The ethics of pharmacists (multivitamins and more)

Discussion in 'Politics, Religion, Social Issues' started by .Andy, Jul 28, 2012.

  1. .Andy, Jul 28, 2012
    Last edited: Jul 28, 2012

    .Andy macrumors 68030

    .Andy

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    #1
    This is a split from the picture of your purchases thread where vitamins came up. Peabody (a pharmacist) purchased a multivitamin "man supplement" for the people in his house. The supplement purchased had claims of "heart health", "immunity", and "physical energy". All completely empty, nonsensical claims.

    We haven't had this discussion in a long time but widespread multivitamin use is not something that is indicated by evidence. The beauty of multivitamins and what makes them a massively profitable industry is that they are of little harm. Therefore people can sell them with unfounded claims of health benefits knowing little morbidity will result. They are also not under the same strict regulations as medicines are in terms of testing and efficacy, instead being categorised in many countries as a food supplement. People also seemingly love to take them, as it is something proactive they can do under the guise of improving their health. In reality however it is really just a good way to empty one's wallet. This is not to say in some circumstances vitamins and supplements aren't indicated for underlying diagnosed health problems.

    This is part of a larger discussion on pharmacists which I think is important. In Australia especially there is a real push away from medicines as the primary source of income for pharmacists on to gifts, medical accessories, vitamin supplements and even worst pseudoscientific paraphernalia. Given pharmacists are a largely trusted profession I think these acts are really undermining the profession and tricks of the confidence of the public.

    Kudos if you are a pharmacist out there who takes a stand or are not involved in such activities.

    Would you bother to test or advise people test for the extremely rare proponderence of vitamin deficiencies or their cause? Or is selling more important? What about the cause of their deficiency? Are you an expert in that? Are you qualified to examine someone and/or test for deficiencies?

    You went to university. Many people did this. This is it an excuse to act unethically in the market under the guise of being a professional. As a professional in a medical field you are obliged to strive to treat people based on evidence.

    Selling vitamins wholesale to the public is aiming to improve public health outcomes :confused:? Can you supply a source for such a claim that vitamins result in a positive public health outcome? You can't.

    It also isn't restricted to unnecessary vitamins. Pharmacies these days sell all sorts of nonsense including fat reducing shakes, magnetic arthritis underlays, immune system boosters etc etc. ln my mind pharmacies and pharmacists have an obligation to be honest about these things and not sell them. They are undermining the trustworthiness of the profession wholesale.


    tl;dr should pharmacists sell any old bollocks under the guise that it helps your health or should they have greater standards?
     
  2. radiogoober, Jul 28, 2012
    Last edited: Jul 28, 2012

    radiogoober macrumors 6502a

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    #2
    Alcoholics usually do have vitamin deficiencies: thiamine, folate, etc.

    I do not believe that a healthy adult needs a multivitamin. In fact, the recent womens health study showed that multivitamin use resulted in increased mortality. Vitamin E causes prostate cancer (read the results of the SELECT trial.) Vitamin A increases risk of stroke.

    I fully anticipate all of the natural nuts to come on here and start worshiping vitamins, but they're wrong. Keep in mind vitamins are active substances and we don't fully understand their physiology in the body, and all the evidence keeps pointing towards reserving supplementation with vitamins for people who have a proven vitamin deficiency. If we look at the evidence, peabody is absolutely wrong. Vitamins do not improve outcomes in any way, shape, or form for the general public. Absolutely no evidence of that whatsoever.

    There are legitimate vitamin deficiencies, but to be honest they are rather easy to diagnose, and there is absolutely zero evidence to suggest everyone taking a multivatmin because there is a risk of someone out there having a deficiency. That would be like saying everybody should take a blood pressure med because some people have blood pressure, ie, ridiculous.

    If anyone is interested in actually learning:

    http://www.sciencebasedmedicine.org

    Boy, I bet you hate the black hate crime guy being on your side!
     
  3. Big-TDI-Guy macrumors 68030

    Big-TDI-Guy

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    #3
    Vitamins make my pee rainbow-colored, that's reason enough alone for me to continue taking them. :D
     
  4. dukebound85 macrumors P6

    dukebound85

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    #4
    energy drinks make mine neon yellow lol
     
  5. Macman45 macrumors demi-god

    Macman45

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    #5
    I take a high dose of vitamin c daily, prescribed by my GP after a study was conducted that indicated it could be beneficial in the prevention of arthritic attacks, particularly Gout.

