Pressure on pharmacies from changes to the Pharmaceutical Benefits Scheme and ‘big box’ discount retailers has led to an explosion in the sale of vitamins and supplements. Yet many of these products are unproven at best and their sale could conflict with pharmacists’ role as health professionals. Ann Arnold investigates.
The pharmaceutical establishment is fighting a turf war with doctors—pharmacists want to offer more clinical services—but their pitch to be taken seriously as health professionals is at risk.
The booming vitamins and supplements industry is a lucrative income stream for pharmacies. But there is, at best, mixed evidence for many of these products. Some pills and supplements have never been independently tested, even to check their contents. The Therapeutic Goods Administration takes manufacturers at their word when it comes to ingredients. Follow up checks are only completed in some cases.
It makes us look like a bunch of retailers, but we should be a bunch of professionals doing the right thing by everybody.GEOFF MARCH, PROFESSIONAL PHARMACISTS AUSTRALIA
Geoff March is a lecturer in pharmacy practice at the University of South Australia, and president of Professional Pharmacists Australia.
‘I’m concerned that pharmacies are selling a lot of products where there is no evidence for the claims that are suggested,’ March says.
Pharmacists’ willingness to make those sales—or simply permit them at their store—diminishes their credibility in March’s eyes.
‘It makes us look like a bunch of retailers,’ he says, ‘but we should be a bunch of professionals doing the right thing by everybody.’
A Background Briefing investigation has found that on the pharmacy floor, complementary health products are often sold with no mention of whether their supposed benefits are backed by evidence.
In over a dozen pharmacies in two cities, we observed people shopping for complementary health products; most do not seek the opinion of the pharmacist, they simply load their baskets with often discounted items.
When a pharmacist’s advice was requested it was usually available—although some pharmacists could offer little information about some products. Most staff—both pharmacists and shop assistants—simply read from the labels, which under TGA regulations about not over-promising, generally use vague language like ‘can help’ and ‘may preserve’.
In a Roy Morgan survey last year, pharmacists were named the most trusted profession. Some are now worried that that reputation is on the line.
Adam Phillips, a pharmacy industry leader and an advisor to the Therapeutic Goods Administration on the safety of medicines, is troubled by the current direction his industry is taking.
Standing in a suburban Adelaide pharmacy puzzling over a container of pills, he says: ‘So the claim on this bottle is that the vitamin B3 will release energy from blood, the 3 being nicotinamide. I don’t believe that would be the reality for the majority of healthy people. I actually don’t understand that claim on the bottle that well myself.’
Releasing energy from the blood is not exactly scientific language, he suggests.
‘I don’t think this product would really be sellable on an evidence platform.’
He spots another item: ‘So, “liver detox”. In this case we have a product that claims to support liver health and it helps relieve indigestion and bloating. But of course the name of that—liver detox—is quite a strange concept from a physiological point of view, given that’s what the liver does anyway.’
Phillips, however, argues that pharmacies should still be able to sell supplements, so long as they provide advice to consumers.
Complementary medicines should be treated like other therapeutic items and displayed close to the pharmacist, he says. The pharmacist should come out from behind the counter and spend time on the floor advising people.
Some pharmacies overtly pursue high sales of vitamins and supplements. Nine years ago the federal government changed PBS rules, effectively reducing the profit that pharmacists could make selling prescription drugs. This made retail sales much more important for pharmacies.
‘Big box’ chain stores like Chemist Warehouse and Chem-mart have shaken up the industry even further with their bulk, discounted retail offers—especially for vitamins and supplements.
The federal government is now pouring an extra $2.4 billion into community pharmacies, under last year’s five year Community Pharmacy Agreement. The Pharmacy Guild, which represents employer pharmacists, negotiated the agreement.
No-one from the Guild was available for interview, but a spokesman pointed Background Briefing to a position statement on complementary medicines, which said pharmacists should provide evidence-based advice only. The spokesman said the Guild was not a regulatory body, so could only provide guidance.
In the meantime, in stores where pharmacists are barely visible behind long rows of supplements, you might instead get your advice from an in-store naturopath. And she might tell you, as she did this reporter, that bilberry is good for your eyes, because bilberry is blue, which means it’s good for your upper head area.
‘Because if you look at it in terms of your chakras, and the colours that move up, your purple blue colour is in your head area.’
PSA is the peak national professional pharmacy organisation representing Australia’s 29,000 pharmacists. This is their position statement on complementary medicines.
Hear Ann Arnolds full investigation into the Australian pharmacy industry on Background Briefing at 8:05am on Sunday. Subscribe to Background Briefing on iTunes, ABC Radio or your favourite podcasting app.