First published in Crikey here
The recent deal between the Pharmacy Guild and complementary medicine manufacturer Blackmores has raised the ire of both doctors and consumer groups.
The Pharmacy Guild has signed a deal with Blackmores to include an automatic prompt for pharmacists dispensing specific medications to suggest that customers also purchase a particular Blackmore’s product targeting their condition.
For example, you go in to fill your prescription for a cholesterol-lowering medication and come out with a herbal concoction designed for people with high cholesterol.
Of course, the AMA’s objection is simply sour grapes because doctors aren’t able to cash in on the growing market for complementary medicine.
However, the deal does raise some genuine concerns for consumers.
No doubt there are some people who would welcome – and benefit from – the advice from a pharmacist to take a complementary medicine designed for their particular condition. Many consumers have an interest in complementary medicine and are frustrated that their doctors are focussed solely on conventional therapies.
However, the context in which this advice is provided means that most consumers will not be able to make informed decisions about whether or not these particular products are right for them.
It is important to remember that complementary medicines are (in general) not tested for efficacy by the TGA. As low risk products they are simply required to meet certain safety and manufacturing standards.
Of course this does not mean they are NOT efficacious but it does mean that consumers can’t be sure that a complementary medicine will have the effects claimed for it on the label. This is crucial to informing decisions consumers make about whether or not to purchase these products.
It’s already difficult for consumers to tell the difference between identically-packaged medicines that are registered (and therefore tested for efficacy) and listed (not tested for efficacy).
Having a pharmacist recommend a complementary medicine while simultaneously dispensing a prescription medicine will no doubt confuse the issue even further.
It’s one thing for a consumer to knowingly choose to purchase a complementary medicine aware that there is a fair chance it won’t do anything and quite another for someone to feel compelled to buy an unproven remedy because a health professional in a white coat tells them they need it.
Also, many of these products are not cheap because unlike prescription medicines they aren’t eligible for PBS subsidies. If someone on a low income – which is many people with chronic conditions – spends $50 on a complementary medicine it may reduce their budget for food, electricity or other essentials.
Other possible issues of concern are the potential for side-effects and inter-actions between complementary and prescription medication. While pharmacists should be aware of this and ask the appropriate questions before recommendation a complementary medicine, we all know that in a busy pharmacy this does not always happen.
The separation of prescribing and dispensing is an important feature of the Australian health system. Consumers would be concerned – and justifiably so – if they knew that their doctor had a vested financial interest in recommending particular treatments. It would undermine the trust we have that our doctor is giving us their unbiased advice about the best treatment option for us.
However, this separation is increasingly becoming blurred as pharmacists seek to expand their role in the health sector, occupying the primary care space being conveniently left open by the medical profession which has failed (in general – there are many individual exceptions) to meet the changing health care needs of the community.
The Pharmacy Guild has done a much better job of recognising and adapting to community (and Government) needs for a primary care sector focussed on more flexible, individually-targeted and coordinated care.
For example, the Diabetes MedsCheck program, currently being piloted, gives consumers the opportunity of having their diabetes management and medication reviewed in a local pharmacy.
While the AMA has the highest profile of probably any lobby group in Canberra it would be a mistake to assume that it has the greatest power. The Pharmacy Guild has been far more successful in pushing its own agenda with its behind-the-scenes lobbying and smart moves which help the Government deliver on its policy agenda.
In return, it’s been able to maintain its monopoly on the dispensing of prescription drugs and continue a protectionist regime for its members that makes the waterfront of the 1990s look like a paradigm of free-market efficiency.
A former high profile Labor politician used to describe the Pharmacy Guild’s expansionary agenda as wanting to turn pharmacies into “everything but a pizza joint and a knock-shop”.
He may have been right on one count – but I wouldn’t rule out the pizza joint option just yet.