Registered Homeopathic Pharmacies Can Sell Anti-Vaccine Books

Last week, I discovered that two UK homeopathic pharmacies (Helios and Ainsworths) were selling anti-vaccination books. This is no surprise, since homeopaths have a track record of engaging with anti-vaccine views as found by Schmidt & Ernst in 2002 (as one example), and on occasion have been found to be providing ineffective homeopathic alternatives to vaccines in the UK. Concern has been expressed that regulators are not taking this issue seriously enough.

This is the sort of book they were selling (several were for sale).

Anti-vaccine book sold at Helios
Anti-vaccine book sold at Helios

Pharmacies in the UK are regulated by the General Pharmaceutical Council (GPhC), they exist to ‘protect, promote and maintain the health, safety and wellbeing of members of the public by upholding standards and public trust in pharmacy.’ The GPhC has stated in 2011 that they would continue to monitor the situation in one pharmacy after the selling of homeopathic malaria prevention treatments: ‘the information gathered as part of the (recent Newsnight) investigation including the original complaint may be taken into account if we receive any further complaints about the pharmacy professional in the future.’

I was therefore hopeful that action, or at the very least an investigation, might happen when I complained to the GPhC about the two registered pharmacy premises who were selling the books, and additionally I noted that a homeopathic preparation (pertussin homeopathic remedy) that could be used as a homeopathic vaccine was being sold by one.

Despite being pretty much an absolutist on free speech, I feel this is appropriate. That is, I do not have a problem with the publication or selling of anti-vaccine literature from bookshops, my only concern is that registered healthcare professionals are supplying this material from registered premises.

In my opinion, the selling of anti-vaccine books by a registered pharmacist/pharmacy is incompatible with the Code of Conduct for Pharmacists.

I have received a prompt response from the GPhC this morning to my complaint. They have not investigated my complaint, but have looked at whether it sits in their area of jurisdiction.

GPhChomeopathyresponse-1

 

The response raises a number of issues for me since it dropped through the postbox this morning:

1. How can someone be fit to practice as a pharmacist (which includes knowledge) and knowingly sell an anti-vaccination book?

2. Is selling an anti-vaccine book from a pharmacy purely a commercial matter? I might agree if I had complained about hair dryers or cameras. Does the pharmacy regulator not have a role in public health? Remember they exist to ‘protect, promote and maintain the health, safety and wellbeing of members of the public’. Does this mean anything if pharmacists can sell anti-vaccine books? Can they sell cigarettes on this basis too?

3. There is a hole in regulation. Selling anti-vaccine books, and selling homeopathic remedies that are suggested in those books is tantamount to putting an indication on the remedy.

4. There is no evidence that a registrant is acting outside of their competency. Isn’t a pharmacist in control of a registered premises? If so, isn’t the fact the book is on sale evidence they are dangerously ill-informed, and a threat to public health?

5. There is no evidence they holding themselves to be anti-vaccine specialists.  I am not sure that is important. I was not making the accusation they are anti-vaccine specialists in my complaint, but implying their are vaccine ignorant. Selling anti-vaccine books shows a startling lack of knowledge of immunity, the science of vaccination and public health. How is that compatible with professional registration as a pharmacist?

I’m not a fundamentalist on homeopathy, I can see how differing health beliefs of patients might lead them to use such products, despite the lack of plausible mechanisms, and evidence for their effectiveness. I also have some issues on how pharmacists are targeted as suppliers of homeopathy by skeptics, when they may well be employees with little to no control over stock in their store (unlike their superintendent pharmacists). However, in this case it seems clear-cut to me that products dangerous to public health are on sale from a registered pharmacy, which is under the control of a pharmacist.

And there is apparently nothing to be done about it.

NOTE: A big thanks to eagle-eyed Rob who spotted this material in the first place


 

 

A synergistic interaction: Clinical Pharmacologists and Pharmacists

The British Pharmacological Society (BPS) have a new report out calling for a commitment from government to give greater support to clinical pharmacology.

The British Pharmacological Society launched today a new report calling for an increase in the number of clinical pharmacologists across the four UK nations. This medical specialty, the only one focusing on the safe, effective and economic use of medicines, is well placed to help the NHS surmount the biggest financial challenge since its creation.

This has led to some negative reactions from pharmacists on twitter.

I suspect the wording of the BPS “This medical speciality, the only one focusing on the safe, effective and economic use of medicines” is being misread as “Clinical pharmacology is the only profession focusing on the safe effective and economic use of medicines”. That isn’t the claim, the claim is that clinical pharmacology is the only medical speciality focusing on the safe and effective use of medicines. I would argue that clinical pharmacologists are friends of pharmacy and one of our best advocates.

