Over a number of years I have been involved in some attempts to limit the effect of quackery in pharmacy, speaking at the British Science Festival at a Royal Pharmaceutical Society debate, speaking out about the regulation of homeopathic pharmacies, and trying in the past to change the Royal Pharmaceutical Society’s position on homeopathy at the branch representatives meeting in 2009. We lost at the latter debate, but in the end the Royal Pharmaceutical Society’s position did change as the picture at the top of this blogpost shows. The regulator for pharmacy that arose from the old Royal Pharmaceutical Society, the GPhC, has however had it’s problems policing homeopaths within the profession. I’ve been critical of homeopathy for the ten years this blog has been running, and I hope no one who has been educated by me has ever been left with any impression that there is evidence that homeopathy works. I am no apologist for quackery of any kind, and that extends to OTC medication of dubious value.
I’ve often cited Dr Edzard Ernst, either his papers, or his excellent book that he published with Simon Singh. He has just put up a blog post titled ‘Pharmacists should finally get their act together…or lose credibility‘. I don’t disagree with the vast majority of it, and the study of pharmacy student attitudes the article draws upon (covered in depth at Science Based Pharmacy) is even more interesting when compared to the UK. In the US Pharmacy students have to complete 2 years of post secondary education, in the UK most students arrive directly from secondary education. It would be interesting to see if those two years (presumably largely science-based) are beneficial or not in this context.
The substantial point of Ernst’s post is the need to change retail pharmacy, and I assume across the planet since my experience of visiting pharmacies seems to show the problem is not confined to the US or the UK (certainly French pharmacies seem particularly bad), but how I wish he could try a little more to sway pharmacists with persuasion rather than beating them over the head with a stick. Ernst has a fairly low opinion of pharmacists, ‘I find the overwhelmingly positive views of pharmacists on even over quackery quite troubling.’, ‘One of the few critical pharmacists’, ‘pharmacists who sell bogus remedies, i.e. virtually all retail pharmacists‘, and ‘too many pharmacists are doing very nicely with fooling their customers into buying expensive rubbish‘. He also says that pharmacists are not forced to work for companies that break the ethical code of their profession. Given the state of the pharmacy job market at present, justifying to one’s family, and mortgage provider, that you’ve resigned your post on the principle of the availability of the ludicrous Bache Rescue Remedy on a shelf (that you’d never recommend) is not an appealing option to most rational pharmacists.
Most of the work that UK community pharmacists carry out is NHS-based and therefore in the arena of evidence-based medicine (in so far as we are all fighting to do our best there). Most pharmacists are far more likely to be passive actors in this area, just far too busy keeping their head above water, being pummelled with MUR targets, running vaccine clinics, with ever increasing script numbers, and sometimes with inadequate staffing levels. To them, maintaining the safe supply of prescribed medicines is probably a hard enough job, without taking on another battle with management over homeopathy (and sometimes customers) they don’t even have time to recommend even if they were pro-homeopathy. While the continued availability of homeopathy in pharmacies may be the most important thing about pharmacy to a skeptic, to the average pharmacist it probably isn’t even something they routinely see in their practice. Beating pharmacists over the head again, aping the management that forces the quackery on them in the first place, will just make them disengage from the arguments, rather than taking them up. Let’s build a rational coalition between pharmacists and those parts of the skeptic movement that actually want to help change things.
Of the 4 arguments used to defend the current status quo of homeopathy in pharmacy Ernst cites, I’d agree with with him that 3 of them can be rightly dismissed, but the first is defendable.
those working in retail chains cannot do anything about this situation; head office decides what is sold on their premises and what not
There are pharmacists already locked in disputes about more fundamental employment rights, they seriously haven’t got the mental energy as individuals to start another battle in this toxic environment. This is something that needs to be dealt with at a regulatory and professional body by the whole profession, and I am certain we have the majority of the UK pharmacy profession on side.
Ernst also says ‘when eventually something does happen, it will almost certainly be a slow and long process until quackery has been fully expelled from retail pharmacies.’ I’d disagree with the first part, things are already happening. Compared to 5 years ago, we now have our key professional body specifically stating that ‘pharmacists should advise on the lack of evidence on the efficacy of homeopathic products’ and that ‘there is no evidence to support the clinical efficacy of homeopathic products beyond a placebo effect, and no scientific basis for homeopathy.’ This is a vast improvement, but I agree with Ernst that a complete change will be a slow and long process, just as it will be in eradicating homeopathic prescribing and acupuncture referrals by General Practitioners.
I’d like to set out a number of things pharmacists can do to improve matters further:
- Pharmacists involved in education at any level from counter assistants, to pre-reg tutors, to academics in Schools of Pharmacy can ensure that teaching is evidence-based, perhaps using quackery as examples of how to think critically or apply concepts of evidence-based medicine, rather than as distinct subjects. There should be no differences in standards between teaching about homeopathy in back pain and ACE inhibitors in heart failure.
- Pharmacists in all branches of the profession should lobby their professional body (the RPS) and any other pharmacy organisations they are members of to have a strong policy on non-evidence-based, anti-science treatments, and if such a policy already exists seek to ensure that policy is propagated when opportunities arise.
- Pharmacists and pharmacist organisations need to put further pressure on the pharmacy regulator to have a stronger stance on unprofessional behaviour in relation to quackery provided by pharmacies. How is it possible to have a homeopathic pharmacy registered by the GPhC? It is a contradiction in terms.
- Professional bodies need to send strong messages to pharmacy contractors that selling quackery is as inappropriate as the sale of cigarettes in pharmacies. While it is hard for individual pharmacists to change company stocking policies, pressure from professional bodies should be possible.
- Take personal responsibility. Don’t recommend this junk, you have a four year science degree, not a certificate a cat can get. If your store does stock this material, have you tried asking if it can be removed? If they say, it can’t, perhaps in your role as the responsible pharmacist you can tell counter staff that it shouldn’t be sold without your intervention when you are in (and make evidence-based recommendations to patients who do want to buy it). I wouldn’t advice on anyone walking out on a job over this issue (and it is sanctimonious bullshit to suggest they ought to), but you can at least hold your head high that you aren’t contributing to the problem.