Abstract
A significant issue for pharmacy, at a time of much change for the profession, is the extent to which alternative medical practices are acceptable to the profession. More and more concerns are being expressed as increasing numbers of pharmacists sell homeopathic, herbal, and other alternative remedies. In fact, alternative medicine challenges long-standing ideologies within pharmacy, particularly the emphasis on being a scientific profession. At the same time, pharmacy is developing new professional strategies; these include more involvement in clinical aspects of health care. Despite this, the profession is not yet addressing, in any comprehensive way, the substantial public interest in alternative medicine (including self-care) and its potential impact on health care services, such as the integration of alternative medicine into conventional care.
The purposes of this review are
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1.
To indicate briefly the fundamental changes occurring in the profession of pharmacy (particular attention is given to North America and the United Kingdom, where the commercial atmosphere of retail pharmacies is obvious);
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To make clear that alternative medicine challenges pharmacy to examine closely ethical issues in its new trends, and that pharmacists have an obligation to study these issues as they become involved directly in selling alternative medicines or offering general advice about them; and
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3.
To promote informed discussion on such matters within and outside pharmacy.
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Notes and References
. Barrett, S. and Tyler, V. E. (1995) Why pharmacists should not sell homeopathic remedies. Am. J. Health-Syst. Pharm. 52, 1004 – 1006.
Pray, W. S. (1996) The challenge to professionalism presented by homeopathy. Am. J. Pharm. Educ. 60 198–204. This includes such other statements as “Pharmacy cannot stand further erosions of its scientific credibility at the very time it is striving to enter the realm of pharmaceutical care.”
Veatch, R. (1995) Informing a patient about a homeopathic preparation. Am. J. Health-Syst. Pharm. 52, 2437–2441. Quotation below, p. 2439.
For recent summary of alternative medicine and the view that it is a social movement, Crellin, J. K., Andersen, R. R., and Connor, J. T. H. (eds.) (1977) Alternative Health Care in Canada Nineteenth-and Twentieth-Century Perspectives. Canadian Scholars’ Press, Toronto, Canada.
For U.S: Eisenberg, D. M., et al. (1993) Unconventional medicine in the United States. Prevalence, costs and patterns of use. New Engl. J. Med. 328 246–252; for other figures, especially for Canada. See ref. 4. Note added in proof: A CTV/Angus Reid Poll, conducted August 1997, reported 42% of Canadians using alternative medicines and practices.
Specific documentation for this viewpoint is not available, but visits to pharmacies during the past two years in Canada, United Kingdom, and United States reveal that advice offered with the sale of homeopathic or herbal preparations is very fragmentary. When it exists it is often questionable.
For a general sense, see such texts as Sonnedecker, G. (1976) Kremers and Urdang’s History of Pharmacy. Lippincott, Philadelphia, PA. Perhaps nothing has highlighted the tension or the controversies more in recent years than the views of Dr. Philip Brown, editor of the influential Scrip Magazine. In arguing that he sees no need for a separate pharmacy distribution system, he stated that it is difficult to justify the pharmacist in professional terms against changes in the market place. See Pharmaceutical Journal (1994) 252 6980. Although Brown is writing for the British scene, his remarks are equally relevant to North America.
A vast literature on pharmaceutical care has appeared in professional journals, but much of this is summarized in new texts such as Knowlton, C. H. and Penna, R. R. (eds.) (1996) Pharmaceutical Care. Chapman and Hall, NY.
. Buerki, R. A. and Vottero, L. D. (1994) Ethical Responsibility in Pharmacy Practice. American Institute History of Pharmacy, Madison, WI, p. 22.
For general discussions on the new ethics: Buerki, R. A. and Vottero, L. D. (1989) Ethics, in Pharmacy Practice Social and Behavioural Aspects, Wertheimer, A. I. and Smith, M. C., eds., Williams and Wilkins, Baltimore, MD, and ref. 9.
