Do you suffer from migraines, back pain, acne, diarrhea or constipation? Rexall pharmacies have a product that may help, but it is not an over-the-counter medication or solution.
It’s more of an IgG test called Hemocode which screens for 250 food intolerances – and costs $450. The test, conducted off-site, returns results that the pharmacist shares with the customer, who then discusses with a naturopath what recommended foods to eliminate and what vitamins and supplements to add.
The problem: the science behind it is lacking. It is believed that IgG show exposure to food, not an intolerance. (Food intolerance exists, but the best way to diagnose it is to keep a food diary and a elimination diet.)
The video on the Rexall website that explains the Hemocode system. (From Neil Dankoff on Vimeo.)
The Canadian Society of Allergy and Clinical Immunology has go out against IgG testing, stating: “The CSACI does not support the decision of licensed physicians and our pharmacist colleagues to offer such testing, given the overwhelming consensus against the validity of such testing. » It also highlights potential dangers, such as exclusion diets for children and an increase in referrals to overworked allergists.
Other natural health products line the shelves of many pharmacies. Alongside traditional over-the-counter medications, such as acetaminophen or antihistamines, customers will find homeopathic remedies, supplements and vitamins, as well as diet pills.
Considered the most accessible healthcare providers, pharmacists have special education and it is a regulated, science-based profession driven by the desire to help patients.
The Ontario College of Pharmacists of British Columbia code of ethics states that pharmacists must “provide information that is evidence-based, relevant, up-to-date, and consistent with standards of care.” THE code of ethics The Ontario College of Pharmacists is not as direct, but says they are “obligated to act in and advocate for the best interests of the patient.” They also emphasize the national level Standards of Practice Modelswhich emphasizes an evidence-based approach and recommends “appropriate recommendations to patients requiring non-prescription drug therapies” and “appropriate education of patients to whom (pharmacists) have sold medications without a prescription or recommended self-care.”
Yet because they work in a for-profit retail environment, there is a potential conflict between what is best for the customer and what is best for the bottom line.
Thanks to the popularity of complementary and alternative medicine, consumer demand for natural health products is increasing. Seventy-three percent Canadians take natural health products and 13% of Ontarians consult alternative health care providers. So, what are pharmacists’ responsibilities when it comes to stocking complementary and alternative medicines, and what should they tell patients about them?
Across the country there are around 9,000 community pharmacies. Chain stores represent only about 16% income from industry, while the rest comes from the self-employed. Recently, both types of people in Ontario have faced financial hardship due to declining incomes. generic reimbursements.
In the meantime, pharmacists have expanded their scope of practice by taking on tasks traditionally performed in the doctor’s office. Pharmacists in Ontario can renew prescriptions and prescribe medications to help people quit smoking. In 2012, they began offer flu vaccinessomething pharmacists across the country can now do.
The Ontario College of Pharmacists has also ordered its pharmacists not to sell complementary and alternative products that have not been approved by Health Canada. (Products that have requested approval but have not yet received it were previously allowed to be sold.) All of these products are now expected to be approved. natural health products or approved homeopathic remedies. Health Canada approvals mean the products are safe and meet quality standards – but there is a lower standard to prove that they work only for drugs, which go through clinical trials.
Health Canada compiles research on natural health products, but much of it is on a smaller scale than trials conducted by pharmaceutical companies, says Sean Simpson, a pharmacy owner in Niagara- on-the-Lake and vice-president of the Ontario Pharmacists. Association.
Some argue that pharmacies should not sell products that are not supported by sound science. “There should be strong evidence to support a therapy if it is to be sold in pharmacies,” says Scott Gavura, an Ontario pharmacist who writes the blog Science-Based Pharmacy. “There is the risk that if products are sold in pharmacies, these products are given a veneer of authenticity.”
That was one of the concerns of the Canadian Society of Allergy and Clinical Immunology regarding IgG testing, says Stuart Carr, past president of the society. “This concerned us because there is a sort of implicit endorsement of an approach like this when a group of credentialed professionals like pharmacists propose it.”
