A recent tweet by Kelly Grindrod drew our attention to an interesting topic regarding pharmacies selling natural health products (NHPs) and dietary supplements (DSs). Kelly points to a meta-study published in the International Journal of Pharmacy Practice (IJPP) that seeks to review existing literature for issues related to pharmacies selling such products.
The study notes two major ethical issues with the sale of NHPs/DSs. The first one is concerned with the fact that although consumer demand for such products is increasing and pharmacists clearly have a responsibility to provide qualified information on such products and detect and prevent interactions between NHPs/DSs and conventional medications, considering that in 16% of cases NHPs/DSs are being used in conjunction with prescription drugs, the pharmacists themselves seem not to be taking these product categories seriously enough, with around half of the pharmacists surveyed agreeing with the statement, ‘herbal medicines are not accepted by the majority of my colleagues’ and only a quarter agreeing with the statement ‘herbs are efficacious’. Such attitudes invariably lead to lack of sufficient knowledge about them to allow the pharmacist to counsel the patients appropriately.
These findigs however must be qualified with the fact that NHPs/DSs are fairly new additions to the responsibility of the pharmacist, with dietary supplements being formally recognized only since 1994 in the USA and natural health products being recognized in Canada since 2004. It stands to reason that the increasing role of these products and alternative therapies is now being integrated into pharmacy teaching and that future pharmacists will have far higher knowledge of these products and will be able to provide patients with the appropriate level of counsel.
The second issue that is mentioned is the fact that pharmacies are willing to sell products “for which there is no scientific evidence of effectiveness or safety” suggesting that a profit motive is the main factor at play here. Well this second issue is not an easy one - on the one hand it’s true that private pharmacies are profit seeking entities just like any other retail outlet and as such are seeking to sell as much product as possible (a conflict of interests prevalent in most of the pharma/healthcare industry). On the other hand it’s not the pharmacies which are responsible for allowing products with little or no efficacy or safety information onto the market. If the national health regulators of a country approve a product for market, with its corresponding health claims, it should not be the job of the pharmacist to second guess these approvals. If a product is lacking enough information about safety or interactions, it should not have been allowed on the market in the first place. The fact that it has been allowed should mean that pharmacies are absolved of ethical issues in selling it.
Having said that, we have ourselves encountered situations where our better judgement has prevented us from allowing products to be offered on our online stores, despite these products being approved by the health authorities. In specific, despite that most of our partner pharmacies carry homeopathic remedies in their stocks, we have restricted the sale of such products because our conclusion was that there is clear evidence that homeopathic remedies can not have any clinical effect except perhaps as a placebo.
Nonetheless, if there is any blame or ethical question to be placed for the sale of such products, then it should squarely rest with the health authorities that approved the products for sale in the first place. All of this however is rather amusing when placed into the wider context which is that in the US, you don’t even need a pharmacist to sell products with far stronger active pharmaceutical ingredients than anything found in a NHP/DS - you can just buy your OTC meds in the supermarket, gas station or kiosk ! Now that’s really ethically questionable.
