People trust pharmacists and can reasonably expect them to sell effective health-related products. Despite this, we've found many products sold at pharmacies are not only ineffective, some are unsafe. So what are some of these dubious products pharmacies sell?
Ear candles are long hollow cones inserted in the ear canal and lit. Proponents variously claim the candle draws earwax and “impurities” or “toxins” out of the ear canal, and provides relief from sinus and ear infections, headache and earache, as well as improving hearing. There’s no evidence they’re effective, and injuries such as burns, perforated eardrums and candle wax blockage of the ear canal have been reported.
Homeopathic remedies Whether homeopathy works has been long debated. Systematic reviews of clinical trials say no. However, homeopaths argue you can’t just treat symptoms, you treat the whole person – so a one-size-fits-all homeopathic symptom remedy such as those used in clinical trials don't provide a fair trial. But since this one-size-fits-all symptom relief is exactly what’s sold in pharmacies, it would not be expected to be effective.
Herbal weight-loss remedies While some may be better than others, there’s no good evidence they provide any significant weight-loss benefit – keep an eye out for our upcoming review of these products.
Anti-snor acupressure rings are metal rings worn on the little finger to prevent snoring by means of acupressure. There’s currently no evidence they work. In fact, in 2010 the ACCC took action against the company to prevent them claiming they do. The product is still sold in pharmacies and, by virtue of its name, claims to stop snoring.
In addition to these, there are things like anti-ageing creams and lotions that do no more than a good moisturiser - they certainly don't get rid of wrinkles; many herbal remedies that don't live up to their claims, and some cases can be dangerous; and even some cough and cold remedies that lack evidence of their effectiveness.
HOTBAND bracelets - the most dubious of all!
Like the Power Balance that featured in the 2010 CHOICE Shonkys, the HOTBAND is a rubber bracelet with an embedded plastic hologram. The bracelet is advertised as having powers to improve muscle strength, balance, flexibility and range of motion. However, claims go beyond even the Power Balance - which, after all, is probably only first generation hologram technology – to include alleviating motion sickness and jetlag. Given its apparently amazing medical powers, it's perhaps not surprising it's sold in pharmacies. But we were skeptical.
One of our staff members, a lawyer, was curious to know how pharmacists could justify selling such a product, and visited a pharmacy where they were sold. A pharmacist wearing a white lab coat - and a HOTBAND – offered assistance. Their conversation went something like this:
CHOICE guy: I was just interested in the HOTBAND. I see that you're wearing one. Are they good?
Pharmacist: Well... I don't know really.
CHOICE guy: But why do you wear one?
Pharmacist: Yeah, I got it for free... and it's a bit of a fashion statement. I don't know.
CHOICE guy: It says on the package that it corrects my ionic balance. What is ionic balance?
Pharmacist: Oh... it's (he then looked in another direction) I don't really know what it is but it's supposed to improve your balance. I don't know. CHOICE did a report on them and panned them. I think there's going to be a backlash against them soon.
CHOICE guy: Do you think you should be selling them in the pharmacy and wearing one, if it's no good?
Pharmacist: Yeah, I don't really know... It comes with a money back guarantee, so you can try it out and if it doesn't work you can always bring it back. It's up to you.
Should pharmacies sell only safe stuff that works?
Pharmacists are required to undergo a four year specialist degree in the chemistry, action and formulation of drugs, and many people believe pharmacists know more about medicines than the GPs who prescribe them.
The last president of the Pharmacy Board of NSW has gone on record as saying, “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.”
Furthermore, “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.”
In other words, there is an onus on pharmacies to sell stuff that works, and on pharmacists to stand by the safety and effectiveness of these products. But some of the products pharmacies sell aren’t effective and can be unsafe. Here are the arguments for and against:
- Many pharmacists defend their right to sell the sorts products we’ve called into question, arguing that while they may lack evidence for their effectiveness, there’s also no evidence that they’re not effective.
- Should one or more of their customers appear to benefit from a particular product, a pharmacist is likely to take that into account when someone else asks about it. That’s not necessarily as cynical as it sounds – a placebo effect is a genuine and significant aspect of medicine, and a pharmacist with good people skills can size up a customer and determine if it might help them.
- Pharmacists also point out that even some prescription pharmaceutical products have debatable efficacy, while warnings of serious safety concerns about prescription medicines sometimes emerge after being on the market for a long time (recent examples include Celebrex and Reductil). So evidence and safety are works in progress.
- Many people have publicly criticized some of the more dubious products available in pharmacies. By selling quack products, they argue, pharmacies are taking advantage of people’s belief in credibility of products sold by pharmacists and abusing the trust they’re accorded.
- When products don’t work, they’re not only a waste of money, but they risk delaying more appropriate treatment. They should stick to selling safe and effective products supported by scientific and clinical evidence.
As frontline health care professionals, pharmacists play an important role in advising the community about health and medical issues.
It’s certainly possible that selling quack products gives pharmacists the chance to entice people into their pharmacies and advise them about more appropriate health care measures and treatments – provided, of course, the customer actually seeks the help of a pharmacist. Given their training, you’d expect pharmacists’ advice to be more evidence-based than that of someone working in a health food store or supermarket. Although we came across some terrific pharmacists in this respect during our shadow shop, we also found some who were indifferent or gave poor advice.
Your best course of action is to ask to speak to the pharmacist about a new or novel product you’re considering, and ask about the evidence upon which they base their advice. Don’t let them fob you off – if you feel you’re not being taken seriously, ask for written information or reliable references.