Australasian Science: Australia's authority on science since 1938

A Pharmacist’s View of the “Natural” Route to Health

By Ian Carr

A growing tendency to sell and even promote alternative remedies and “natural” supplements is putting the reputation of pharmacists at risk, and adding to the burgeoning health costs of the nation.

“No matter how cynical you become, it’s never enough to keep up.”
– Lily Tomlin

When I started my career in 1980 working for a major pharmacy chain, vitamin profits were seen to be a major contributor to front-of-shop viability. Before the formalisation of the concept of “evidence-based medicine” there did not seem to be much harm in persuading our clients to buy and ingest large (often unnatural) quantities of “natural” substances. The result was presumably a placebo feeling of “wellness” and the production of expensive, vitamin-enriched urine.

Recently I had the opportunity to interact with some final-year pharmacy students at a university-sponsored mentoring event. The clinical skills of the students consistently impressed me: less so did the attitudes of some mentors, who were still loudly insisting that the vitamin department was the key area of growth, and the key to financial success.

Today’s pharmacy student is given a world-class grounding in the science of medicine, only to be spat out into a commercial environment where their clinical skills and opinions are often made irrelevant or compromised, the prestige of their degree helping to legitimise dubious and fraudulent products.

In previous decades, finding unbiased evidence on complementary and alternative medicines (CAMs) was difficult, frustrating and sometimes impossible. For every fad disproven or panacea debunked, a new miracle cure would immediately arise.

In 2014 we pharmacists have no excuse: excellent databases and easy access to clinical trials are as close as a computer or smartphone. Indeed, since the advent of internet communication, the existence of a fervent, growing international community of sceptics and science campaigners is steadily exposing the frequent irrationality of CAM and questioning its place in public policy.

Here are a few thoughts engendered by my professional considerations of CAM:

  • “Natural”. Is it not ironic that vaccination – a natural process whereby our bodies create antibodies and which has arguably saved more lives than any other single health measure – is targeted for resistance while the billion-dollar supplements industry, largely owned by big pharma, persuades us that taking the good stuff out of food and packaging it in plastic bottles is the “natural” road to wellness? CAMmers, it is due largely to science that the cousin who died in childhood or faced a life crippled by polio is now unknown to most of us.
  • “Support”. Many products claim to “support” our immune system, our cardiovascular system, our brain function. Before CAM, these supportive substances were known as food. As copious research has shown, the ingestion of a variety of quality food is usually the only support we require.
  • A tip: when reading vitamin product labels, mentally replace the words “may assist” with “may not assist” or “probably won’t assist”. You may well be closer to the truth of the claim.
  • “Clinically Proven”. Without tertiary level statistics or training in the interpretation of clinical trials, it is probably best to ignore this labelling altogether. If there is robust clinical proof we are probably dealing with a real medicine.

Faced with a typical pharmacy’s vitamin section, stocked to the ceiling with hundreds if not thousands of items, ask yourself this: exactly which supplements do I not need? Would anyone honestly tell me I did not need one? Is there such a thing as over-antioxidation? (I suspect there may well be.) Do I start with one supplement, and add one every week until I have no more capacity to dose? How will I know when I have achieved complete wellness?

Here’s your homework. Go to your local pharmacy, select a CAM product (especially something homoeopathic) and ask the pharmacist: “What is the evidence that this works?” Do not accept attempts at diversion like: “People tell me it works for them”.

Those of you who, like me, are supporters of science in medicine must let the pharmacy industry know that it is being watched by us, and will be held to account.

Ian Carr is a community pharmacist practising in Taree, NSW. He does not allow his pharmacy to stock homoeopathy, magic diet pills, detoxifiers or ear candles, and recommends supplements only where evidence is conclusive: that is, very rarely.