What'sthe alternative?

Do complementary and homeopathic products have a place on pharmacy shelves? What about weight-loss shakes and ear candles? The changing face of community pharmacy is a complicated landscape. Fran Molloy

Community pharmacists have always needed to tread a fine line between trusted health care professional and profit-making retailer - but lately, their professional conduct has come under fire as various groups question numerous products stocked on the shelves of many pharmacies.

While the community dispensary plays a critical role in the management of public health, the average pharmacy devotes far more of its shelf space to cosmetics, hair care products and sunglasses - and now, vitamins, herbal remedies and weight-loss products - than it does to pharmaceutical medications.

The tension between the pharmacist's dual roles has become more fraught in recent years, as an increasing focus on evidence-based medicine lies cheek by jowl with the rise and rise of the complementary medicine industry, with two-thirds of adult Australians now using at least one complementary medicine each year.

The Therapeutic Goods Administration (TGA) defines complementary medicines as "medicinal products containing herbs, vitamins, minerals, and nutritional supplements, homoeopathic medicines and certain aromatherapy products".

Australian consumers spend about $2 billion a year on complementary medicines, most commonly self-prescribed vitamins, minerals and herbal supplements.

But a report released by the National Prescribing Service in December 2008 showed that consumers, pharmacists and GPs all struggle to find independent evidence-based information about complementary medicines.

And it seems that the growth of the complementary medicine sector has not detracted from medications prescribed by doctors. A 2007 poll of 630 adult Australians conducted by Research Australia found that 94 per cent of respondents had confidence in prescription medicines, compared to just 56 per cent stating they had confidence in complementary or alternative medicines.

All things to all people

Recently, pharmacists have come under fire for dabbling in the 'dark arts' of complementary medicines.

Sydney GP Jon Fogarty last year wrote an opinion piece ( Pharmacy News , 23 October 2008) accusing pharmacies of becoming "a Pandora's box of bizarre and outrageous products" and pharmacists themselves "purveyors of liver-cleansing diets and fat-dissolving concoctions," with the dispensary "relegated to an almost apologetic window at the back of the store."

"In a nation that is...