Week in Review
Pharmacies flout homeopathy rule
A Newsroom secret shopper exercise found pharmacies are telling customers homeopathic products work "really, really well"
Eighteen months after it was introduced, pharmacies continue to ignore a code of ethics that requires them to inform customers if a product has no evidence of efficacy.
One of the guidelines from the code of ethics references states: “Pharmacists must advise patients when scientific support for treatment is lacking.”
Newsroom visited eight Auckland pharmacies last week to enquire about a homeopathic product for sale. These included Life Pharmacy, Unichem and Chemist Warehouse stores as well as independently-owned pharmacies.
Pharmacy staff were asked what they knew about a homeopathic product on their shelves and if it worked.
All failed to share information about the lack of scientific evidence showing the product works.
Instead, Newsroom was told a homeopathic solution of arnica sold as a treatment for injuries, bruising and post-surgery trauma “works really, really well'', was “awesome” and could also cure headaches.
A Chemist Warehouse staff member was the only person to mention it was a homeopathic product. They explained homeopathy works on the premise "similar treats similar" and they doubted it would work for bruising, as it was better for “drawings”. They did not explain what this meant. At a different Chemist Warehouse store Newsroom was told the same product worked well for bruises.
At other pharmacies, the conversation centred on whether the liquid, spray or tablet form of the homeopathic product was most suitable. One salesperson checked with the pharmacist whether the product was suitable for swelling post-surgery and was told it was fine as long as no other medication was being taken at the same time.
There is no credible evidence homeopathy works better than a placebo. Its effectiveness has been rejected by many scientists and by large government reviews conducted in the UK, Australia and Europe.
According to homeopathic teaching, the more dilute something is, the stronger it is. A 30C solution has been diluted a trillion trillion trillion trillion trillion times. It's unlikely a single molecule of the original ingredient is present.
Even if a staff member personally believes a homeopathic product works, guidelines referenced by the code of ethics say this should not sway the information given to the customer.
"Patients must be made aware of the likely effectiveness of a given therapy according to recognised peer-reviewed medical publications, in spite of your personal beliefs."
As well as in-store, the rules are being ignored online too.
Life Pharmacy sells homeopathic gripe water for babies at $49.99 for a 60ml bottle in its online store. The description on the website says it works in minutes and has been “proven to work in even the toughest cases”.
Another website, pharmacydirect.co.nz, sells a homeopathic fever product for babies without including information about the lack of evidence homeopathic products work.
The contentious rule change that paved the way
The Pharmacy Council, which created the code of ethics, was established under the Health Practitioners Competence Assurance Act. The council’s primary role is to protect the health, safety and wellbeing of the public.
Before 2018, the pharmacy code of ethics banned the sale of products that did not have credible evidence of efficacy. However, this rule was widely ignored.
In 2014, a complaint was made to the council about a pharmacy selling a homeopathic wart treatment to a customer. The council opted to review, rather than enforce, its rules.
In March 2018, the code of ethics was updated to allow the sale of products that have no proof of efficacy as long as customers were informed of this.
This change drew scathing criticism from the New Zealand Medical Association (NZMA) and generated questions from pharmacists about whether it was ethical to sell products that had no proof of efficacy.
NZMA's Dr Kate Baddock told Newsroom at the time she was concerned that having "snake oil" on a shelf next to legitimate medicines was confusing for customers.
“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.”
She was sceptical pharmacy staff would be able to provide the level of detail the code of ethics stipulated.
Shortly after the code was changed in March 2018, Newsroom performed the same secret shopper experiment at four pharmacies and found the new rule was not followed.
Eighteen months on, nothing has improved.
Consumer advocate group the Society for Science Based Healthcare made the initial complaint, which sparked the change of code. Chair Mark Hanna said there was no excuse for pharmacies to sell this kind of thing without warning.
“Pharmacists should know better. Full stop. They should not be misleading their patients, they should not be letting their staff mislead their patients. If they don’t know, that’s incompetence.”
Hanna thinks people should be able to trust pharmacies to give them accurate advice when they walk into their local store.
“I would expect to be given reasonable, evidence-based advice, possibly some different options with the reason why I might choose one over the other. I wouldn’t expect to be misled and sold something that wouldn’t work.”
He thinks if the Pharmacy Council is going to make rules, they should be followed and enforced.
When told of the results of Newsroom’s latest research, the New Zealand Medical Association said it remained opposed to the use of complementary medicines.
“It is our view that CAMs [complementary and alternative medicines], currently unregulated in New Zealand, are the antithesis of evidence-based medicine. We would like to see pharmacists end the sale of complementary therapies or other healthcare products for which there is no credible evidence of efficacy and for which there may be safety concerns and also there may be interactions with standard drugs that may make them less effective,” said Dr Jan White.
If no one complains, it's not broken
What is the Pharmacy Council going to do about its rules being broken? Nothing, unless a complaint is laid against a pharmacist.
The Pharmacy Council doesn't check if the rules it set in place are being followed. Chair Jeff Harrison explained the council's role is only to respond to complaints:
"It [the Pharmacy Council] does not inspect or audit pharmacies."
Even when complaints are made there appears to be a limit to what the council can do. A member of the public complained about advice given after completing a phone survey of a number of pharmacies.
"Since a complaint was not raised against a specific pharmacist, Pharmacy Council was unable to act; however, the complainant was referred to HDC [Health and Disability Commissioner] and the Pharmaceutical Society of New Zealand for further advice and action."
Complaints laid against pharmacists are handled on a case-by-case basis, said Harrison. This can be informal and consist of a conversation.
He said pharmacists were responsible for the training of other staff working in the pharmacy, and including referring customers to a pharmacist for advice.
Green Cross Health is a licensee for Unichem and Life Pharmacy stores. A spokesperson told Newsroom the code of ethics applies to pharmacists but not all pharmacy staff. It said its decision to sell products where there is no scientific evidence of efficacy is all about patient choice:
"... the sale of these products in a pharmacy allows patients to have a conversation about their health and these products, compared to say a self-serve retailer like a supermarket".
A question asking why the code was not being followed was not answered.
The spokesperson said a reminder of the code of ethics had been sent to pharmacies in June. It was recommended all staff be made aware of the code:
"We encourage you to share this protocol with your entire team – even though it is a protocol for pharmacists, the reasoning also extends to other staff members in the pharmacy and it is important that all staff ensure that the patient has been provided with sufficient information to make an informed choice."
Complaints about pharmacies not informing customers of the lack of evidence of products for sale can be made through the Pharmacy Council website.