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Some reaction to the news on the Pharmacy Guild and Blackmores

Some pithy comments have already landed on the previous post covering the canning of the controversial deal between the Pharmacy Guild and Blackmores, which would have seen pharmacists prompted to promote Blackmores products as “companions” to certain popular medications.

Here is some more reaction: from Dr Ken Harvey, the  National Prescribing Service and Senator Richard Di Natale.
(Update, 7 October: Andrew Podger’s comments have been added).

Andrew Podger, professor of public policy at the ANU and former secretary of the Federal Health Department, says:

Glad to see some common sense, but the serious lapse of judgment shown by the original Guild decision still demonstrates the many dangers of the anti-competitive Pharmacy Agreement. It breeds the risk of  arrogance in addition to adding substantially to the costs of both consumers and taxpayers, with questionable benefits to public safety. While so far neither major Party has shown the courage to address the need for more competition, perhaps this episode, despite the climb down,  will help to show the pharmacy emperor really has no clothes.

***

Public health advocate Dr Ken Harvey (who previously criticised the deal) says:

I found it ironic that that the Pharmacy Guild press release states that the only problem with this deal was, “media reporting of the endorsement which was ill-informed and inflammatory”.

In my view (and that of others as per this report in MJA InSight, registration needed), it was the deal itself that was “ill-informed and inflammatory”!

Blackmores also have a press release out in which they note that, “Blackmores will remove the Gold Cross endorsement from the four products, we will not feature these products on the proposed IT dispensary software and we will update the product names to reflect the key ingredients, under the Companions brand”.

In other words, the Guild endorsement goes, the Guild dispensing software prompt goes and the product names, “BIOTIC Companion”, “ANTIHT Companion”, “STAT Companion”, and “PPI Companion” go.

I wonder if this back-flip had anything to do with complaints to the ACCC and AHPRA alleging that this Pharmacy Guild – Blackmores deal breached the anti-competitive provisions of the Competition and Consumer Act 2010 and the Codes and guidelines of the Pharmacy Board of Australia.

Finally, the press release goes on to say, “Blackmores has recently published a research review for healthcare professionals to highlight the scientific evidence underpinning these formulations; and we continue to believe that the Companions range will improve natural health outcomes for many Australians”.

“Belief” appears to be the operative word here; an independent review of the evidence for these “companion products” conducted by the National Prescribing Service (NPS) said:

“People shouldn’t take complementary medicines just because their prescription medicines could cause nutritional deficiencies or side effects. Adding an additional medicine should never be done lightly, especially if you’re already on multiple medicines — it adds to your financial cost, and might cause side effects or medicine interactions or even affect how well you take your other medicines.

If someone has, or suspects they have a deficiency or other side effect that is a result of taking a prescription medicine, it is important for them to see their doctor and ask questions about their medicine. Evidence of effectiveness and safety with complementary medicines is often limited”.

In particular, the NPS said:

“Evidence for any benefit of zinc supplementation in the absence of zinc deficiency is limited. People taking antihypertensives should only be considered for a zinc supplement if they are deficient in zinc. Results from the only trial investigating zinc supplementation with an antihypertensive (hydrochlorothiazide) were inconclusive.”

“No trials have shown that taking a Co-enzyme Q10 supplement with a statin prevents myalgia. Randomised controlled trials of Co-enzyme Q10 to manage statin-associated myalgia have conflicting results and do not support routine use with statin therapy.”

“No studies have investigated the use of a magnesium supplement to prevent magnesium deficiency during PPI therapy. A magnesium supplement should only be considered if a PPI has caused a deficiency in magnesium that requires treatment. Evidence for using a supplement with a PPI to treat magnesium deficiency is based on case reports.”

There is not enough evidence to determine the following about probiotics: the minimum dose that is effective for preventing antibiotic-associated diarrhoea; how well they work for different age groups; whether they prevent diarrhoea caused by Clostridium difficile (which can lead to more serious complications); how different probiotics compare in effectiveness and safety; the best length of time to take them for; whether the effect of a probiotic differs depending on the type of antibiotic taken or for how long the antibiotic is taken.”

***

Today’s statement from the National Prescribing Service

NPS welcomes decision by Blackmores and Pharmacy Guild to drop endorsement arrangement

NPS welcomes the decision by Blackmores and the Pharmacy Guild to cancel the Gold Cross endorsement of the Blackmores Companions range of complementary medicines.

A statement issued by NPS last week in response to the arrangement called on pharmacists to continue to tailor advice to individual patients based on their need and the evidence available.

“NPS was concerned that pharmacists being encouraged to sell complementary medicines as companion products alongside prescription medicines would cause confusion about medicines, and possibly lead to adverse events,” says NPS CEO Dr Lynn Weekes.

“We are relieved that the endorsement arrangement has been withdrawn. Pharmacists are trusted health professionals, and it is important that their approach to providing advice to their patients remains independent and evidence-based,” says Dr Weekes.

News of the partnership last week prompted NPS to review the evidence for the complementary medicines that were to be promoted. Full reports on the evidence for each of the complementary medicines in question is available.

Consumers with questions about the medicines they’re offered, including how the medicine works, possible side effects and interactions with other medicines, can contact Medicines Line on 1300 MEDICINE (1300 633 424) from anywhere in Australia for the cost of a local phone call (Monday – Friday, 9am – 5pm EST).

***

Greens’ health spokesperson, Senator Richard Di Natale

Pharmacy Guild decision a win for patients

Greens’ spokesperson for health, Senator Richard Di Natale, said that the decision by the Pharmacy Guild of Australia to withdraw its endorsement arrangement with Blackmores was a good outcome for patients.

“This outcome is a win for patients and a win for the profession.”

“The relationship between a pharmacist and a patient must be uncompromised by commercial arrangements.”

“Patients can’t have faith in the healthcare advice they are given when they are being ‘upsold to a combo’.”

“The right outcome has been achieved but it is disappointing that the Pharmacy Guild required pressure from the public and a number of pharmacists to do the right thing.”

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