A recent article in the Canadian Pharmacists Journal by Neal Davies, dean of pharmacy at the University of Manitoba, made the same argument. “Why are we still selling products without scientific merit or research to support their use? ” he asks. “We have an ethical duty to our patients to promote sound, evidence-based pharmaceutical practice. Unless product claims can be supported by solid evidence, we must abandon our addiction and stop selling products of no or questionable health value.
Others say it’s best for consumers to purchase natural products at a pharmacy, where they can discuss potential risks or benefits with a pharmacist. A 2009 literature paper by Heather Boon, now dean of the Faculty of Pharmacy at the University of Toronto, found that “most publications explicitly or implicitly identify that pharmacists have a key role to play with respect to NHPs (NHPs). natural health)/DS (food supplements). ).»
This support, he says, comes from the idea that pharmacists are in a unique position to advise people on the use of these products, as well as possible interactions, especially since many patients already use these products.
Simpson’s Pharmacy offers a wide selection of natural health products. He decided to stock them so that his patients would have the opportunity to discuss the possible pros and cons with a pharmacist. “If we don’t have that conversation, they might very well buy it at a health food store and not necessarily be aware of all the issues…our customers are using more informed pharmacists and are not necessarily making choices based on Dr. Oz’s recommendations.
He also believes that there is evidence to support many natural products, such as probiotics and omega 3. “Natural health products may not have ‘high quality’ evidence like some medications, but that doesn’t mean there isn’t any evidence to support their use,” he says. “There are certain products that have a lot of evidence, and then there are other things that are emerging.”
The evidence for natural health products can differ significantly. The most popular offering is vitamins and minerals, which are absorbed by a little more 50 percent of Canadians. Prenatal vitamins and those intended to treat B12 or iron deficiencies, for example, are well supported by evidence; others, such as vitamins A and E, have been proved ineffective and perhaps even harmful in recent years. Other solutions, like neti pots for colds and pesticide-free lice removal kits using lice combs are also sold under the banner of complementary and alternative medicine, but backed by solid evidence.
At the other end of the spectrum are remedies with no scientific basis, such as homeopathic preparations. These are particularly important in the case of cold medications due to a gap in the market. Since 2008, Health Canada banned the sale of cough syrup and cold medicine to children under six years old. But homeopathic cough remedies advertised for this age group are still on shelves – often right next to more traditional cough syrups.
Is it reasonable to expect consumers to know the difference? Gavura says this is not the case. “The labeling is misleading and suggests it contains active ingredients,” he says. “The only reason they are allowed to be marketed for use in children is, ironically, because they do not contain drugs.”
He said he told many parents that the cough remedies were homeopathic and they didn’t know that’s what they were buying.
Edzard Ernst, a leading alternative medicine researcher in the United Kingdom and author of Trick of Treatment, agrees. “Pharmacists have an ethical duty to sell only products supported by reasonably strong evidence,” he says. “At a minimum, they should inform their clients objectively about the evidence. »
Simpson focuses on informing consumers rather than limiting these products. “I don’t think I would ever pull out a bottle of store-bought homeopathic cough syrup and say here: Here’s what I recommend,” he says. “Ultimately, the evidence is lacking. But it’s all about asking someone to make an informed decision. If anyone is interested in choosing a homeopathic product, I want to do my best to help them choose the right one for them.
Jim Semchism owns a pharmacy in London, Ontario. and has been in business for 33 years. He has a small store and 90 percent of sales come from the dispensary rather than over-the-counter products. It does not normally stock natural health products, but provides them upon request. And he tries to keep his clients informed of the most recent research. For example, he dissuaded people from taking vitamin E as the evidence against it mounted – but he still brings it to a few customers who feel it helps them.
“I think most pharmacists of my generation and even more recent graduates probably have some skepticism about nontraditional therapies,” he says. “But I have a few colleagues who really think complementary medicine has a lot to offer, and they really promote it.”