Clinical pharmacology became important in the 1960s, in the wake of concerns about drug safety, yet even in the 1970s there was concern about lack of clinical pharmacology. Here is Professor Owen Wade, a member of the original Committee on the Safety of Drugs, on the importance of clinical pharmacology.[1]

“Medical schools in Britain, with a few exceptions on the Celtic fringe, have recently neglected clinical pharmacology. […] The establishment of full-time chairs in these subjects is an urgent need in any medical schools where they do not already exist. Undergraduate students need instruction on the proper use of drugs, knowledge of their common adverse reactions and appreciation of the dangers of their misuse.”.

These concerns have continued. Despite increasing governmental focus on drug safety in the past 10-15 years, clinical pharmacology has continued to diminish with 68 specialists in the UK in 2003. A 79% increase in medical specialists from 1993-2003, could be contrasted with a 24% fall in Clinical pharmacologists.[2] There have been recruitment difficulties, and careers were more likely to be found in the industry, rather than into academic medicine. Some of this loss was also due to the high value placed on clinical pharmacologists into organisations such as NICE and the MHRA, but clinical pharmacology has also been hit by a target driven NHS, the rise of cardiology and primary care in cardiovascular management, and changes in undergraduate medicine (around an integrated curriculum) that have damaged some disciplines (in particular the teaching of prescribing to undergraduates).[2] The BPS report highlights that there are now only 77 clinical pharmacologists in the UK.

The British Pharmacological Society, and their members, have for a number of years been concerned about this decline, and the effects on prescribing safety in particular. In recent years there has been a fight back, with the creation of the Prescribing Safety Assessment for undergraduates. Prior to this localised schemes were developed to assess competency in prescribing, and these have always drawn on pharmacists. Locally, I have been involved in OSCE assessments of prescribing competence, as have a number of other pharmacists. Clinical Pharmacologists and pharmacists working together to improve patient safety. A model that we ought to bear in mind.

I’ve worked with clinical pharmacologists for about 14 years, firstly on wards, where they were often the clinicians most likely to want a pharmacist on their ward round. [See note at end] Indeed, one was even a qualified pharmacist as well. Then as a pharmacist in a Yellow Card Centre, where the Director was a clinical pharmacologist. Wherever I have seen clinical pharmacologists work they have been a key ally of pharmacy in the medical arena, helping pharmacy push through Drug and Therapeutic committee decisions, and not anti-pharmacy at all. Senior academic clinical pharmacologists have been nurturing towards pharmacists, often encouraging pharmacists to develop their academic side, getting them involved in research, and in many cases setting pharmacists off on a course to obtain a PhD helping to develop the pharmacy workforce. Certainly, the Yellow Card Centres across the UK are one area where this can be seen, which are centres of excellence in terms of pharmacists working with clinical pharmacologists. I know I am not alone in seeing this synergism.

The BPS provides a quote from Roger Walker on the role clinical pharmacologists play with pharmacists, and gives an example of pharmacists working together with clinical pharmacologists:

The All Wales Therapeutic and Toxicology Centre (AWTTC), a partnership led by clinical pharmacologists working together with pharmacists in Wales was able to provide resources and training to support prescribers in Wales in reducing primary care prescribing costs in three main areas.

I am part of a team that obtained a grant to develop Safe Prescriber a website about prescribing safety for F1 doctors, that is now being rolled out nation wide for other prescribers. That team consists of clinical pharmacologists and pharmacists from the start. The main editor is a pharmacist. From the start modules have been largely co-developed with a medical and pharmacist contributor. In my main job as a Programme Director on an undergraduate pharmacy course, the clinical pharmacologists are an essential resource.

Clinical pharmacologists are not a threat to clinical pharmacy, nor do they devalue pharmacy. Why would they put a quote from a pharmacist in their own report to back-up their own importance if they felt pharmacists were not valued? Practically, there are not enough pharmacologists to deal at ground level with the tsunami of drug-related harm that patients experience, they need pharmacists as a partner.

I am a member both of the BPS and the Royal Pharmaceutical Society. These organisers work together, for one example see here. I hope we continue to do so, and I would hope that we can support the clinical pharmacologists in their call to re-envigorate their speciality.

The swamp of medicine-related problems is vast. Neither pharmacy and or clinical pharmacology is going to drain it alone, but we can at least work together to fix the parts we can.

1. Wade OL. Adverse Reactions to Drugs. 1st ed. London: William Heinemann Medical Books Ltd, 1970

2. Maxwell RJ, Webb DJ. Clinical pharmacology – too young to die? The Lancet 2006;367(9513):799-800

Additional note: Rather than focusing on a non-existent threat from clinical pharmacology pharmacy ought to concentrate on its own profession. There are a number of threats to clinical pharmacy services in the UK, such as re-banding and redundancy pressures on senior experienced clinical pharmacists in the NHS. Additionally, ward rounds, anecdotally, appear to be contracting as hospital pharmacy starts to focus on process driven targets, rather than clinical care in its widest sense. We ought to start a discussion about how we can insure that pharmacists become part of clinical teams, to ensure that the clinical aspects of their expertise that cannot be measured with targets continues to be valued. Why not speak to your clinical pharmacology colleagues to see how you can work together?

