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Skeptics, Pharmacists and the Evidence Base - Commentary by Gerard McInerney

Issue: Issue 81: April 2009
Author: Pharmedia News Reports

Editor's Introduction:
A range of media received an open letter from the Australian Skeptics Inc in March 2009 that implied that Australian pharmacies and pharmacists were being unprofessional in selling "quack " products, that had nil or inadequate evidence to support their sale, and that some dubious services were also supported (iridology, homeopathy and naturopathy).
As editor for i2P E-Magazine I agreed to seek some official comment, or failing that, comment from a pharmacist with an expert working knowledge of pharmacy practice.
Correspondence then took place with Gerard McInerney, president of the Pharmacy Board of NSW, and he agreed to submit our request to the full board.
The Pharmacy Board pointed to a range of material published in their regular bulletins, and these were collated by Gerard and forwarded to form part of this Pharmedia commentary.
While the skeptics pointed mainly to complementary and alternate medicines, I believe that the debate needs to be extended to the so called "real medicines".
Some manufacturers of certain classes of these drugs "cherry pick" the positive bits of evidence garnered through large scale clinical trials and suppress or hide any adverse findings.
This occurred recently with some of the anti-inflammatory drugs (causing heart failure) and has now extended to certain antidepressant drugs.
One manufacturer is currently facing around 9,000 lawsuits in the US because of failure to disclose the drug was likely to cause diabetes.
Trust in these instances has been destroyed with both consumers and health professionals.

I would recommend subscribers to read Harvey Mackay's column in this edition relating to trust in business.
Pharmacists have worked hard for many years to build trust with their communities, and it would be very sad to see this element damaged.
Trust is the most important component of any professional practice for without trust you do not have a profession.
Therefore, we recommend that all practicing pharmacists evaluate what the Skeptics have to say, and if any part of your daily practice needs reviewing, then please take the time to undertake a proper adjustment.

Perhaps other pharmacists might like to make a comment as a "letter to the editor".

What follows is an open letter from the Australian Skeptics together with the selected extracts compiled by Gerard McInerny from the Board Bulletins..

Australian Skeptics

An Open Letter to...
The Pharmacists of Australia

Australians trust Pharmacies and Chemists’ shops.
As pharmacists, you play an important role in the health of the Australian public by functioning as a conduit between doctors and prescription or pharmacy drugs.
You also have a respected role as a first resource for medical advice for many people in our community.
We are all familiar with the slogan “Ask your Pharmacist”.

When we ask our Pharmacist, what kinds of answers do we want?

Not quack products like ear candles that do nothing except pose a hazard.
We now ask our Australian pharmacists: What standards do you set for yourselves?
You sell a growing number of products for which there is little or no scientific evidence of efficacy.
Calling them “alternative” does not make them work.

Examples include homeopathic preparations, magnetic pain relief devices, detox programmes, dodgy weight loss products and ear candles.
Such products commonly appear in a “Natural Medicine” section of pharmacies but are sometimes displayed alongside real medicines whose benefits are scientifically proven.

Ear candles are of particular concern.

There are reports of serious injuries from them including temporary hearing loss, burns, ear canals blocked by dripping wax and punctured ear drums.1
Health Canada has banned them in Canada.2
Even the first professor of alternative and complementary medicine at Exeter University, Edzard Ernst, called for them to be banned.3
Despite this, many Australian pharmacies are selling them.

“Ear candling is one of those CAM modalities that clearly does more harm than good… its mechanism of action is first implausible and second, demonstrably wrong... in my view, therefore, it should be banned.”3

What next, will you start selling cigarettes?

Like the supermarkets, who you do not want to be allowed to sell pharmaceuticals because they do not have qualified staff?
What standards do you set for yourselves for staff?
We see a growing trend of so-called “practitioners” with little or no scientific training being brought in as “consultants” including iridologists, homeopaths and naturopaths.

