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New code of ethics makes way for homeopathy

A new pharmacy code of ethics will clear the way for pharmacies to sell homeopathic products.

The Pharmacy Council’s previous code required that credible evidence of efficacy exist for any products sold at pharmacies, however, this rule was often ignored by pharmacists.

The new code, which comes into effect March 12, does not require credible evidence for what it refers to as complementary and alternative medicines, but does require pharmacy staff tell customers if a product lacks scientific evidence of efficacy.

Homeopathy is based on the belief that extremely diluted amounts of active ingredients are effective against ailments. The more diluted the active ingredient, the more potent homeopaths believe treatment is. Homeopathy’s effectiveness has been rejected by many scientists, and by large government reviews conducted in the United Kingdom, Australia and Europe.

The Code of Ethics 2018 update came after consumer advocacy group, the Society for Science Based Healthcare (SSBHC), complained when they discovered homeopathic products were being sold in pharmacies in an apparent breach of the industry’s own code of ethics.

The Society’s chairperson, Mark Hanna, said a parent contacted him after realising they had been sold “crap” by the pharmacy and had thrown the homeopathic product in the bin.

“In 2014 they had a rule which basically was – you can’t sell quackery – but they didn’t want to enforce you can’t sell anything in particular.”

Hanna said he believes the entire code was reviewed because the Pharmacy Council did not want to tell pharmacies what they can and can’t sell.

The Pharmacy Council was established under the Health Practitioners Competence Assurance Act. It’s primary role is to protect the health, safety and wellbeing of the public. Chief executive, Michael Pead said the code was updated to recognise the changing health sector.

“The real issue here is you can have what is a regulated medicine, say for example omeprazole sitting on the shelf next to shark oil. What happens is the presence of the omeprazole gives legitimacy to the shark oil."

“It’s a much more patient-centric, integrated health care model in New Zealand and we felt it was more appropriate to have a more principal-based code of ethics.”

The code is now simplified into principles, and much of the detail of what was in the previous version is now set out in separate standards and statements documents.

When asked if products with no scientifically-proven benefit should be removed from pharmacy shelves Pead said: “The pharmacy council has not taken a position of that in its case, once again we look to the pharmacist to make those judgments in helping to make sure they are dealing with informed patients fundamentally.”

The New Zealand Medical Association’s (NZMA) chairperson, Dr Kate Baddock, made a submission to the Pharmacy Council against pharmacies selling complementary and alternative medicines during the code’s review process.

She said the Pharmacy Council has created a document the NZMA is disappointed with.

“The real issue here is you can have what is a regulated medicine, say for example omeprazole [a medicine for heartburn] sitting on the shelf next to shark oil. What happens is the presence of the omeprazole gives legitimacy to the shark oil.

“As long as you have pharmacists stocking products like that side by side you’re going to have an unsuspecting public believing them to be equally important, equally effective, equally efficacious and equally having scientific basis for them being used.”

Baddock said she is concerned how the codes requirement for pharmacy staff to inform customers of a product’s lack of efficacy will translate to real-life situations.

“I think there is going to be great difficulty in ensuring that whomever you may see when you walk into a pharmacy is going to give the prospective buyer the amount of detail that is being stipulated, even more - to ensure that everybody in the pharmacy does that.”

Understanding what enforcement measures there will be when pharmacy staff do not adhere to the requirement to let customers know a product may be ineffective is difficult.

Pead said complaints to the council are a basis for action and the code of ethics is a base to assess whether a pharmacist was fit and competent.

“All our standards, guidelines and statements from there give us more and more specific places to say 'Hey, you didn’t quite meet the expectation, you need to reconsider your position on those matters'.”

Hanna said SSBHC members would be checking to see if the new measure requiring customers be informed when there was a lack of evidence supporting a product was being adhered to. He said the society would be making complaints to the Pharmacy Council if pharmacies were not following the new code.

“Ideally, I think pharmacists shouldn’t choose to stock these products. If that can’t be enforced, I think that this is the next best way to go, to make sure they are not misinformed about them.”