Australia’s first comprehensive pharmacy review in two decades, released this week, asks the important question:
“Is it confusing for patients if non-evidence based therapies are sold alongside prescription medicines?”
Let me save the reviewers some trouble: the answer is “yes”.
The harder question, of course, is “What, if anything, should be done about it at a regulatory level?” I don’t pretend to have an answer, but doing nothing at all will be a poor outcome for consumers.
The Review of Pharmacy Remuneration and Regulation (the ‘King review’) can be found here (pdf).
I spend a lot of effort highlighting potential conflicts of interest when it comes to doctors’ prescription decisions being swayed by marketing rather than evidence. But this is merely fine-tuning within a system already ensuring most doctors gain no direct financial reward.
The community pharmacy model is, necessarily, far more prone to financial conflicts of interest. Arguably, this could loosely apply to any business with a cash register, but the health industry requires particularly careful oversight.
“Would you like supplements with that?”
A teenager suggesting you upsize your fries is just clever marketing, but a health professional asking if you’d like a bottle of supplements with your prescription warrants scrutiny at a broader level.
Unbeknown to the consumer, those pills may contain substances which have not been shown to work (vitamin supplements in most circumstances), or even worse, have actually been shown NOT to work (homeopathy in all circumstances).
Where there’s a market, there’s a seller, of course; nothing wrong with that. But the issue is that this seller might potentially leverage their well-deserved respect as a medicines expert, and use it to sell a product which will not improve health. This situation, while often handled well by the pharmacist, is intrinsically vulnerable to a conflict of interest, and therefore worth reviewing.
Most employed community pharmacists I speak to (admittedly a biased sample) consider this aspect of their work somewhat distasteful – they are intelligent folk who entered a science-based profession.
And many of their pharmacy bosses genuinely struggle in the knowledge that their business viability relies on a turnover of non-evidence based products.
But lost somewhere in this current financial model are consumers, who are at risk. For prescription medicines, they have good reason to trust the advice of the expert, but they may be unaware of the inherent potential conflict as they walk towards the non-evidence-based shelves.
Individual pharmacists already successfully deal with this risk, but regulation applying to everyone would be fairer.