Healthy Skepticism Library item: 3875

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Publication type: news

Cresswell A.
Devil in the retail
The Australian Newspaper 2006 Mar 18
http://www.theaustralian.news.com.au/common/story_page/0,5744,18494318%255E23289,00.html

Notes:

Ralph Faggotter’s Comments:

This article looks at several issues, including the potential collective power of pharmacies to influence pharmaceutical company policy and the tendency of modern pharmacies to fill their shelves with products of uncertain merit.

Full text: Devil in the retail Pharmacy leaders fear a hard-sell approach is dragging their profession into disrepute. Health editor Adam Cresswell reports March 18, 2006

NO doubt about it, Australia’s pharmacists are angry – and one of the world’s biggest drug companies may be about to feel the full force of that anger.

The announcement this week by GlaxoSmithKline that it will allow supermarkets, corner shops, petrol stations and other outlets to sell nicotine-replacement lozenges and patches has infuriated many pharmacists, who until now have enjoyed a monopoly on the $84 million a year market.

Some individual pharmacists are now making dire warnings of retaliation against GSK.

“I’ve been working on a suitable retribution for GSK – they think that their products don’t need pharmacy input, so why does pharmacy need their products?” asked one irate pharmacist on a web-based discussion forum this week.

The message went on to itemise the elements of the planned revenge strike: prices of GSK’s Nicabate range would be increased, while prices of competitor products, such as Pfizer’s Nicorette (which Pfizer will continue to restrict to pharmacy-only sale), would be reduced. A range of other GSK products – such as half the range of its Panadol liquid paracetamol formulations, Zovirax tablets (used to treat genital herpes), the antibiotic Augmentin, the heartburn and dyspepsia treatment Zantac and others – would be deleted and replaced with generic alternatives manufactured by other companies.

Other GSK products would be selectively deleted or have their prices reviewed, in some cases increasing the choice or lowering the price of alternative rival products.

Several other pharmacists replied to the post, urging its author not to overreact or “throw the baby out with the bathwater”; another observed pharmacists were “at war with the supermarkets, not the manufacturers (no matter how short-sighted some of their decisions may be)”. The message alarmed the website’s organisers sufficiently for them to attach a note to the incendiary post, saying the site would “not be party to any attempt to co-ordinate an attack on GSK”.

Little of this has surprised industry watchers, who say this sort of reaction is precisely the reason most drug giants – not to mention governments – bend over backwards to avoid antagonising the industry.

“The pharmacy groups are savage – they are savage,” one insider said. “No manufacturer has any interest in being out there in the public domain going head-to-head with the pharmacy groups. It (a row) might affect how aggressively pharmacists suggest (treatment) alternatives to their customers.”

GSK, which wrote to every pharmacist beforehand to alert them to its decision, declined to comment on the threats. It remains to be seen whether any of the retribution takes place, let alone whether it is widespread enough to cause GSK any damage. But the row has exposed cracks in pharmacists’ professional edifice, particularly some blistering criticisms of the industry made recently by its own leaders.

The Pharmaceutical Society of Australia – representing the interests of the country’s 16,000 pharmacists – last week admitted many pharmacists were not bothering to hand out consumer medicine information (CMI) as they are paid to do, a dereliction of duty the PSA said was “undermining the work” of those pharmacists who took their obligations more seriously.

As pharmacists pin their argument to remain the exclusive outlet for nicotine replacement products on the fact that they are qualified to counsel buyers how best to use them, revelations that patients are not always given the advice they are supposed to get is damaging – to say the least.

While the PSA’s warning related to printed CMI information – which some pharmacists claim can be confusing to patients – other evidence suggests failure to counsel goes wider. In late 2004 the Australian Consumers’ Association’s Choice magazine visited 87 pharmacies around the country to rate services provided, and found advice was “poor” in 58. The ACA also found speaking to the pharmacist as opposed to the pharmacy assistant was no guarantee of good advice.

Last month the PSA had an earlier spray at its own members, criticising the many pharmacists who are selling “miracle” products.

