That fancy homeopathic children's cough medicine you picked up from your local pharmacy may be nothing more than expensive water. Your pharmacist may have recommended it. And Health Canada most likely approved it for sale as a health product.
Despite having a Health Canada "seal of approval," many of the natural health products Canadians buy and use are simply not backed by science. This concern is not merely academic; in a survey of 400 pharmacists in Alberta, we found that a majority of them recommend only natural health products that are licensed by Health Canada to clients, and that some rely on Health Canada approval as the primary basis for recommending natural health products.
If you find this distressing, you may be happy to know a change is imminent. The Globe and Mail recently reported that Health Canada is making significant changes to the regulation of natural health products. The changes are largely motivated by loopholes in the existing regulatory framework, which allows the licensing of products that do not meet scientific standards for safety and efficacy. Just last year, a CBC Marketplace investigation of the licensing system for natural health products revealed that Health Canada approved a fake homeopathic remedy for children. The Marketplace sting suggests something else: The natural health product in your local pharmacy may be junk and Health Canada cannot tell the difference.
Under the proposed changes, natural health products would be subject to the same level of scientific scrutiny as conventional drugs. Products that do not pass scientific muster will not be allowed to make health claims and will remain unlicensed. This would ensure that health products marketed to Canadians are assessed on the basis of the best scientific evidence, and that Canadians spend their hard-earned dollars only on products that make scientifically verified health claims. The latter is no trifling matter; recent statistics show that more than 70 per cent of adult Canadians bought at least one natural health product in a given year, and the total yearly spending in 2015 by Canadians on natural health products exceeded $1.5-billion.
One issue that the proposed changes will not address is the availability of natural health products in community pharmacies across Canada. Licensed or not, displaying natural health products in pharmacy aisles affords them a stamp of legitimacy. Pharmacists, as owners and operators of pharmacies, have a business incentive to recommend these products to customers. In our survey, we found that a majority of pharmacists (68 per cent) routinely or occasionally recommend natural health products to clients.
Given the evidentiary questions about natural health products, and the possibility that many would not meet licensing requirements under the proposed regulations, should pharmacies be allowed to sell such products to the public? On one hand, selling natural health products in pharmacies could be seen as a matter of free enterprise. Pharmacists, as entrepreneurs, should be free to provide natural health products, and to help their customers understand the information and health claims associated with them. On the other hand, the involvement of pharmacists in the marketing of natural health products facilitates public demand for products that lack good quality evidence to support safe or effective uses. It undercuts the view that pharmacy is an evidence-based profession practised by professionals who deal only with health products that have been rigorously and scientifically tested to ensure they are safe and effective.
In short, pharmacists may have a hand in legitimizing snake oil.
Most would agree that health products should be marketed to the public only if they pass the best available standards for safety and efficacy. What is less clear is whether regulated health professionals should facilitate access to products that do not meet this standard. At a minimum, pharmacists have a legal and ethical obligation to provide science-based advice and recommendations to their clients.
Of course, some community pharmacies operate within businesses that sell other products, including groceries and household goods. Where the pharmacy begins and ends in such cases can be difficult to place, but one thing is clear: Consumers will not turn to the pharmacist for advice on a cheese grater, even one that makes health claims.
Ubaka Ogbogu is an assistant professor in the faculties of law and pharmacy and pharmaceutical sciences, and Candace Necyk is a clinical assistant professor, faculty of pharmacy and pharmaceutical sciences, University of Alberta.