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@WePharmacists 4/6/13

Pharmacy: A Quack Profession?
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Julia Scott

on 7 June 2013

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Transcript of @WePharmacists 4/6/13

@WePharmacists Pharmacy: A Quack Profession? @SparkleWildfire: The RPS Guidance on homeopathy is clear. But is the GPhC's?
@dracox: Why does the GPhC register homeopathic pharmacies?
@lecanardnoir: Indeed. A license to quack.
@Zeno001: Who knows. Not very many exclusively homeopathic pharmacies, though. Helios, Ainsworths Sanjivani, Nelsons.
@SparkleWildfire: Would some clear action from the GPhC send a positive message, or a negative one?
@JosephBush: Positive (and much needed)
@RanveerBassey: Only GPhC can assert the professionalism needed to overcome £ incentive. Employed pharmacists hve no say What of our professional leadership? @VishJP: [We need to] Learn more about homeopathy and how to explain to pts it most likely wont work
@zeno001: ...And why it might *seem* to work when it hasn't.
@VishJP: Need books on homeo and herbal as long as we sell the products...I have more of a clue of frontline tick for dogs than homeo so still needed
@Zeno001: Here's all you need to know: @dracox: Skeptics should support pharmacists who want to change this situation. We should be allies
@zeno001: I think we are!
@dracox: Not everybody is. There is a particularly unhelpful generalising that goes on. We need to win people over.
@SparkleWildfire: it cultivates an "us and them" feeling which isn't particularly welcoming.
@Dracox: There are certain skeptics I have stopped following because they are just ANGER and not constructive
@SparkleWildfire: the #skeptics network is a great place for pharmacists to learn skills and info. Pharmacists need to be welcomed into it, as I've been...I'm an infinitely better pharmacist because of #skepticism. I really think the whole profession could benefit from the principles.
@VishJP: we all need to be that annoying kid asking why Support from skeptics? What is YOUR understanding
of homeopathy? OR THIS....? Why DO pharmacies
sell homeopathy? @JonnyB_at_RMP: If allowing room for other peoples health beliefs whilst trying to build trust with them so that I can make meaningful interventions and change health behaviours over time (incl. med choices), and this involves the supply of 'simple' remedies w appropriate explanation, is quackery then I'M THE GREATEST QUACK WHO EVER LIVED!
@JosephBush: 'simple'? Do you mean 'placebos'?
@JonnyB_at_RMP: I mean products which may provide some soothing effect/perceived symptom relief but have little true therapeutic value. I explain their 'effect' in context of other self-help measures - rest/fluids etc
@SparkleWildfire: how do patients respond to explanations?
@JonnyB_at_RMP: they usually listen & accept what I'm saying as I tell the truth without being derogatory about their beliefs...BUT, even knowing there is no evidence for a product will not deter some purchases - anecdotes & personal experience are powerful motivators for customer/pt choice. As they are for prescribers & p'cists let's be honest! Homeopathy BAD or
Evidence-based medicine GOOD? @SparkleWildfire: Would love to see anyone interested in skepticism in healthcare or evidence-based medicine in tonight's #WePh chat. Come say hello....I believe firmly that my interest in skepticism has made me a much better pharmacist. How can we introduce principles in2 practice? The Skeptic's View? @VishJP: We sell homeopathy cos it meets a market need. Not because of any evidence
@SparkleWildfire: ethical?
@VishJP: Probably not but as long as its not been hit with a mhra/nice ban hammer it will continue
@SparkleWildfire: the RPS have said there is no evidence on which to sell it. Maybe GPhC need to take some action also?
@VishJP: Wud love GPhC to take a stand. But I think it won't happen because sales involved. Any C&D info on sales?
@RanveerBassey: Nelson's 2011 turnover was £45m so not insignificant. Supply Boots/Tesco own-label & hve lots of other brands
@VishJP: And that's why comm pharms sell it. We need the money to offset losses from dispensing
@MedsManPharm: What sort of price are we talking for homeopathic remedies off the shelf these days?
