Doctors and pharmacists clash over complementary medicines

Ann Privett, partner at the Unichem Pharmacy in Miramar, Wellington, believes complementary medicines have a place in ...
MAARTEN HOLL/FAIRFAX NZ

Ann Privett, partner at the Unichem Pharmacy in Miramar, Wellington, believes complementary medicines have a place in pharmacies, even if they only provide a placebo effect.

Pharmacists want more freedom to sell homeopathic and herbal treatments, even when there is no evidence they will help patients.

A proposed tweak in the Pharmacy Council's code of ethics on complementary medicines, such as homeopathy or health supplements, has sparked vigorous protest from doctors.

The debate focuses on whether the obligations to protect patients from bogus remedies trumps the patient's rights to decide their own treatment.

The changes proposed by the Pharmacy Council would remove the obligation for pharmacists to only sell complementary medicine where there "is credible evidence of efficacy", in other word where there is substantial evidence showing the medicine does what it says on the box.

Instead, pharmacists would only have to provide customers with information about a medication's "risks and benefits" and whether better alternative treatments are available. Pharmacists should still not "promote" ineffective complementary medicine, and needed to be confident it was safe, but they could sell it.

"Pharmacists must ... respect patients' rights to freedom of choice or autonomy in relation to their treatment options."

But Dr Kate Baddock, chairwoman of the New Zealand Medical Association's GP council, said pharmacists were health professionals and shouldn't be offering products they knew didn't work.

"I think its a fine line between selling these products and promoting them," she said.

"If you're selling something with credible evidence and right beside it you're selling something without credible evidence, the edges are always going to blur."

The proposed changes would send a signal to pharmacists that it was ethically acceptable to sell ineffective products, resulting in more of them on the shelves, she said.

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"It ups the ability to sell more products, whether there is a commercial imperative there, you'd have to ask pharmacists."

But Pharmacy Council chairman Dr Andrew Bary said the rules as they stood were "unworkable" and many pharmacists, including himself, were already selling complementary medicines, even if they didn't believe their claims.

The proposed changes would strengthen pharmacists' obligation to tell the patients if a pill, supplement or ointment didn't work while retaining patients' right to choose it anyway.

"There seems to be some anxiety that pharmacists will be prescribing homeopathy and herbal remedies but that's just not the case," he said.

"What we [the council] can't do is direct which products are fit for the shelves." 

Ann Privett, partner at the Unichem Pharmacy in Miramar, Wellington, said she sold homeopathic remedies and herbal supplements with no scientific evidence proving they worked.

Any customers requesting these products were told they wouldn't do anything medically. However, some chose to buy them anyway and still believed they worked.

"Some people find a particular product works for them even though the science isn't there," she said.

"If it makes them them think they feel better, and it's not doing any harm, that is still a benefit."

Removing complementary medicines from pharmacies would just drive customers to less reputable sources, paying too much for mythic cures that could actually put them at risk.

"At least in the pharmacy they get the right information."

Submissions on the proposed change close on Thursday.

WHAT ARE COMPLEMENTARY MEDICINES?

Complementary medicines cover anything intended to be taken alongside conventional medicines. They include homeopathy, naturopathy, Chinese medicine, mineral or herbal supplements, and active therapies such as acupuncture.

By definition, complementary medicines have not been through the same randomised trials that conventional medicine must pass before being approved for use and, for many, the evidence of their effectiveness is contested.

In March, an Australian National Health and Medical Research Council review of 1800 studies of homeopathic therapies, sold in many pharmacies here, found there was "no good quality evidence to support the claim that homeopathy works better than a placebo".

Detractors of complementary medicine claim that not only do they not work but they are dangerous. They can interfere with conventional medicines' effectiveness and, in extreme examples, can be used as an ineffective substitute, leading people to forego potentially life-saving treatment.

Supporters counter that in practise complementary medicine do help individuals' health, without the side effects associated with invasive conventional treatments, and clinical trials are an inappropriate was to measure their effectiveness.

Even if they don't work, it has been argued complementary medicines are harmless and their positive "placebo effect" have a legitimate place in the treatment of some patients.

 - Stuff

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