    I have been taking it for approx. 6 months now, and whilst it hasn't stopped the attacks occurring, it does seem to shorten them. As a prescribed medication It's free too.

    Prior to taking it, I was sent a copy of the study. Strangely enough, it does not work as well (or possibly not at all) in women.
     
  6. citizenzen macrumors 65816

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    #6
    .Andy, I think that you have a realistic view of multivitamins and their efficacy.

    I have heard—from what I believe are reputable sources—that any normal human being needs no more than a single multivitamin a day.
     
  7. radiogoober macrumors 6502a

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    #7
    Humans do not need a multivitamin daily. Unless perhaps they are consuming a ridiculous diet, or no food at all.
     
  8. .Andy thread starter macrumors 68030

    .Andy

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    #8
    That they do. But should be adequately diagnosed as such via blood tests to verify. In cases of prolonged deficiency they should really be started in hospital on intravenous high dose thiamine. (I know you know this it is a more general comment).

    if they were advertised for this delightful result and not obtuse medical claims I would have no issue :D!

    Definitely no more than a single multivitamin. Much less (I.e. zero) would be better for people's wallets and equally efficacious to their health however :p
     
  9. radiogoober macrumors 6502a

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    #9
    Can you please post the information on the study you are referencing? There are several good studies that show high doses of vitamin C can decrease serum uric acid levels, but there is not much good data saying it has any real effect on gout. The biggest study I found was only an observational study, which is one of the weakest forms of evidence. Sounds promising, I hope they do more research.
     
  10. MorphingDragon macrumors 603

    MorphingDragon

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    #10
    I have multivitamins prescribed by my doctor. $3 for about 3 months worth. I have a Staph infection that refuses to subside so my doctor just wants to make sure that my Immune system is as strong as possible.

    Most supplements are a waste of money, for health or athletic purposes.
     
  11. Big-TDI-Guy macrumors 68030

    Big-TDI-Guy

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    #11
    Have you considered a break from those sushi rolls? ;)
     
  12. MorphingDragon macrumors 603

    MorphingDragon

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    #12
    Sushis cheap man, and fast to make.
     
  13. radiogoober macrumors 6502a

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    #13
    I completely agree. Let's be honest, a true alcoholic isn't going to spend their money on either multivitamins or blood tests! :) In the hospital, we just assume people who abuse alcohol will be deficient. We give them a "banana bag" which has thiamine, folic acid, magnesium, and multivitamin in it. We also give them additional thiamine daily, and I usually write for Ativan in case of agitation. If the patient is a real bad alcoholic, we'll usually just write the ativan as a step down. Just to keep any crap from hitting the fan, because alcohol withdrawal can be fatal.
     
  14. .Andy thread starter macrumors 68030

    .Andy

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    #14
    While that is a good price I am not sure what your doctor is hoping to achieve. A vitamin deficiency is not something a young person should have to such an extent that they are acquiring infection. Nor am I aware that there is evidence it will help your immune system. I'm sure they have but I hope your doctor has cast the net far more widely for other causes. A rumbling staph infection if it leads to a bacteraemia is bad news
     
  15. peapody, Jul 28, 2012
    Last edited: Jul 28, 2012

    peapody macrumors 68040

    peapody

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    #15
     
  16. MorphingDragon macrumors 603

    MorphingDragon

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    #16
    I've had Anemia and Hypocobalaminemia(I think is the right term, Vitamin B Deficiency) before, so she just wants to make sure that they aren't a future issue.

    I actually changed GP. My original family one thought it was normal Acne and tried to give me stronger and stronger Acne medication, up until he tried to give me stuff that's heavily regulated by the government and has an insane amount of side effects. I just changed GP and she's much better.
     
  17. radiogoober macrumors 6502a

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    #17
    See, in that circumstance it seems perfectly fine to put you on a multivitamin. That extra bit of your past medical history helps out, and being on a MVI seems perfectly reasonable.

    That your old GP confused acne with a staph infection is downright scarry. Are you in the USA? Is he/she actually a GP or a family practice doc? (There's a difference: a GP has 1 year of post graduate training, family practice is a full 3 year residency after graduating.)

    ----------

    Actually, there is no high quality evidence that ginkgo has any effect on memory. It does not slow down cognitive decline, or anything else. Even the huge-waste-of-taxpayer-money NCCAM writes this.