@SparkleWildfire: someone worked out it is more expensive than crude oil I think
@RanveerBassey: £5/6, more than a lot of real meds! @SparkleWildfire: The majority of people I speak to about homeopathy think it is herbal medicine. Has anyone experienced similar? @VishJP: Yes. I think people get confused. Especially with herbal and homeopathy products sold together
@JonnyB_at_RMP: I've experienced all sorts of misunderstandings - my job to explain differences/+ves/-ves.
@SparkleWildfire: I genuinely think (hope) most comm pharms think they're selling herbal meds too. thoughts?... It seems as tho as soon as homeo is mentioned, pharms panic due to lack of knowledge & forget basic principles. Would you agree?
@dracox: I think that is a good point - added to that fear of upsetting person... @dracox: I'm interested in how many pharmacists were actively taught that homeopathy works as an undergrad? Anybody?
@MedsManPharm: Taught NOTHING on homeopathy at uni. Did my training pack at Boots as a Saturday girl though!
@RanveerBassey: We had a whole module on alternative meds which included a lecture on homoeopathy
@SparkleWildfire: I think part of one lecture was devoted to the principles of it. But I never realised just how ludicrous it is until a yr ago
@VishJP: I don't think was mentioned. Herbal info was.
@epparry: We had a single lecture on Homeopathy at Welsh School. It was a joke!
@darkvignette: Had a single lecture by a sceptical professor who encouraged us to look at the science AND the evidence
@TheMMP1: You might take that further - it's about the science, the evidence and the experience How does this affect
the image of pharmacy? @lecanardnoir: [Pharmacy's] retail success depends on the selling of mostly unproven, untested, absurd or pseudoscientific product
@JosephBush: Disagree. Its RETAIL success depends on deodorants, sanitary towels, deodorants and sandwiches. CAM small change....I'm not disagreeing with your fundamental point. I think it's abhorrent but CAM not main contributor to pharm turnover
@JonnyB_at_RMP: the VAST majority of our income is derived from NHS contract services incl. dispensing.
@dracox: CAM is peanuts - and damaging profession for virtually nothing. Community employees put in toxic environment...They have absolutely no control over retail stock. Under immense stress, guy turns up and says "I want to buy this"...
@JosephBush: Dr Cox raises a key issue. Some anachronistic thinking in wider world. Assumption that pharmacist has control over what is stocked @lecanardnoir: "That is because its retail success depends on the selling of mostly unproven, untested, absurd or pseudoscientific product...Go into any retail pharmacy and you will be met with walls of vitamins, supplements, syrups, bangles. All deceiving the consumer... The central issue for retail pharmacy is the presence of the pharmacist lends credibility to a whole bucket load of quackery." @dracox: Such publications are a hangover from the old society, and should be sold off. No place in a learned society. http://www.howdoeshomeopathywork.com @LauraLouGraham7: In the uk we need to broaden the access to adequate info to make these judgements-natural medicines database
@Zeno001: What sort of thing do you mean?
@SparkleWildfire: Medicines information centres should have access. and comm pharms can ring them. Natural Medicine Comprehensive Database is a gold standard meds info resource. But very expensive. @SparkleWildfire: Should we be focusing on the negatives of homeopathy, or the positives of evidence-based medicine?
@JosephBush: Aren't the two inextricably linked?
@dracox: This is less about evidence, than it is about honest presentation of the evidence.
@RanveerBassey: Unless we think products with no evidence have no place in a pharmacy at all? GPhC could force that
@SparkleWildfire: I don't think they do have a place. I think evidence-based medicine should be our only focus.
@VishJP: I agree but the prob is chains want the money and the share dividends.
@AngrySwans: pharmacies sell cough medicines. Pharmacy has always been about profit over effect.
@JBSemple: There's a difference between initiating quack treatment and being (unwilling?) accessories to it. Pharmacy: A Quack Profession? A @WePharmacists chat summary by @MedsManPharm For the background to this chat, see the pre-chat info here: http://bit.ly/Zv2gST @FaraazHussain: If there is no evidence for/against homeopathy, what does it really matter, if it can make the pt feel good surely it's more gd thn bd
@JosephBush: Because homeopathic pills are much more expensive than their raw sugar equivalent
@Zeno001: Plenty of evidence against homeopathy! But there are other harms as well
@josephBush: Oh, and harms in use at expense of effective remedies and to pharmacy's professional reputation Is it all about the £££££? @JonnyB_at_RMP: I think another factor is during the last decade when complementary therapies became much more mainstream & fashionable...and it simply became the 'done thing' to stock a wide range of CAM products & buy into the concept.
