusted partners, however, they and their associations must examine how to protect their economic viability while embracing an evidence-based approach to therapeutics in which they only endorse products for which there is credible evidence for any clinical effectiveness claimed. Indeed they should be helping the public understand the need to ask any health provider to describe the evidence that supports a proposed treatment.

John Dwyer, Emeritus Professor of Medicine at the University of NSW, is an Immunologist and medical educator with a long history of involvement in efforts to protect the public from health care fraud. He is a co-founder of Friends of Science in Medicine.