Don’t trust advice from pharmacists

I recently picked up some prescription medication from a local pharmacy. The pharmacist on duty insisted on advising me as to the safe way to use the substance so as to minimise one of its most common and serious side-effects. The advice was accurate and probably would have been useful were it not for the fact that it was common sense, written on the packet, written on the enclosed safety leaflet, written on the instruction sheet I had received from the hospital that prescribed it to me and explained to me over the phone by a hospital representative. But it would have been pretty churlish of me if I had resented receiving that advice again – the consequences of not following it are potentially severe – so I was content to stand there and hear it.

But I would never rely on a pharmacist for any kind of medical advice whatsoever, despite the fact that they have received more medical training than have I. Why? Because they are riddled with conflicts of interest. They are not doctors, they are shopkeepers.

When I lived in Ashfield a local pharmacist used a database of all nearby people who had purchased asthma medication from him to send personal letters inviting us to attend an asthma education lecture at the local town hall. His presentation was friendly, slick, easy to comprehend and mostly accurate – though some of the information he gave was somewhat dated and no longer corresponded to best practice asthma management – but only took up half the time allotted to the meeting. The other half was devoted to a representative from a medical device company he had invited to demonstrate and try to sell his wares to us. At least one of those devices had been superceded almost a decade earlier by technology the pharmacist had failed to mention during his lecture.

I don’t know if he received kickbacks from the company that manufactured the devices. I don’t know if he cynically misinformed us about up-to-date asthma management to help the sales rep sell his dated products. But I do know I was very uncomfortable about having my private medical information accessed by him at all, much less for reasons that were at least partially aimed at selling me something.

When I contacted the Pharmacy Guild to lodge a complaint they were completely uninterested and insisted the pharmacist had done nothing unethical.

However this incident alone is not why I would not take medical advice from a pharmacist.

I often purchase multiple asthma inhalers at a time. I like to have one at my bedside, one at my workplace and one in my backpack. It’s not good to be caught without an inhaler during an asthma attack.

On four occasions pharmacists have refused to fill my prescription for more than one inhaler at a time, insisting loudly and within earshot of other customers that inhalers are addictive, prone to recreational use or illegally on-sold to children. None of those things are true. In one case one of the other customers happened to be a doctor, who took the pharmacist to task for giving false information and insisted that he fill my prescription in full, which he did. In the others I retreated humiliated under the gaze of disapproving customers and purchased my inhalers elsewhere.

People with dark skin or who ‘look like a druggie’ – like me for instance – can find it pretty difficult to fill a prescription for painkillers too.

Pharmacists have been known to berate women seeking contraceptives that conflict with their religious convictions.

Surveys have repeatedly shown that pharmacists routinely give inadequate advice to their customers.

In 2008 the UK consumer magazine ‘Which?’ found that a third of UK pharmacists gave incorrect or misleading answers to at least one of three fairly basic questions about their products. Customers who followed such advice would have been at risk of taking wrong medication for migraine, missing a serious bowel infection or contracting a sexually transmitted disease. The Australian equivalent to ‘Which?’, ‘Choice’ magazine, recently discovered that pharmacists are recommending pregnant women take herbal and alternative treatments that risk harming their unborn child but many fail to give important advice about iodine and other supplements. Iodine offers much smaller profit margins than do most herbal medicines. In a similar vein, ‘Pharmacy News’ reports pharmacists’ knowledge of which medications can be safely used by breastfeeding mothers is ‘poor’. Infant formulas provide a steady income stream to most Australian pharmacies.

A Melbourne pharmacist recently sold strychnine to a man who wanted something to put on his son’s fingertips to stop him biting his nails. If used it would certainly have stopped him. Stopped him dead.

If you walk into any pharmacy in Australia you will see a large range of products prominently displayed that are of no medical value or potentially harmful. I’m not just talking about cosmetics and hair care products. Most of the nutritional supplements, arthritis treatments and diet programs that are the bread and butter of the pharmacy business have been repeatedly shown to be ineffective or, in a few cases, actively harmful. I have seen pharmacies around Newcastle promoting herbalists, naturopaths, iridologists and chiropractors. I have also seen highly inappropriate marketing campaigns for over the counter medicines, such as carry bag giveaways for buying multiple boxes of anti-diarrhea pills that work by paralysing the large intestine.

Pharmacists often enter into promotional agreements with companies that sell products of dubious medical value.

In 2011 the Pharmacy Guild of Australia was forced to back down after widespread condemnation of a deal it had made to use its computer network to prompt pharmacists to offer Blackmores’ supplements to patients filling prescriptions for certain kinds of medicines. Bioceuticals and MyGene have recently teamed up with a large number of individual pharmacists to market expensive and unproven genetic tests that will supposedly match customers to specific supplements they manufacture.

There are certainly problems with the medical knowledge of many GPs. They do not have time to read all the journals and keep up to date with current medical research. Increasingly they are getting their continuing medical education from drug company representatives, which is why there is so much unsafe prescribing that flies in the face of clinical evidence, such as antidepressants for people with bipolar disorder. But unlike pharmacists, few doctors draw a large proportion of their income from unproven or fraudulent therapies.

You would not take advice about motor vehicles from a car salesman with a lot full of lemons.
You would not seek nutritional information from a McDonalds manager.
Don’t trust medical advice from snake-oil salesmen.

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Postscript (01 March, 2017): Choice recently sent mystery shoppers to 240 Australian pharmacies to seek advice about dealing with stress. While almost half the pharmacists advised seeing a doctor fewer than 30% recommended the relaxation techniques, cognitive behavioral therapy or changes in diet, exercise and lifestyle that are considered the gold standard in treating stress. About a third recommended alternative medicines such as homeopathy, Bach flowers, Valerian or St John’s Wort that have no evidence base for stress management. A further 46% recommended vitamin supplements that are unlikely to be more effective than a placebo. 85% gave incorrect assurances that the recommended product(s) would work with 24% falsely claiming it was scientifically proven (18% told the mystery shopper Bach flowers had been shown to work by science). 97% gave advice which, if followed, would have resulted in financial benefit to the pharmacy. Some even attempted to sell Metacalm – a supplement with no evidence base or safety data and which can’t be legally sold in Australia. This is consistent with earlier Choice investigations revealing Australian pharmacists promoting and selling quack remedies to consumers.