Page 90 - The 'X' Chronicles Newspaper - Jan-Feb 2018, Vol 27, No 1

90 Beware of the Integrative Pharmacy

Beware of the Integrative While I don’t personally work regularly Research on Complementary and Integrative
in retail pharmacy, I think of myself as a strong Health (NCRCI). Change the standard of
Pharmacy - Part I advocate for the community-based pharmacist’s practice, and what was ethically verboten is now

role – and for their potential to do much more. acceptable – and that’s what integrative
Not only are pharmacists among the most medicine proponents are explicitly trying to do
by Scott Gavura
accessible health professionals, they can also in health care.
have close, supportive relationships with their
Imagine a retail pharmacy where some of the
patients. And pharmacists are well-positioned to The integrative pharmacy
medicines on the shelves have been replaced do much more to enhance the safe and
with similar-looking packages that contain no appropriate use of drugs – from managing doses If you integrate unproven remedies with
active ingredients at all. There is no easy way to and side effects, to simplifying regimens, and by proven medicine in your pharmacy, it does not
distinguish between the real and the fake.
ensuring that prescribed medications are being improve pharmacy practice or patient care – it
Another section of the store offers a
taken safely and appropriately. If you’re makes that care worse.
number of remedies with fantastic claims, such
generally healthy and don’t need medication, A HuffPo column a few years back was
as “boosting” the immune system, “detoxifying”
you may not even know a pharmacist. But those a call-to-action to pharmacies to embrace
the body, or “cleansing” you of microscopic
with high medication needs tend to know their integrative medicine – it was a depressing read
Candida. They look sciencey, unless you realize
pharmacist well, and many rely on their to anyone that advocates for science-based
that they treat imaginary medical conditions. pharmacist as a key member of their health care principles. Entitled “Who Will Own the Brand
A corner of the store offers unpurified team. I know the impact a good pharmacist can of Integrative Medicine? “, the column
drugs supplied as tinctures and teas. The active have on the health of a patient. But I’m described integrative medicine as a business
ingredients aren’t known, and the batch-to-batch
increasingly dismayed at retail pharmacy opportunity:
consistency of the product is unclear. The store
practices that call the credibility and good “There is a revolution happening in
will suggest products for you based on your
intentions of the pharmacist into question. North American medicine. If successful, it will
symptoms.
educate and empower consumers, introduce us
Walk past the enormous wall of vitamins
Old whine in a new bottle to a world of new cures, and leave most of us
and other supplements and you’ll find a
wondering, ‘Why didn’t we do this 50 years
nutritionist who will tell you what products you Integrative medicine is ascendant. Terms like ago?’
should be taking. You’ll also find a weight loss “alternative” and “complementary” are falling It profiled the Pharmaca chain of
section. From a science-based perspective, this out of favor, in part because it’s increasingly pharmacies in the US. The CEO of Pharmaca
shouldn’t even exist, given no product has been
recognized that these terms carry a stigma – they was quoted:
shown to offer any meaningful benefit. But there
are not part of mainstream medicine. Integrative The common US model is one
are dozens of products for sale.
medicine seeks to explicitly embed pharmacist, and a bunch of clerks stocking
At the back of the store you’ll finally
complementary and alternative medical shelves. In our case, we have the highly trained
find the pharmacist. A sign on the counter offers
practices into conventional, science-based pharmacist, but also highly skilled practitioners
blood- and saliva-based tests for food
medical care. It purports to take a “best of both with homeopathic or naturopathic backgrounds.
“intolerance” and adrenal “fatigue”, claiming to worlds” approach, mixing science-based No one expert has the full answer. Instead, we
test for medical conditions that actually don’t treatments with a variety of unconventional collaborate to offer our customers a more
exist or lack an evidence base. The pharmacy treatments. The fundamental challenge with holistic approach to managing their health.
also offers a large compounding practice,
integrative medicine is that “integrative” Not surprisingly, Pharmaca advertises a
advertising what it calls “personalized”
products and services don’t have scientific wide array of ineffective treatments, from
approaches to hormone replacement with
evidence to support them: if they did, they’d products that claim to offer adrenal “support” to
“bioidentical” hormones.
simply be called “medicine”. Instead of homeopathy, detox kits and a weight loss
evidence, promoters of integrative medicine rely selection that Dr. Oz would approve of. To their
Welcome to the “integrative” pharmacy.
on other standards – many are grounded in belief credit, they also offer important pharmacy
systems, such as the idea of “vitalism“. While services such as vaccines, including the
You may not see all these features in your local ideas like vitalism are long-discarded from whooping cough vaccine. It’s a shame they’re
drug store, but they’re coming: claims of a new science-based medicine, they live on in the also actively promoting and profiting from
“integrative” way to provide health care that is
philosophies of practices like homeopathy, selling pseudoscience.
changing the face of retail pharmacy.
naturopathy, and chiropractic. And the retail part Another integrative pharmacy that was
Unfortunately, it’s harkening back to the era of
of the pharmacy profession sees an opportunity, profiled in the same column was Vancouver’s
patent medicines and snake oil. It’s not good for
like this advertisement seems to suggest. Pure Integrative Pharmacy:
the pharmacists and the profession of pharmacy,
Misleading patients and selling them Up to now, there’s been a polarization
and it’s even worse for patients.
inert, ineffective products is unethical medical between advocates of traditional and
As the blog’s only pharmacist, I like to practice. But under an “integrative” framework, conventional pharmacy. We believe the way
think I bring a different but (cough) pharmacies are simply offering homeopathy – forward lies in using treatments that are backed
complementary perspective to the contributions. after all, it’s trusted by millions. Basing your by evidence, regardless of their origin.
Naturally I like to write about drug-related
medical advice on pre-scientific ideas is and the CEO continued:
issues, and I’ll occasionally scrutinize the
incompetence from a conventional, science- I want to get rid of the whole east meets
profession itself. One trend in the profession
based perspective. But integrative medicine west stereotype. This isn’t about east meets west.
seems to be accelerating: It’s the increasing
seems to mean the freedom to simply make up It’s about getting the best product, or
volume of scientifically-questionable products
diseases, and then to sell treatments for them. combination of products, for our customers. And
on pharmacy shelves. It hit home the other day
Scientific evidence is no longer the basis for those products come with proof of efficacy.
when I found yet another local pharmacy that your practice – it’s become more holistic,
proudly advertises that it will sell you sugar pills embracing “different ways of knowing.” I’ve Read Part II of “The Integrative Pharmacy” in
and call it medicine. A twitter discussion ensued, written before about the harms to hospitals and the February 2018 Edition of The ‘X’
with one pharmacist commenting that his own
academic settings from the embrace of Chronicles Newspaper.
retail pharmacy looks behind-the-times simply
“integrative medicine”. In short, there is no
because he puts patient care and ethics ahead of
medical standard with integrative medicine –
revenue, and refuses to sell products like
and that’s why “integration” is so problematic.
homeopathy. Pharmacy is a health profession,
The bandwagon is growing, however. On
but retail pharmacy is also a for-profit business.
Monday, David Gorski noted that the National
This is a continual conflict, and I fear the Center for Complementary and Alternative
professional side may be losing ground in the Medicine is jumping on board, with a proposal
drive to increase revenue. to change its name to the National Center for