Iridology is a discredited way of diagnosing the dysfunction of internal organs via the markings on the iris.
There is no evidence that it works but some pharmacies promote the fact that customers can get “readings” in their stores.
Your customers rely on you and anyone in a professional capacity within your store to provide sound medical advice and products.
We fear that in some cases they are receiving what amounts to little more than magical sugar pills and spurious health advice.
Pharmacies need to make a profit, but this should not be done through quack products and bad advice.
To regain the status a pharmacy should have – a place to get sound advice and effective medicine, supported by scientific and clinical evidence – we implore our pharmacists to stick to worthy products sold by knowledgeable staff.

Australian Skeptics Inc.

1. Seely DR, Quigley SM, Langman AW. Ear candles – efficacy and safety. Laryngoscope. 1996; 106(10): 1226-9.
2. last accessed February 24, 2009.
3. Ernst, E. Ear candles: a triumph of ignorance over science. The Journal of Laryngology and Otology. 2004; 118: 1-2.
Australian Skeptics Inc. PO Box 438 Collaroy Beach NSW 2097
You are free to copy, print and distribute this page.

The following extracts were collated from the Pharmacy Board of NSW bulletins by Gerard McInerny (president).


The community holds pharmacists in especially high regard and places its trust in pharmacists' professional judgment, and relies on pharmacists' professional advice. Because a recommendation by any pharmacist for any medicine gives that medicine special credibility, it is essential that the recommendation is soundly and scientifically based. The trust in pharmacists and pharmacies is such that simply because a medicine is available in a pharmacy, consumers will infer that the medicine carries the pharmacist's endorsement and recommendation. Therefore, pharmacists must be personally and properly persuaded of the safety and effectiveness of the medicines available in their pharmacies.

Consumers have a right to make their own choices but pharmacists must protect the consumers by not inadvertently making a recommendation by implication. Pharmacists who recommend alternative medicines to consumers must be appropriately and properly trained. Additionally, recommendations may be made only according to the principles of evidence based medicine. So as to assist pharmacists in the evaluation of published papers, it recommends completion of a course of critical appraisal of scientific literature as part of proper training. One such course approved by the Board, is Critical Literature Review, a module of the Graduate Diploma in Clinical Pharmacy offered by the Australian College of Pharmacy Practice.

The Board recognises that some pharmacists are likely to have a passion and appropriate training for alternative, complementary and natural therapies. Nevertheless, pharmacists must limit their provision of advice about such therapies only to those who voluntarily seek it, and only about therapies for which there is documented evidence of effectiveness.
Pharmacists must especially refrain from intervening inappropriately with prescribed medicine. If an intervention is appropriate, it should be made only through the prescriber.


Alternative medical practice or therapies, such as iridology, aromatherapy, reflexology, homeopathy and similar "natural" approaches to health care have apparently found a place in the community, but the Board can see little or no place for them in the practice of pharmacy. Regardless of any pharmacist's other heath care interests, no pharmacist may ever disregard their standing in the community as a provider of primary health care. Pharmacists have been registered as health care providers after completing a rigorous course of university training followed by an
equally rigorous period of practical experience and assessment of their fitness to

Because a recommendation by any pharmacist for a therapy or medicine gives
that therapy or medicine special credibility, it is essential that the recommendation is
soundly and scientifically based. Pharmacists who recommend alternative therapies or medicines to consumers must be appropriately and properly trained. Additionally, recommendations may be made only according to the principles of evidence based medicine. To assist pharmacists in their evaluation of published papers, the Board recommends completion of a course of critical appraisal of scientific literature as part of proper training.

Associate Professor Louis Roller, Victorian College of Pharmacy makes the following
comment in respect of homeopathy, that, at this point in time, there is no evidence pointing towards the efficacy of homeopathic products. Pharmacists would be well advised to apply Professor Roller's advice to the available evidence relating to other alternative health care procedures or medicines. Any pharmacist who, after proper training, chooses to practise as a naturopath or other alternative health care provider, must ensure that practise as a pharmacist and the conduct of the alternative health care business is carried out in separate premises. This will ensure that the distinction between practice as a pharmacist and operations as a naturopath, or other alternative health care provider, is so obvious that there will be no question in the mind of the public in respect of the person with whom they are dealing.

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