The PSA singled out one, a so-called “stabilised liquid oxygen” product called Oxygen4Life, as “just the latest in a long line of dubious offerings which have attempted to trade off the back of community trust in pharmacists. By selling ‘miracle’ products that offer no evidence for their quasi-therapeutic claims, some pharmacies are undermining the very basis for the profession’s trusted position in the Australian community,” PSA president Brian Grogan said last month.

“When deciding to block supermarkets from opening in-store pharmacies last year, Health Minister Tony Abbott specifically used the notion of a retailing ‘culture’ as a key reason why supermarkets were unsuitable to sell potentially dangerous medicines. This is exactly why pharmacies should deliberately set out to avoid generating any public perceptions that they are simply another aspect of general retailing.”

Oxygen4Life is hardly an isolated exception: some pharmacy shelves are groaning with all sorts of dubious weight-loss aids or herbal pick-me-ups, few of which have any evidence to back them.

The PSA is concerned all this is undermining the profession’s aspirations to carve out a bigger role in primary health care. The shortage of doctors and other health professionals is prompting governments to have a long hard look at how they can share the health workload more equally among the various health professions, and pharmacists have been mounting a strong case for a bigger role, for example by monitoring patients with chronic diseases such as diabetes.

Ken Harvey, adjunct senior research fellow in the School of Public Health at La Trobe University, says this tension between the retail and professional pharmacy sides of the business has “been a long-running split”.

“The medical profession has got the same tensions, perhaps not so blatantly exposed,” Harvey says. “I think ultimately these guys have got to decide what they are. Are they health professionals? That means they have got to embrace being health professionals by getting rid of shonky stuff, and changing their pharmacies so there are facilities for private conversations and counselling.

“The normal pharmacy … you know there are a few exceptions, but the assistant is at the front, the pharmacist is on his throne at the back, and it’s not at all conducive to saying ‘I want some help with my weight, what should I do?’. I don’t think I have seen any pharmacy that provides the sort of counselling service and confidential space in which to do it.”

Some individual pharmacists have been appalled by the PSA’s criticisms, and the Pharmacy Guild – which represents about 4500 pharmacy owners, as opposed to the employed pharmacists who work in them – is also dismayed. Senior national vice-president Pat Reid says the PSA was “remiss” for criticising pharmacists selling commercial products, without also giving them practical help – such as questions to ask sales reps. Others are more supportive of the PSA, particularly in its reservations over Oxygen4Life and other unproven retail products.

Another post on the discussion forum from a locum pharmacist said that while many pharmacies did “their level best to provide good services, I also come across many other pharmacies that are functioning more as a retail outlet than as service providers”.

Several pharmacists interviewed by Weekend Health said Oxygen4Life was not only widely sold in pharmacies, but that some would even order it in for customers asking about it.

Tasmanian pharmacist Mark Dunn is the publisher of the AusPharm suite of websites that hosts the discussion forum. He is setting up a new web-based service to scrutinise, and if appropriate debunk, health claims of products such as Oxygen4Life. “I guess it started with my personal angst that products like Oxygen4Life and (weight-loss product) SLIMist can make it onto the market,” Dunn says.

Oxygen4Life has already been the subject of a complaint to the Therapeutic Goods Administration’s Complaints Panel. The complaint was upheld in April last year, after the panel agreed a magazine advertisement implied the product would assist with a list of claimed oxygen deficiency symptoms, and had failed to substantiate claims it was a “liquid oxygen supplement” and “oxygen therapy in a bottle”. No orders were made after it was decided the product was a food, not a therapeutic good.

Dunn’s new service, called AusPharm Consumer Health Watch – which at one point was going to be called “Quackbusters” – will use the expertise of a panel of pharmacists, a doctor and a consumer representative to give a balanced, evidence-based assessment of products.

While Dunn thinks pharmacists as a whole are “overwhelmingly doing the right thing”, he says such products should not be marketed at all, but if they are, should not be sold by pharmacists who he says “should be selling products where there’s evidence to support their use”.

“It’s undeniable that there are members of the profession that are possibly motivated more by commercial considerations than professional considerations,” he says. “But in a situation where there are 5000 community pharmacies, it’s inevitable you are going to get some who are going to lean that way.”

www.consumerhealthwatch.net.au