@JosephBush: The 'done thing' being a business decision. I think we need to give precedence to health professionalism
@Zeno001: In what way more mainstream?
@JonnyB_at_RMP: media coverage, celebrity endorsement, rise of various CAM clinics, GPs Pxing homeopathy & doing acupuncture etc.
@JonnyB_at_RMP: interestingly, I think some pharmacies saw CAM as an opportunity to stock health related products instead of non-health related stock ('tat') and felt it displayed a more 'professional' image. !
@Lecanardnoir: I fully accept that an evidence-basd pharmacist may have little choice but to work in the 'toxic' environment of retail
@SparkleWildfire: the question is, given that environment, why don't we all sell responsibly? What do we teach pharmacists about homeopathy? @JonnyB_at_RMP: I'm sure CAM crept in to CPPE and NES programmes too, as it perhaps did in MPharm. Again just an observation.
@JosephBush: If practice widespread then should be in undergrad. Key is how you teach it (objectively - obviously)
@dracox: Well we both teach this stuff in a skeptic sense... What is going on elsewhere?
@JosephBush: I have no idea although I have some doubts all schools teach it as we do
@dracox: False division with MPharm between prescribed medication and OTC medication?
@SparkleWildfire: I teach an hour on skepticism to pre-regs. It always seems like a revelation to them that critical appraisal doesnt just mean journals
@AngelaAlexander: we show Reading students the Mitchell and Webb sketch. Says it all really. @zeno001: Lobby the GPhC and get them to act?
@dracox: I think the RPS can still do more to lobby on this issue and other areas around it
@RanveerBassey: Lobby GPhC & in mean time call for a redefined pharmacist role in sale of CAMs with focus on consumer education
@lecanardnoir: Agree. Only regulators can make a difference here.
@L1ttlepetal: if evidence against homeopathy is strong,why can gphc not step in and ban its sale in pharmacies?Why bring profession into disrepute?
@camshim: gphc are concerned with public/patient safety. Reputation of profession a leadership issue. See society
@L1ttlepetal: you're right, our professional body needs to help restore the faith of the public with pharmacy. @rpharms THIS? What CAN be done?
What can individual pharmacists do? Lobby the @TheGPhC and @RPharmS.....
SparkleWildfire: Open letter anyone? Learn enough about homeopathy and the lack of evidence to be able to advise on this confidently....
cathrynjbrown: I think community pharmacists need not to be shy of highlighting evidence, or the lack of it Develop your sense of skepticism.....
@SparkleWildfire: I'm going to personally carry on blogging about the important role of skepticism in healthcare...And continue teaching pre-regs its importance. I'll just keep shouting about the harms as loudly as this little pharmacist can Those in academia - look critically at CAM teaching (or the absence of it) in your institution....
@cathrynjbrown: I think academics need to look at how it's included in the syllabus Thank you to everyone who took part -
we hope you can join us in another chat soon!
@WePharmacists #WePh @Faraazhussain: shouldn't they need approval and be taken off the shelves totally, if they are that serious?
@JosephBush: Well, MHRA approval was silly. If ppl want 2 buy overly expensive sugar pills thn that's their choice...
@Zeno001: It comes from EU Directives and MHRA were given the job of 'regulating' them.
@JosephBush: ...but any claims for effectiveness should not be allowed &, IMHO, pharm shouldn't be involved
@Jaiminthakrar: Pharmacists should supply if a pt requests but never recommend as a treatment option.
@VishJP: Pts can be wrong. So shud we provide and advise to just say no evidence?
@Zeno001: Yes. The customer isn't always right!
@VishJP: Knew someone who say they not always right but shud be given benefit of doubt.
@Zeno001: Only if they know more about medicines, science and evidence than you! The wordcloud summary... ...and chat stats,
courtesy of Symplur...
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