16th October 2015, Volume 128 Number 1423

Benjamin B Albert, Olivia J Albert, Paul L Hofman, Alistair J Gunn, Timothy Kenealy, Wayne S Cutfield

Dear Editor,

We write to share our concern about a proposed change1 to the Code of Ethics of the Pharmacy Council of New Zealand (PCNZ),2 which would remove the requirement that health products sold by pharmacists have “credible evidence of efficacy”. As doctors, we have a keen interest in products and services sold to provide health benefits, and in particular their scientific plausibility and the evidence that they are safe and effective.

The pharmacist has an important role in the multi-disciplinary delivery of health care services. Every prescription leads the patient to an interaction with a pharmacist. Further, they are the first accessed health provider for many patients, and there is increasing emphasis on the pharmacist’s role in diagnosis, provision of advice and education, and more recently, prescribing.

Pharmacists, like many health providers, have a conflict of interest when they sell and give advice about health products from which they make profit. There is evidence that financial pressures impact the clinical decisions of pharmacists.3 The pharmacist is trusted by patients, and other members of the scientific health care team, because of their scientific training. Many patients will assume that the pharmacist endorses the health products sold in the pharmacy as scientifically supported. But many pharmacies sell products that are known to be ineffective, such as homeopathic remedies4 or potentially harmful, such as ear candles.5 Selling such products conflicts with the principles of the current Code of Ethics2 as it reduces patient autonomy (the patient that wrongly assumes a health product is scientifically supported is ill-prepared to make an informed decision). More broadly, it tarnishes the reputation of pharmacists as a profession.

Clause 6.9 of the Code of Ethics is important, as it specifically precludes pharmacists from selling and promoting unsupported treatments:

“Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.” (emphasis added)

Unfortunately, many health products sold in pharmacies do not meet this standard. The PCNZ has identified this breach, and should enforce their ethical code. However, the current proposal would change the code so that the sale of ineffective treatments becomes permissible. The new clause (6.9b) currently under consideration states that pharmacists must:

“Only supply any complementary therapy or other healthcare product where there is no reason to doubt its quality or safety and when sufficient information about the product can be provided in order for the purchaser to make an informed choice with regard to the risks and benefits of all the available treatment options.”1

We support the idea that adequate information on complementary therapy should be provided, and that an informed patient has the right to choose remedies that have no scientific basis. However, if such remedies belong anywhere, it is in the supermarket or health food shop—not in pharmacies where the scientific mantle is tacitly cast across all products.

The proposal that the PCNZ would no longer require that health products sold by pharmacists should have “credible evidence of efficacy” would undermine the scientific basis of health treatment in New Zealand. It also risks real harm to patients, not just in terms of wasted money, but in lost opportunities to receive effective treatment. More generally, it encourages the public to believe that treatments that are unproven or entirely implausible may be relied upon. There is substantial evidence that this causes harm6.

The Chief Scientist of the Royal Pharmaceutical Society (UK) recently wrote:

“Surely it is time for pharmacists to cast homeopathy from the shelves and focus on scientifically based treatments backed by clear clinical evidence”7

Surely it is. The sale of ineffective health products as if they are effective is unethical. In this age of science, pharmacists should be outraged by the proposed change to their ethical code.

Kind Regards,

Dr Benjamin B. Albert FRACP
Paediatric Endocrinologist, Liggins Institute, University of Auckland, Auckland

Dr Olivia J. Albert FANZCA
Anaesthetist, Royal Hospital for Women, NSW, Australia

Prof Paul L. Hofman FRACP
Professor of Paediatric Endocrinology, Liggins Institute, University of Auckland, Auckland

Prof Alistair J. Gunn FRACP
Paediatric Endocrinologist and Professor of Physiology, University of Auckland,  Auckland

A/Prof Timothy Kenealy FRNZCGP
General Practitioner and Associate Professor of Integrated Care, University of Auckland, Auckland

Prof Wayne S. Cutfield FRACP
Professor of Paediatric Endocrinology, Liggins Institute, University of Auckland, Auckland

Author Information

Dr Benjamin B. Albert, FRACP, Paediatric Endocrinologist, Liggins Institute, University of Auckland, Auckland; Dr Olivia J. Albert, FANZCA, Anaesthetist, Royal Hospital for Women, NSW, Australia; Prof Paul L. Hofman, FRACP, Professor of Paediatric Endocrinology, Liggins Institute, University of Auckland, Auckland; Prof Alistair J. Gunn, FRACP, Paediatric Endocrinologist and Professor of Physiology, University of Auckland, Auckland; A/Prof Timothy Kenealy, FRNZCGP,General Practitioner and Associate Professor of Integrated Care, University of Auckland, Auckland; Prof Wayne S. Cutfield, FRACP,  Professor of Paediatric Endocrinology, Liggins Institute, University of Auckland, Auckland.

Correspondence

Dr Benjamin B. Albert, FRACP, Paediatric Endocrinologist, Liggins Institute, University of Auckland, Auckland

Correspondence Email

b.albert@auckland.ac.nz

References

  1. Bary A. Consultation document: proposed supplementary wording to clause 6.9 of the Code of Ethics 2011: Pharmacy Council of New Zealand; 2015 [cited 2015 17 September]. Available from: http://www.pharmacycouncil.org.nz/cms_show_download.php?id=582.
  2. Zealand PCoN. Code of ethics 2011: Pharmacy Council of New Zealand; 2011 [cited 1015 17 September]. Available from: http://www.pharmacycouncil.org.nz/cms_show_download.php?id=200.
  3. Chaar B, Brien Ja, Krass I. Professional ethics in pharmacy: the Australian experience. International Journal of Pharmacy Practice. 2005;13(3):195-204.
  4. Ernst E. A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol. 2002;54(6):577-82.
  5. Seely DR, Quigley SM, Langman AW. Ear Candles-Efficacy and Safety. The Laryngoscope. 1996;106(10):1226-9.
  6. Anonymous. Whats the harm? 2015 [cited 2015 17 September]. Available from: http://www.whatstheharm.net.
  7. Lawrence J. Homeopathy - should pharmacists be selling homeopathic products? : Royal Pharmaceutical Society; 2015 [cited 2015 17 September]. Available from: http://blog.rpharms.com/england/2015/06/17/homeopathy-should-pharmacists-be-selling- homeopathic-products/.