by
Dr Ken Harvey

The four Guild-endorsed Blackmores products were a probiotic to be promoted with antibiotics, zinc with blood pressure drugs, coenzyme Q10 with vitamin D3 for statins and magnesium with proton pump inhibitors.

The National Prescribing Service (NPS) and others have pointed out that there is no good evidence to support the routine use of these supplements with the prescription drugs targeted.

In addition, this practice would unnecessarily add to the “medication burden” experienced by many patients taking multiple drugs, including compliance difficulties, increased cost and potential drug interactions.

Finally, it presents ethical problems for GuildCare (who were recommending one brand only) and for individual pharmacists (who would benefit financially if they went along with prompts that may not be in their patient’s best interest).

Several polls have shown that the deal diminished the standing of pharmacists in the eyes of consumers and medical practitioners. This cancelled deal brings back memories of another: pharmaceutical advertisements in prescribing software.

Health professionals and consumers also raised strong concerns about this practice and subsequently the Medicines Australian Code of Conduct was changed to include the clause:

Advertisements for prescription products must not be placed in any section of prescribing software packages.

The Code of Practice of the Complementary Health Care Council of Australia would benefit from proscribing similar deals.

The NPS evaluation of the Blackmores Companion products highlights the need for more independent information about complementary medicines, as does the increasing number of upheld complaints about their promotion and post-marketing data from the Therapeutic Goods Administration (TGA) showing high rates of regulatory non-compliance.

The recent Australian National Audit Office report titled, Therapeutic Goods Regulation: Complementary Medicines, said (paragraph 43):

It would enhance transparency and help inform both consumers and healthcare professionals if the TGA were to place the summary of evidence it collects from sponsors, as received, on its website – with a clear indication of whether it had been assessed or evaluated by the TGA.

There are a small number of registered CMs on the Australian Register of Therapeutic Goods (ARTG). If these products were registered recently, they have been thoroughly evaluated for quality, safety and efficacy (unlike listed CMs which predominate on the ARTG).

Examples include Blackmores Flexagil pain relief cream (a clinically proven comfrey root extract) for the topical treatment of sprains and osteoarthritis, and Flordis Iberogast (a clinically proven nine-herb mixture) for irritable bowel syndrome.

Unfortunately, some registered CMs were “grandfathered” into the ARTG without proper evaluation. At this point in time, there is no way the ARTG can be searched to obtain a list of registered CMs, let alone those that have been properly evaluated as distinct from grandfathered.

The TGA should be encouraged to include a list of properly evaluated, registered complementary medicines  to help consumers and doctors separate the wheat from the hype-driven chaff.

In addition, the NPS (or other independent groups) should be encouraged to provide more independent information about evidence-based CMs that have not been registered.

However, this information needs to be product specific, not generic. Not all herbal products (or other CM formulations) are phyto or therapeutically equivalent.