Fringe session at the Royal Pharmaceutical Conference 2014

If you are attending the Royal Pharmaceutical Society’s Conference this Sunday and Monday, Birmingham and Solihull RPS would be pleased to see you at our breakfast Fringe session at 8am until 9:30am on Monday the 8th of September 2014. There will be coffee and danish pastries… Further details should be in your Conference Pack and at the registration desk. There is a form to register at the end of this post.

Here’s what you can see, and there will be time for Questions and Answers.

Innovation in pharmacy practice: Three case studies.

1. West Midlands Emergency Department Project (8:10am until 8:30am)

Health Education West Midlands identified a role for the Pharmacist in areas such as pre-discharge medicines optimisation in the ED and Acute Medicine Units, as well as within Clinical Decision Teams in the undertaking of medicines-related and minor¹s-focused clinical duties. This project aims to develop enhanced roles for Pharmacists, to improve patient safety, the patient experience and to increase capacity in the acute care pathway.

2.RPS BNFc QRG and SCRIPT Paediatric E-learning Modules (8:30am-8:50am)

SCRIPT eLearning is an established innovative and interactive eLearning programme to improve prescribing competency. Initially commissioned by Health Education West Midlands for Foundation trainees, the project has recently been extended to Paediatric Specialist Trainees, with 12 modules commissioned for development in collaboration with the University of Birmingham and Birmingham Children¹s Hospital. This exciting project sees Paediatricians, Specialist Paediatric Pharmacists and Nurses collaborating to develop module content that will improve knowledge relating to prescribing and therapeutics, with the overall aim of reducing medication errors in the paediatric setting. The learning will be made available online at www.paediaticprescriber.org.

3. PINCER: The use of a pharmacist led technology intervention method to show a reduction in patient harm (8:50am-9:10am)

The PINCER trial published in the Lancet February 2012 demonstrated that a pharmacist-led technology intervention method was effective in reducing a range of medication errors in general practice. Walsall CCG medicines management team has implemented a systematic process across all member practices to implement these safety interventions utilising the expertise of the informatics team and a software tool from PRIMIS. The improvement is safety and quality of prescribing has been demonstrated by the reduction in numbers of at risk patients across all categories and reduction of new patients identified.

Perceptions of risk and Uzi 9mms

Interesting cultural differences in risk in today’s news about football/soccer concerns in the US:

A group of American parents is suing FIFA to force it to limit the number of times young soccer players can head the ball.

The class action suit was filed Wednesday in California to demand more protection from concussions, and also names as defendants the United States Soccer Federation and the US Youth Soccer Association.

Contrast that with yesterday’s tragic news from a shooting range:

A 9-year-old girl at a shooting range outside Las Vegas accidentally killed an instructor on Monday morning when she lost control of the Uzi he was showing her how to use.

Another child died in a similar incident. Despite this, TV and radio interviews appear to suggest that a sizable number (or vocal minority) of people think the problem is more about the management of the shooting range, rather than the actual access to guns by children. Restricting such access is seen as “tyranny” by some gun enthusiasts.

In the UK the perception would be totally reversed. The concern about headers in football might be seen as “nanny state” and the gun culture associated with children seen as completely insane. Fascinating, yet tragic.

Picture from Alonzo Harris.

 

Let’s have some over-the-counter evidence

I have an editorial in The Pharmaceutical Journal on over the counter medicines and pharmacists relationship with them. Here’s part of it:

While the secret shopper work carried out by the consumer watchdog Which? in 2013 investigated[1] the quality of advice on OTC medicines given in pharmacies at the point of sale, an earlier report[2] in Which? published in 2012 focused on OTC products themselves. Among the products that were judged to be below par were sub-therapeutic doses of drugs, dubious herbal slimming tablets, oils that allegedly reduce scarring and some highly implausible alternative remedies. A pharmacist drawing up a local formulary of prescription drugs for a GP would take into account evidence of effectiveness, advice from evidence-based guidelines and a positive risk-benefit ratio. How many OTC products would reach the required standard?

Read more…

E-Cigarettes

Here’s a link to my brief piece on e-cigs in The Pharmaceutical Journal:

No drug is safer without regulation and that includes nicotine. Licensed e-cigarettes used as part of pharmacists’ smoking cessation role would be a step forward. Concern at the meeting that e-cigarettes were becoming an “easy fix” was supported by suggestions that smoking cessation services were not being renewed on the basis that e-cigarettes had solved the problem. Pharmacists need to defend the added value of those services and ensure e-cigarettes are an option when we have a licensed product.

In the meantime, we cannot support the sale of unlicensed e-cigarettes in pharmacies. This places pharmacists in a difficult position of selling an essentially recreational product with no licensed medicinal claim. There is potential for variation in dosing with unlicensed e-cigarettes, without the regulatory oversight of quality and safety the MHRA provides.