The Pharmaceutical Journal
Vol 268 No 7189 p359
16 March 2002

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Pharmacists must not shun complementary health approaches

By Jo Barnes

I agree with some of the views expressed by Simon Whitaker in his piece on "Baddy Chemists" (PJ, March 2, p288), namely those relating to the quality of some "alternative remedies", the practice of evidence-based medicine, and the pharmacist's duty of care towards patients, but I have an entirely different perspective with regard to the pharmacist's role in this area.

In my view, it is not in the best interest of patients (or the pharmacy profession) for pharmacists to shun complementary/alternative health approaches, remove complementary medicines from their shelves and, presumably, direct patients to health food stores and the like where there is no trained health care professional available and where poor advice may be given.¹

The use of complementary medicines and therapies is extensive,² and market research indicates that the popularity of complementary medicines is continuing to increase.³ People use complementary therapies and complementary medicines in addition to, or instead of, conventional medicines regardless of pharmacists' views on these approaches and whether or not pharmacies sell such products. Cutting pharmacists out of the loop may have implications not only for individual patients, but also for public health (if safety concerns are not identified) and for pharmaceutical care.

Patients' use of complementary medicines presents an opportunity for pharmacists to carve out a unique and credible professional role for themselves as expert advisers on such products. Who, other than the pharmacist, has the potential to advise patients on the importance of selecting good-quality products, and on the concurrent use of drugs and herbal medicines? Pharmacists would fulfil a duty of care towards patients and maintain the respect of other health care professionals if they stock only good quality complementary medicines and practise evidence-based complementary medicine, just as they practise evidence-based medicine.

On evidence, Mr Whitaker states that all complementary medicines lack any credible evidence base, and mentions homoeopathic and herbal medicines almost as if they were the same. Let us be clear about this: herbal medicines are chemically rich preparations, many with documented pharmacological activity;⁴ some, such as senna preparations, are widely considered to be conventional medicines. It is true that evidence for the efficacy of homoeopathy is lacking. But several herbal medicines, such as St John's wort and ginkgo extracts, have been investigated extensively in basic scientific studies and rigorous randomised controlled trials. Furthermore, those trials have been subject to Cochrane systematic review.⁴

The pharmacist's role with regard to complementary medicines could also comprise a monitoring function. The contribution that pharmacists can make in terms of monitoring the safety of herbal products has already been recognised outside the profession by the Medicines Control Agency (MCA) and Committee on Safety of Medicines (CSM) — pharmacists are specifically requested to report suspected ADRs in areas of limited reporting by doctors, namely over-the-counter medicines and herbal products. Pharmacists have fought long and hard to be included formally in the yellow card scheme — surely we should be encouraging the profession to embrace this role and, as part of that, encouraging patients to consult us for advice on suspected adverse drug reactions? The MCA and the CSM also recognised that pharmacists had an important role in disseminating information to patients about the potential for interactions between St John's wort and certain conventional drugs when reports of these emerged a couple of years ago.

The potential for drug-herb interactions also illustrates why pharmacists should encourage patients to tell them about their use of herbal products. It would also be important to know if, for example, a patient was using acupuncture for pain, as this could indicate that prescribed medication was not providing adequate pain relief. Accepting that patients may be using complementary medicines and therapies does not necessarily mean that pharmacists are endorsing such approaches, but if pharmacists are not aware of, or choose to ignore, patients' use of complementary medicines and therapies, it may in part compromise pharmacists' ability to provide pharmaceutical care. How can we ignore herbal and complementary medicines, some of which are P or POM, some of which can be prescribed on FP10, and some of which have important interactions with conventional drugs?

Of course, pharmacists need to be trained in order to take on the role described, and this involves developing teaching and learning at both undergraduate and postgraduate levels. I do not mean that pharmacists should become homoeopaths or aromatherapists, but that pharmacists should have sufficient background and evidence-based knowledge of herbal and complementary medicines in order to be able to understand what patients are doing and to advise them appropriately.

In my view, it would be a credit to our profession to accept that patients use complementary medicines, to encourage them to disclose such use to a pharmacist without fear of being judged, and to consult a pharmacist for advice on choosing good-quality products and for objective, reliable information on their use.

Dr Barnes is a pharmacist at the centre for pharmacognosy and phytotherapy at the School of Pharmacy, University of London