    Garlic does have favorable effects on cholesterol levels, but it's not indicated to consume it in pill form. Appropriate treatment for hyperlipidemia is lifestyle changes (improve the quality of your diet, exercise, weight loss) then a statin if the levels don't improve enough, or if you present with the levels too high to start with. If anyone has questions look up the ATP III guidelines. Plain as day. There is no evidence for the regular use of garlic supplements as pills in the treatment of HLD.

    Anecdotes are just that: anecdotes. They mean nothing. Suggesting anybody take a physiologically active chemical because of anecdotes is malpractice. You should know better.

    I think you need to hit the books, you're pretty out of it. Are you a pharmacist or a student? I don't feel like you know anything about the research surrounding your field.

    Note: I don't think pharmacists are distrustful or money scheming, but I also don't think you should be pushing multivitamins on people because there is simply no evidence that a otherwise healthy person benefits from their regular use. I do think it's crappy that big name pharmacies (Walgreens, CVS, RA, etc) carry homeopathic products. That's absolutely despicable and that is money grubbing.

    Also, regarding these pharmacies. A pharmacist friend told me that in the big name store, the pharmacies actually lose money. They make like a dollar a fill, and the only way the pharmacies are supported is because the rest of the store makes money and offsets the losses of the pharmacies. I don't know if that's true, but it's what I was told by one who had no reason to make anything up.
     
  18. SuperJudge macrumors 6502

    SuperJudge

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  19. Macman45 macrumors demi-god

    Macman45

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    #19
    I will scan the study and post it...It's actually a US research...Might be a link on the documents....


    Got it...this is the document I have:

    http://archinte.jamanetwork.com/article.aspx?articleid=414828
     
  20. .Andy thread starter macrumors 68030

    .Andy

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    #20
    I refer you to your men's health bottle. There are many unsubstantiated claims in the front which are most certainly misleading.

    Anecdotes are not tests. It is absolutely not ethical for a health professional to sell something without evidence based on anecdote without telling people there is no evidence. It is another thing to have it the claim plastered all over the bottle with an asterix or "may" next to it. That is there to deceive, nothing more.

    I accused pharmacists that sell products with unsubstantiated claims that people don't need as distrustful, and undermining your profession. The rot is from the inside your profession. I stand by that. Like it or not, you are by your vocation a health professional, and the purchases that you make and advertise (in this case men's health supplements) influence others.

    Which i would believe if pharmacists weren't undermining by selling vitamins, minerals, and pseudoscience to people who don't need it or are tricked by vacuous claims on those products.
     
  21. radiogoober macrumors 6502a

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    #21
    Thank you for linking it. Yeah, that's the one I read too. Just so you know, that's an observational study, which is a very weak form of evidence. It very well may be that high doses of vitamin C can decrease the frequency of gout attacks, but we cannot say that with any level of confidence at this point. Considering how relatively benign vitamin C is, it's a reasonable recommendation from your doctor.
     
  22. Macman45 macrumors demi-god

    Macman45

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    #22
    I still have to take Naproxene...and because of other health issues...Omeprazole as well...can't take them at the same time though...I'm not sure if the Vitamin dose is directly related to the shorter attacks...Or just me me being super careful with my diet..I have excluded all red meat, all oily fish, and a whole bunch of other things that were also sent to me in list form. Whilst they are very good at identifying Purine rich foods to avoid, the list of what you can have is harder to define. I have a wrecked left leg and sciatica as well so my med. regime is pretty high...I guess taking the Vitamin C does no harm though, but you are correct when you say that the study provides no concrete evidence for it's benefit.
     
  23. radiogoober macrumors 6502a

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    #23
    I just wanted to add that I've never myself experienced the pain of a gout attack, but I've treated patients with it, and damn, that has to suck. It sounds like you're doing a fantastic job in minimizing your risk of attack.
     
  24. Macman45 macrumors demi-god

    Macman45

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    #24
    Anything is better than a sustained attack, even the MST which is my pain releif won't really touch it. So I'm super careful about what I eat...Of course all the things I liked are on the no list, but better that than crippling pain!
     
  25. MorphingDragon macrumors 603

    MorphingDragon

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    #25
    >The Quantum Singularity known as New Zealand (Emphasis Mine :p)

    Uh... pass. I can't remember exactly what he was. The Clinic I go to in Auckland has both GPs and Family Practice Drs. He doesn't work there anymore though. It was lame, the lady I liked was always booked and I got sick of taking Antibiotics and Acne Creams.

    The nurses are legit though, they'll source me bigger condoms for cheap as I don't fit the standard ones too well.
     

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