OCTOBER, Edition # 35, 2001

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During a recent problem based learning tutorial in fourth year, an elderly gentleman who suffered from the hiccups (as a result of one of his medications) asked for a complementary therapy to help with his hiccups.
For me, the answer was a simple one: refer to a Naturopath.
This was met by extreme derision by my fellow classmates, and the learning facilitator.
I quietly laughed up my sleeve that I had created controversy, and had an opportunity to relax during a tutorial while the arguments unfolded.
The first comment I heard was "What would a naturopath know about hiccups". What does a pharmacist know about hiccups?
More importantly, is the pharmacist able to satisfy the request of the patient without any formal training?
(note: a two hour Blackmore's tutorial does not constitute adequate formal training).
Put simply, a pharmacist must keep up to date with therapeutic knowledge through readership of journals and continuing professional education courses.
Until a syllabus of complementary therapy is included in the course and recognised (as it has already at Charles Sturt), are we not better off to ask someone whose professional revolves around such matters?
"Don't you have an ethical issue about selling something without proven efficacy?" Yes. I certainly do have an ethical issue about that.
But one must ask why there is a whole wall of the pharmacy dedicated to herbals, minerals, trace elements and homeopathic substances in most pharmacies that I have set foot in. The obvious argument, and the one which was put forward, was "well if I don't sell it, the pharmacy down the road will".
Ethical dilemma indeed!
"There is no usage of evidence-based medicine in naturopathic circles.
They (naturopaths) simply have no place in the healthcare team."
This is the one that amused me the most, considering the situation and tutorial I was attending. For those of you who are unaware, in fourth year, the problem based learning modules are supposed to be "a patient walks into your pharmacy complaining of these symptoms….".
From that, the pharmacist must then look at issues of diagnostics, lifestyle correction measures, interpretation of pathology results and optimal treatment.
It is extremely interesting to note, despite my continual questioning of the worth of pharmacist diagnostics of large scale diseases, that I am yet to read an evidence based article outlining the beneficial role of the pharmacist in such consultatory positions, and welcome any references in which anyone may have.
At present, pharmacists are fighting to become a major part of the healthcare team in the community (their clinical knowledge is taken very seriously in the hospital setting).
One must wonder how many General Practitioners are suggesting that pharmacists have no role. It is amazing how easily people are willing to put the shoe on the other foot.
My point is that pharmacists are drug specialists, and certainly have the role of optimal therapeutic disease state management, but, just as GPs should consult with pharmacists for best medication management issues, pharmacists should also work in conjunction with reputable, trained professionals in areas which are not specific to their highly specialized training.
I invite any comments, questions, queries or abuse in the newsletter readers forum. I am keen to see how others feel about this.

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