If a pharmacy’s practice is not underpinned by evidence, it is simply a shop

Johnathan Laird

WE need to support the development of a Scottish Intercollegiate Guidelines Network (SIGN) guideline for the sale or supply of over the counter (OTC) medicines in community pharmacy.

One of the really important stances that I am proud to say the Royal Pharmaceutical Society (RPS) stands for is that pharmacy practice should be rooted in scientific evidence.

We are a profession of scientists.

How can it be then, that we allow the sale of OTC products with thin, or no evidence base, from registered pharmacies in this country?

I’m well aware that in most small community pharmacies up to 50 per cent of sales can come from healthcare so I should declare that I don’t make thousands, or tens of thousands of pounds per year on these sales, so it is perhaps easier for me to have this view. Apologies if you don’t agree.

I think that for community pharmacists to further embed their reputation as high calibre healthcare professionals at the heart of communities we need to continue with rigour and follow the evidence in terms of the products we sell or supply.

Otherwise to be frank, we are just a shop.

In Scotland there has been recent leadership and resultant delivery of grass-roots community pharmacy research. I applaud this and indeed actively support it by taking part.

I now work within general practice, but also continue to do the occasional community pharmacy locum. I feel  that, as a pharmacist, I exist in two worlds in more than the physical way.

One world I exist in is general practice — here practice is evidence-based.

The other world is community pharmacy, where we sell and supply OTC products.

In the GP practice, I am currently being supervised to learn how to run ‘on the day’ clinics and also have an established post exacerbation respiratory clinic. In this role I follow the evidence and guidance unless there are compelling and justifiable reasons not to.

For example, the evidence tells me that pulmonary rehabilitation, smoking cessation, inhaler technique checks and advising patients to get the flu jab are all high return interventions that I can make for the person suffering COPD. I have yet to recommend a cough bottle to a COPD patient with a cough because the evidence simply does not support it.

I’m attempting to take a balanced scientific approach to this area of practice.

You must then see my confusion and disconnect with the system when a patient can walk into a community pharmacy, supervised by the “medicines expert”, and buy a cough bottle without question.

I have wrestled with this, and sometimes think I am seeking utopia but I recognise that things will never be perfect and actually it might be fine to sell things that do no harm. Perhaps we should market the fact that we are a profession that actively champions the placebo effect — which there is some evidence for by the way.

Pinning our hopes on the placebo effect to sell basically anything that does no harm would in my view be at least a step in the right direction towards evidence-based OTC sales.

But, just because it does no harm does not, in my view, make it professionally justifiable. If we want to be highly regarded knowledgeable professionals, then I’m not sure we can go on without at least making an effort to assess the evidence base of the various products we sell. In some quarters pharmacists have become the self-proclaimed medicines experts.

Well, surely having a firm grasp of the evidence base underpinning the medicinal products we supply is a critical aspect of this claim.

It is a question of credibility.

I would like to encourage the emerging grass-roots community pharmacy research, supported by the RPS, to look at this very topic. It would be fascinating to view a SIGN guideline for the supply of OTC products. We have traffic light markings on food products now to indicate sugar or fat content. I would like to see some sort of similar approach applied to the evidence underpinning the efficacy of OTC products — a system so clear that patients know exactly what level of scientific evidence supports the use of that product in a given patient for a given ailment. Perhaps evidence could be categorised as strong, moderate, weak or nonexistent.

Maybe this is a naive utopian aspiration however in our emerging data driven world this information will eventually in my view make its way to the consumer anyway.

A SIGN guideline supporting the supply of over the counter medicines would be something that may cause financial pain in the short-term (or maybe not) and would show the collective commitment of the community sector to an evidence-based scientific approach to practice.

Johnathan Laird is a member of the RPS Scotland Board, but he is writing in a personal capacity

1 Comment on If a pharmacy’s practice is not underpinned by evidence, it is simply a shop

  1. Whilst I generally get a bit ticked off with folk making vague & generalized comments re: lack of evidence with OTC products, mainly because IMHO there are actually lots of GSL and P medicines which are quite effective & have good evidence base, I think this blog starts to look at some of the practical issues around the OTC market and that is to be welcomed. Having more guidelines to support our vital symptom assessment, advice, referral & treatment role in community pharmacy practice can only be welcomed.

    Improved licensing, responsible packaging/advertising & consumer guide methods (such as traffic light indicators – love this!!!) for non-prescription medicines very much need to be looked at. As pharmacists we need to start lobbying and shouting more loudly to help shape the future we want to see that would be to the benefit of patients and consumers using non-prescription medicines and self-care options.

    Part of this picture is adequate NHS funding to support our role in supporting self-care. If I spend 5-10 minutes with a patient convincing them all they need is rest & recovery time (which let’s face it, many of us do routinely when advising on self-limiting conditions), then the NHS I am working in & supporting should recognise that. We’re part of the way there on this in Scotland but the evolution & redesign of our NHS contract needs to support these aims & we need to support it too by evolving, perfecting (& in some cases redesigning) the way we provide advice in our pharmacies.

    One last comment though, if the public want access to products that help them feel a little better for a little while e.g. a pack of 75p Soother lozenges (other brands available!) but don’t claim to ‘cure’ their cough or mild sore throat then that’s fine, let’s not medicalise everything! There’s room for simple remedies & that includes branded products, convenience isn’t a sin, I don’t want to have to keep bees & produce my own honey to be able to sooth my sore throat for a few minutes 🙂