May 14 Artlicle

If you look like a duck…….

..Then be ready to called a quack!

When you look around your pharmacy today just ask yourself a question. How many of the “medicines” on your shelves “work” on a basis of belief rather than good scientific evidence.
A few years ago for a joke I posted a spoof ad for a weight loss meal replacement shake on my blog. At that time I suggested using McDonald’s Milk Shakes as a meal replacement. Then right on cue Boots announced their partnership with Tony Ferguson and his meal replacement system. And frankly I think that my spoof was more nutritious. It certainly had a better taste. To bring it up to date we now have NuPo weight loss “system”. Essentially a different meal replacement milk shake. Then I got to thinking. This is always a dangerous thing. Just how many quack preparations are being sold in Irish pharmacies?
Weight loss products are probably one of the biggest turnover wise. They are certainly the most “in your face” if going only by the number of banner sized posters that I see in pharmacy windows. The meal replacement shakes are only part of this. There are no end of vitamin or supplement type products which claim to help you lose weight. There seems to be a new one every week. But the problem for pharmacists is how much of our credibility are we losing by promoting these products? We put ourselves forward as professional experts on medicines and yet many of us are willing to stand over and endorse quackery. In many cases the only “evidence” for the efficacy of these are the claims printed on the packaging.
It is not only the weight loss products which undermine our credibility. You can throw into the mix that once these products have become established they will be launched into the general retail trade. At least if you are going to recommend and build up a product you should do it with one that will remain confined to pharmacy.

Homoeopathy is the other biggie. I know that it has been a long time since I was in college but if my recollection is correct we were told nothing about the memory properties of water. We were told about properly conducted clinical trials and I have yet to hear of any properly run trial which has proved any homoeopathic preparation to be of any efficacy.
The other current fad seems to be for detox regimes. These range from the harmless (and useless) detox patches to what are effectively laxatives. I have also heard of one pharmacy that has a salon attached which carries out colonic irrigation. At least the worst the detox patches can do is a contact allergy to the adhesive. Unfortunately the same cannot be said of many other alternative treatments. To date we have not had a case as bad as the Australian couple who were found guilty of the manslaughter of their 4 month old daughter. The husband, a lecturer in homoeopathy, has treated her eczema with homoeopathy rather than conventional medicine. By the time that she taken to hospital her corneas were beginning to melt as a result of infections. Sadly she died three days later.
This belief in alternative medicine is akin to a religious belief. Could it be that as a society our loss of faith in the church is now being replaced by a faith in quackery and expensive marketing campaigns. It certainly harkens back to the days when the most effective contraceptive available in Ireland was saying a Novena when your period was due.
Now can you visualize the scene at a meeting between the IPU and the Dept. of Health or the HSE. The IPU try to convince the Dept to roll out a minor illness scheme. “We are the experts in dealing with minor illnesses. We know all the drugs and their appropriate use.” And then some smart ass on the other side of the table would comment “Which homoeopathic preparation would you be recommending for indigestion?” We do not lend our credibility to these products, we give it to them. It has taken pharmacists a long long time to earn this credibility and here we are throwing it around like snuff at a wake.
Before you start to assail me for my view do not take the above as an attack on complementary medicine. I differentiate between alternative and complementary. I have no real problems with herbal medicine for instance. There is plenty of good evidence of the medicinal properties of many herbs. There is also plenty of exaggerated claims for some herbs especially in the weight loss area. And what better place to be informed and educated about herbs then in the pharmacy. We have a wealth of information from our years spent studying medicinal plants. The very least that we could do is to guide them away from those which can cause harm and those being sold on the basis of exaggerated claims.
So what to do? My preferred option is the one that I have taken myself. I just don’t stock them. This is easy for me as I started in a greenfield situation. When asked about it by customers I just say that I don’t stock them. Long ago I would have a discussion on why I don’t believe in them but I got tired of the responses that treated me as the odd ball because I didn’t believe that sugar pills could cure cancer or autism. Those with an established business are not so fortunate. My preferred option in this case would be to stop recommending them. All of this pre-supposes that the pharmacist has the final say in the matter. Spare a thought here for the employee pharmacists. I have been made aware of a situation which occurred in a branch of a pharmacy chain based in the south east. The employee pharmacist in question was reprimanded because they would not recommend a detox patch to one of the companies mystery shoppers. What hope is there for ethical pharmacy in that chain?

If we want to be taken seriously and treated as professionals then we must behave like professionals. If we behave like charlatans then we can keep on quacking.


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