02.Choice shadow shop
What we did
A shadow shopper visited 30 different pharmacies in the Sydney metropolitan area over four days in December 2006 and asked to purchase Xenical.
Upon leaving each pharmacy, she immediately wrote down the details of the transaction.
Our shadow shopper
Age: a young-looking 19-year-old female
Diet: healthy diet of meat, fruit and vegetables, rarely eats takeaway food
Exercise: walks three to four hours a week and swims regularly
Occupation: full-time student, employed part-time as a lifeguard at a swimming centre
Health: no obesity co-morbidities (such as diabetes, high blood pressure etc.)
Xenical suitability?: Xenical isn't appropriate for her, according to PSA guidelines.
What we found
Our shadow shopper was sold Xenical in 24 (80%) of the 30 pharmacies visited. This clearly demonstrates that many pharmacists aren't following PSA guidelines (see below) and are supplying the drug inappropriately. Here are the details:
- Less than one third of the pharmacies measured or asked for her height and weight. These details are needed to calculate BMI, which should be considered before supplying Xenical.
- Her BMI was calculated in just nine pharmacies (in one of these she had to do the calculation herself). Three of these pharmacies went on to sell her Xenical.
- Two correctly calculated her BMI as 25 but sold Xenical to her anyway. The third incorrectly calculated her BMI as 27 (using her height and weight measurements, which she gave them) and sold her the drug.
- No-one measured or asked for her waist circumference. The PSA guidelines suggest considering this, along with BMI, before supplying Xenical. (A waist circumference of ¡Ý 102cm in men and ¡Ý 88cm in women is associated with a substantially increased disease risk due to obesity and overweight in adults).
- No-one confirmed our researcher's age (even though the safety and effectiveness of Xenical in children hasn't been established, so it's not recommended to children or adolescents under 18 years of age).
In the 24 pharmacies where she was sold Xenical:
- Eight gave no directions on how to use the product, and of the 16 who did the explanations were brief.
- Only 13 gave her some counseling or advice about diet and exercise when taking the drug.
- Side-effects of Xenical were mentioned in just 16 pharmacies.
- In our shadow shop, the average consultation time was just 6.2 minutes, which sometimes included waiting time. The busy retail environment may be the reason why the pharmacy didn't always undertake a proper consultation.
"She handed me the product, didn't say anything to me at all, only told me the price."
"No info. was exchanged at all, he told me the price of the product and gave it to me."
- 'Ensure consultation is private' is one of the PSA guidelines. But none of our shadow shopper's consultations were conducted in a private area (although on one occasion she was taken to a slightly less busy part of the counter).
Our research revealed that many pharmacies sold Xenical to our shadow shopper even though she didn't meet the criteria for the drug.
- On several occasions the pharmacy commented to our shadow shopper that she didn't need Xenical, but sold it to her regardless:
"He said that I didn't really look like I needed to lose weight, so I could probably use it for around two months."
"She told me that although she doubted I was obese that it's good to set a target weight goal to aim for."
"He told me that I didn't really look overweight, though it would help me to lose a few kilos."
- Xenical isn't a cheap drug, and pharmacists have the opportunity to further mark-up the retail price. In our shadow shop, the price of a two-week pack of Xenical varied between $59.95 and $79.95, with an average price of $67.89.
CHOICE is concerned that Xenical is being supplied inappropriately, and that advertising Xenical direct to consumers is sending the wrong message about weight loss to the Australian public and could encourage excessive use.
We're campaigning for:
- advertising approval for Xenical to be removed
- Xenical's schedule to be changed back to S4 (requiring a prescription)
For details of our campaign, and what you can do to help, see Drug advertising: TAKE ACTION.
Xenical is available from pharmacies without a prescription. But the PSA has developed guidelines for pharmacists to follow when supplying it. These include:
Before Xenical can be sold, pharmacists are supposed to clarify the patient's needs and confirm that Xenical is appropriate. Amongst other things, they're expected to:
- ensure the consultation is private
- consider BMI and waist circumference
- consider health status (existence of conditions such as diabetes or high blood pressure, for example)
- consider age
If Xenical is supplied, pharmacists should then give counselling on points including:
- action and dosage
- drug interactions
- side effects
- lifestyle modifications (including diet and exercise).