For ethical codes (British) in Appelbe, G. E. and Wingfield, J. (1993) Dale and Appelbe’s Pharmacy Law and Ethics (Appendix 17). Pharmaceutical Press, London. (U.S.: in Buerki and Vottero; see ref. 9).
See Buerki and Vottero, ref. 9, p. 161.
. For some useful discussion: Vottero, I. (1995) The code of ethics for pharmacists. Am. J. Health-Syst. Pharm. 52, 2096.
. Zellmer, W. A. (1996) Searching for the soul of pharmacy. Am. J. Health-Syst. Pharm. 53, 1911 – 1916.
Harrop, B. (1991) Homeopathy. Pharm. J. 247, 714.
Perrin, J. (1995) Homeopathy. Pharm. J. 254, 676.
I should add that supporters ofhomeopathy did occasionally make such comments as “in community pharmacy we are dealing with patients, not scientific principles alone, and I do not agree with the suggestion that a full scientific explanation is required before any treatment can be taken seriously.” [(Kayne, S. (1993) Pharm. J. 250 6. Such sentiments, however, do not focus attention on responsibilities to patients.
Kayne, S. (1995) Homeopathy. Pharm. J. 254, 746.
Finberg, M.S. (1995) Homeopathy. Pharm. J. 254, 746.
. Madge, M. (1992) Homeopathy. Pharm. J. (1992) 248, 175.
Select references on ethics and alternative medicine: Ernst, E. (1996) The ethics of complementary medicine. J. Med. Ethics 22 197,198;
Fisk, W. (1995) Multiculturalism, alternative health care, and responsibility for belief. Mount Sinai J. Med. 62 148–151;
Norton, L. (1995) Complementary Therapies in practice: The ethical issues. J. Clin. Nurs. 4 343–348;
Jackson, J. (1994) Unproven treatment in childhood oncology How far should paediatricians co-operate? J. Med. Ethics 20, 77–79;
Pietroni, P. C. (1994) The interface between complementary medicine and general practice. J. Royal Soc. Med. 87 (Suppl. 22) 28–30;
Kottow, M. H. (1993) Classical Medicine v alternative medical practices. J. Med. Ethics 19 51;
Cole, D. and St. George, I. (1993) Medicine at the fringes. New Zeal. Med. J. 106 130–133;
Pietroni, P. C. (1992) Alternative medicine: methinks the doctor protests too much and incidentally befuddles the debate. J. Med. Ethics 18 23–25;
Kottow, M. H. (1992) Classical medicine v alternative medical practices. J. Med. Ethics 18, 18 – 22.
Renton, A. (1992) Alternative medicine: Response to Kottow. J. Med. Ethics 18, 161, 162.
Lyno, N. (1992) Ethical and professional aspects of the practice of alternative medicine. Scand. J. Soc. Med. 20, 217 – 225.
For stimulating discussion: Freemantle, N. (1995) Dealing with uncertainty: Will science solve the problems of resource allocation in the U.K. N.H.S.? Soc. Sci. Med. 40 1365–1370.
For some perspectives: Clouser, K. D., Hufford, D. J., and O’Connor, B. B. (1996) Informed consent and alternative medicine. Altern. Ther. 2 76,77.
Counseling and pharmacy occasions much debate, more so than in many other health care situations because of the generally incomplete information about a patient’s condition and general health on which he pharmacist offers advice and help.
. For some sense of this direction, McCallian, D. J., Carlstedt, B. C., and Rupp, M. T. (1996) Developing pharmaceutical care plans for desired outcomes. J. Am. Pharm. Assoc. (new series) 36, 270–279.
. Muzzin, L. J., Brown, G. P., Hornosty, R. W. (1993) Professional ideology in Canadian pharmacy. Health Can. Soc.1, 319–345.
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Crellin, J.K. (1998). Alternative Medicine. In: Humber, J.M., Almeder, R.F. (eds) Alternative Medicine and Ethics. Biomedical Ethics Reviews. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4757-2774-6_6
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DOI: https://doi.org/10.1007/978-1-4757-2774-6_6
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