Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review

Abstract

Objective The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines. Methods International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists' practices or perceptions, consumers' expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists' responsibilities in selling complementary medicines were included in the review.

Towards consensus: defining and supporting a professional role for pharmacists associated with traditional and complementary medicines – a protocol of implementing an international e-survey

“…In section 3, the level of agreement to three items designed to capture opinions about a set of proposed bioethical responsibilities, 18 and a framework for pharmacists managing T&CM products are requested. 19 …”

“…These findings were raised again in a more recent systematic review 18 that informed the development of a bioethical framework for pharmacists’ responsibilities when selling T&CMs. 19 The framework supported and built on the afore-mentioned pharmacists responsibilities to propose that both pharmacists and their staff should be trained in the provision of evidence-based T&CM recommendations; pharmacy staff should know when to refer to a pharmacist about T&CM products; pharmacists should be able to provide T&CM product information for people to make informed decisions; the layout and business model of the pharmacy should be conducive to consumers receiving T&CM product advice from a pharmacist when purchasing the products; and pharmacists should intervene if the risk of harm is significant.…”

Ethics and Business in Community Pharmacies – A Framework for an Ethical Dialogue

“…On the other hand, pharmacists' employers should develop organizational cultures that support team development to ensure a good working environment and quality of pharmaceutical services [10]. Regarding dispensing complementary medicines, it has become a common practice in many countries to increase sales in community pharmacies, more or less accompanied by counselling [9,11,16,17]. Indeed, the explosion in the number of such products on the market makes it difficult to keep knowledge up to date, even by professionals such as pharmacists, used to search and select proper scientific information.…”

“…Indeed, a very competitive environment, such as that of community pharmacies, may exacerbate the pressure and conflicts between professional pharmaceutical ethics and employers' business interests [9,10,16,18,24,26]. The most frequent conflicts faced by pharmacists in the community pharmacies are related to the setting of sales targets by their employers [10,11,19,24], dispensing complementary medicines [9,11,16,17,19], making time for patient counselling [9,17,18] and collecting expired medicines from patients for proper disposal [3,21,24]. Dealing with such conflict situations frequently may have a major negative impact on the pharmacists' professional satisfaction and commitment to providing quality services to their patients [10,18,26].…”

“…Furthermore, the broadening of community pharmacy activities (e.g., medication review and management, screening, testing, and vaccination) and the development of online pharmacies (e.g., internet sales, online communication with patients, providing software for health monitoring) require pharmacists to develop their ability to manage conflicts between ethics and business, including clinical versus commercial communication, in order to preserve the status of health professionals and protect the patients' interests [7,10,19,27]. Although pharmacists perceive commercial practices as unethical [6,11,[16][17][18]24], patients do not share the same opinion when it comes to incentives or loyalty programs: "pharmacists are perceived to be ethical decision makers" [15]. The patients' trust in pharmacists comes from a long tradition of quality services and fair treatment that they experienced in community pharmacies.…”