Do pharmacists know enough about supplements and traditional medicines?

Community pharmacists are increasingly being called upon to supply information on complementary medicine products, like herbal medicines, vitamins, minerals and other nutritional supplements.Photo: AFP

In the traditional sense of the words, a pharmacy is a place where medicinal drugs are sold and pharmacists are the healthcare professionals who dispense those drugs.

While pharmacies in hospitals and clinics usually adhere strictly to this traditional definition, most retail or standalone pharmacies tend to sell far more products than just prescription and over-the-counter medicines.

According to a study conducted by Taylor’s University School of Pharmacy associate dean (learning and quality) Penny Wong Pei Nee, nearly three out of five Malaysian pharmacies (59%) stock a large variety of complementary medicines (CMs).

Only 1% say they don’t stock any CMs at all, while the remaining 40% report that they offer a limited variety of such products.

Wong showing the Meditag hologram decoder that helps to differentiate between real and fake holograms on medicines and supplements. — ROHAIZAT MD DARUS/The Star
Wong showing the Meditag hologram decoder that helps to differentiate between real and fake holograms on medicines and supplements. Photo: The Star/Rohaizat Darus

This finding is probably due to the fact that over 90% of the pharmacists participating in the study agreed or strongly agreed that such products are an important part of a retail pharmacy’s finances.

They also agreed or strongly agreed that:

• Customers now expect more information about CM products from their pharmacist compared to five years ago;

• Pharmacists have a professional responsibility to counsel customers about CM products; and

• Pharmacists should play a greater role in providing customers with safety and drug interaction information about CM products.

Over 80% also thought that pharmacists should play a greater role in recommending CM products to their customers.

Complementary medicine in this study was defined as “herbal medicines, vitamin and mineral supplements, and other nutritional supplements” that “can be bought in a supermarket, pharmacy, health-food store, on the internet, from a mail-order company or from a T&CM (traditional and complementary medicine) practitioner”.

Local usage of CM

Says Wong: “The use of complementary medicines in Malaysia generally has three purposes for consumers.

“The first one is general health maintenance, like multivitamins; (the second is) treatment and prevention of minor ailments, such as when someone has a cold or flu and are recommended echinacea or vitamin C just to boost up the immune system; and for specific serious and chronic diseases, (for example) saw palmetto, black cohosh and things like that.”

She adds that while there are no specific statistics for CM, the Health Ministry’s Health Expenditure Report 1997-2013 published last year, estimated the sales of traditional and complementary medicines to be about RM1.7 billion in 2013.

“And this is only 7% less than pharmaceutical products,” she says.

According to Wong, CM products are regulated by the ministry’s Pharmaceutical Services Division and need to be registered with the Drug Control Authority.

“A registered product would be given a hologram, and also, a registration number.

“So, all CM products will have a registration number starting with MAL, and ending with the letter T or N – T represents traditional and N represents supplements (nutritional),” she says.

She adds that most pharmacies should have the Meditag hologram decoder issued by the ministry, which can help differentiate between a genuine hologram and a fake one on all registered CM and pharmaceutical products.

sfitx_anr_1109_top5CM.PDFKnowledge on CM

Sponsored by the Blackmores Institute, the study called Survey of Integration and Usage of Complementary Medicines in Pharmacy was conducted between last April and December, and involved 453 community pharmacists from around the country.

Around 47% of them were from large-chain pharmacies (i.e. consisting of more than 10 outlets, like Guardian, Watsons and Caring), 41% from pharmacy chains with less than 10 outlets, and the remainder were from independent pharmacies.

More than half of them (54%) received their bachelor’s degree locally, while the rest graduated from a mix of both Asian and Western countries, especially the United Kingdom (26%) and Australia (12%).

Wong notes that the respondents mostly agreed that pharmacists need to provide integrative care, i.e. the combination of allopathic and complementary medicines.

Around 93% of them agreed or partly agreed that their personal practice of pharmacy centred around integrative care.

The factors that prevented the remaining 7% from practising integrative care included lack of sufficient knowledge, lack of information sources, limited opportunity or insufficient time to talk to customers, the ineffectiveness of the product, and because the promotion of CM products is the responsibility of other colleagues.

Three-quarters of the pharmacists learnt about CM products on their own, 60% through seminars from the product manufacturer, 37% each through seminars from a professional association and lectures during their undergraduate course, and 7% through formal studies like certificate or postgraduate courses.

Six percent said they had no training whatsoever about CM products.

sfitx_anr_1109_drugcminteraction.PDFThe study also found that the top three information sources about CM products used by pharmacists were the manufacturer or brand owner’s own material or training (59%), the World Wide Web (49%), and professional seminars, conferences or lectures (43%).

The top three factors that pharmacists consider when assessing information about CM products are: whether it has a scientific basis (68%), whether it contains both traditional and scientific information (49%), and whether it has been endorsed by a professional or educational organisation (46%).

The information they provide to customers is usually sourced from books or leaflets (65%); their own knowledge (63%); textbooks, journals and the Web (59%); manufacturers or brands (50%); and feedback from other customers (42%).

Explains Wong: “So, to ensure safe use of complementary medicines or conventional medicines, when customers present with a prescription, a brief medical history should be taken by the community pharmacist to see what medications they are taking so that safe drugs can be recommended.”

The study found that nearly three-quarters of pharmacists (74%) always or often ask their customers if they take CM when they present their drug prescriptions.

Fourteen of the pharmacies also currently employ a T&CM practitioner, while a similar number said they would consider employing one.

A T&CM practitioner in this study is defined as one who is registered with the Health Ministry. However, Wong cautions that registration for such local practitioners is currently voluntary, although compulsory for foreign practitioners.

While 17% of the respondents said they would definitely not employ a T&CM practitioner, the top three factors considered most important in employing such a practitioner for those considering doing so were tertiary qualifications (65%), increasing product sales (49%) and being a member of a professional association (43%).

Advice for patients

Wong says that the most important factors for those thinking of taking a CM product are ensuring that it is a registered product and knowing how to use it.

“It is a collaborative effort between pharmacist and patient.

“We know that the pharmacist has their professional role (in educating and providing information), but sometimes, customers need to know what kind of questions they need to ask,” she says.

Some of these questions should include the optimum dose of the product (in order to achieve the optimum effect), whether it is genuine or not, and whether it will interact with whatever medications they are currently taking.

Wong says that customers should also go back to their pharmacist and report if they have any adverse effects from the CM product they consume.

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