Last we visited the Blackmores, Guild Alliance there were serious doubts about evidence from Blackmores or understanding from the Guild.

Not much has changed on admitting fault, even with the removal of the Gold Cross endorsement. Which, by the way, was the fault of “ill informed and inflammatory” media reporting leading us goofy consumers to exhibit a “strong level of public concern”. I wonder where the Guild gets off trying this one on. There’s something missing from this sudden awakening in which “the Guild has listened to these concerns and accepts – mutually with Blackmores… to withdraw the endorsement arrangement”.

For example the AMA, according to president Steve Hambleton, considered the deal “outrageous” and that, “There’s no place for commercial interference in the clinical decision making of the pharmacist”. This was and is reflected in GP’s responses, including some writing notes with scripts to not include the “companion range”. Professor Paul Glasziou, director of Bond University’s centre for research in evidence-based practice had, on ABC, called Blackmores’ bluff on supporting evidence.

Chemist Warehouse had publically and loudly protested, promising to not participate in the deal. “Our pharmacists recommendations are not for sale” and “Professionals Practicing Professionally” stated their defiant flyer. Ouch!

Many individual pharmacists were, to put it mildly, infuriated and appalled at the Guild’s total stuff up which effected the integrity of all pharmacists.

Stuart Baker, a pharmacist from Western Victoria quit the Guild in protest. In view of the decision to drop the Gold Cross endorsement he still won’t be returning. Damage done there it seems. In light of the Guild’s inability to accept responsibility for such poor decision making the damage could be both more widespread and persistent.

Jane McCredie recently wrote in MJA Insight:

PHARMACISTS have long felt like the poor relations in the broader family of health professionals when it comes to status and respect, if not monetary reward.

In recent years, their representative bodies have lobbied for expanded prescribing rights, for recognition of their role as front-line “clinicians” and against allowing pharmacies in supermarkets for fear this would undermine the quality of health care provided.

It’s going to be a lot harder to make those arguments convincingly in the wake of the spectacularly ill advised deal between the Pharmacy Guild and Blackmores that created such a media furore last week.

October 5th saw the Pharmacist Coalition call on the Guild to dump the scheme. AusPharm News reported in part:

The Pharmacist Coalition for Health Reform (PCHR) has called on the Pharmacy Guild of Australia to axe their deal with Blackmores, following the Guild’s admission that the computer prompts to upsell dietary supplements were a pilot only and would be reviewed.

PCHR spokesperson and Chief Executive Officer of the Association of Professional Engineers, Scientists and Managers, Australia (APESMA), Chris Walton, said that pharmacists had rejected the deal and it was now time for the Pharmacy Guild to scrap the pilot. “A Pharmacist Coalition poll of over 460 people has shown that 94 per cent of community members, including pharmacists and pharmacists-in-training, disagree with the Blackmores’ deal and believe ‘it undermines the professionalism of pharmacists’.

“This has been further supported by The Age online poll which revealed that of over 2,000 voters, 94 per cent do not approve of the ‘Pharmacy Guild of Australia’s deal with Blackmores to recommend Blackmore’s supplements’. [….] PCHR spokesperson and Chief Executive Officer of The Society of Hospital Pharmacists of Australia (SHPA), Yvonne Allinson said The Pharmacy Guild has lost credibility and a failure to scrap the pilot would damage their reputation further.

Gold Cross is a fully owned subsidiary of the Guild. Now that the Gold Cross endorsement has been cancelled their logo, if you like, won’t appear on Blackmores companion range. Nor will the pilot project of software prompts at point of sale go ahead. The decision was “made in conjunction with Blackmores”.

The mutual decision has been taken in view of the strong level of public concern about the proposal, based on some media reporting of the endorsement which was ill-informed and inflammatory.

The last thing the Guild would ever want to do is deplete the credibility of community pharmacists, or damage the trust in which they are held by Australians. That trust and confidence is of paramount importance to the Guild and to our Members. The Gold Cross endorsement arrangement with Blackmores was entered in good faith, with absolutely no intention of undermining the professionalism and integrity of participating pharmacists. [….]

Additionally, an optional prompt containing clinical information for the patient to consider in relation to one product of the Companions range was to be available through the dispensary IT programs, on a pilot basis. The software pilot was not intended to commence until at least November, and will now not proceed.

Chris Walton CEO of APESMA Pharmacist division said in response:

This is a pathetic back down by an out of touch organization. The Guild has been dragged kicking and screaming to the decision and still will not take responsibility. They describe their decision to enter the deal as one made in good faith. Good faith must now be code for a bag of coin.

The profession should never forget that the Guild was willing to trade on the good reputation of pharmacists for commercial gain. While the same people are in charge why would we ever trust them again. Any pretence that they represent the pharmacy profession is over.

Still insisting that the “need for these natural health supplements for some consumers is underpinned by a body of scientific evidence”, Blackmores released a statement also with soothing noises about having listened. But they go one further and point out the “considerable confusion” in waking up to their scam. Hmmm. Perhaps they have a supplement for that? Either way, also from October 5th:

We have listened to the feedback on the Companions range and it is apparent that there is considerable confusion regarding the positioning of this range which we believe is detracting from the potential underlying benefit of these products to consumers.

As a result, and following discussions with Gold Cross, 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.

Blackmores have published research on their professional page for “health professionals” which is well summarised here. I suspect in response to the NPS review of evidence to sustain (cough) claims made in defence of the “companion range”. Christine Holgate opens her heart here about “misconstrued” information and accurate representation of “integrity”. Basically, it’s all good and they’re doing Aussies a favour. No, really.

All up, it’s rather shameful. The Guild haven’t in effect admitted being at fault. At most they seem to grudgingly admit to a type of PR blunder. Blackmores is sticking to it’s guns pleading misunderstanding on the part of the public and a raft of health professionals. Marcus Blackmore bemoaned that a full scale assault on complementary medicines had grown out of the same misunderstanding. ABC have a comprehensive write up with audio and video.

Jane McCredie finished her MJA Insight article in style:

The Pharmaceutical Society of Australia is due to release a new code of ethics for its members — along with a vision for the profession’s future — at its annual conference later this week. It would be nice to think that code might require pharmacists to disclose the level of evidence for any non-prescription medication they sell — hardly an unreasonable demand of people who want to be recognised as clinicians.

I’m imagining the conversations now if this code is implemented. Pharmacists selling homoeopathic remedies will be required to tell each and every customer: “There’s not a skerrick of evidence this works, but if you want to throw your money away…”

Therein lies the very source of the problem. Blackmores’ deal stood out because it officiated upselling and would have included entirely unwarranted prompts. Both the Guild and Blackmores knew it to be a grab for money. So did everybody else. Yet pharmacists do recommend and sell junk to consumers. Assistants do little if anything to dissuade from spontaneous buying.

Doctors will testify to patients at times admitting to taking large amounts of useless supplements. It’s documented that patients are reticent to admit to doctors they use alternative products. In the main doctors are missing out on vital information they need to properly treat their patients.

The only durable solution is for the TGA to move forward with sharp teeth and legislation to call CAM what it really, in the main is.

Unproven and unnecessary.