Nearly a third of Australian pharmacists are recommending complementary medicine products that are not supported by evidence that they work.

Key points: Australian chemists' sale of complementary medicines criticised by Australian Medical Association

Australian chemists' sale of complementary medicines criticised by Australian Medical Association Pharmaceutical Society of Australia does not support sale, but has no enforced rule against doing so

Pharmaceutical Society of Australia does not support sale, but has no enforced rule against doing so Less than 5 per cent of complementary medicines compliance checked, TGA pushing for reform

That finding and others by the consumer advocacy group Choice is explored in a Four Corners investigation.

The program asks why Australian pharmacies are increasingly relying on the sale of complementary medicines with often unproven benefits including vitamins, mineral and herbal supplements.

Australian chemists' embrace of complementary medicines has put them in conflict with the peak doctors' body, the Australian Medical Association (AMA).

"When we look at the most trusted professions, year on year on year, I'm proud to say that at the top is doctors, nurses and pharmacists. So that respect has been hard won," said AMA president Dr Michael Gannon.

"That's put at risk if they're being seen to promote treatments that increasingly the average consumer recognises might be a load of rubbish," he said.

Last month Choice sent undercover "shadow shoppers" into 240 mostly large chain chemists around Australia and complained to pharmacists of stress.

Choice's head of campaigns and policy Erin Turner told Four Corners that most of shadow shoppers were told to buy a complementary medicine product.

"Fifty-nine per cent of people were just told that it worked, they were not given any further information, while 24 per cent of people were told that it was scientifically proven to work," Erin Turner said.

"Forty-six per cent of people were told to buy a vitamin B — and there is some evidence that a vitamin B can assist with the signs of stress.

"However it's the 26 per cent of people and the 3 per cent of people who are told to buy things that just don't work — Bach flower remedies [such as 'rescue remedy'] — homeopathic options, that's where this is really disappointing."

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'No evidence of homeopathy working'

Homeopathy was the subject of a 2014 review by the National Health and Medical Research Council, led by Bond University's Professor Paul Glazsiou.

"The bottom line is that we found no evidence of homeopathy working for any of the multiple conditions, about 60 of them, that we looked at in this very thorough review," Professor Glazsiou said.

Flower essence products — also known as Bach flower remedies — have also been found to have no effect over that of a placebo in systematic reviews of clinical trials.

What are supplements? Supplements is a broad term describing a wide range of complementary medicine products

Supplements is a broad term describing a wide range of complementary medicine products These may include herbs, vitamins, minerals, nutritional supplements and homoeopathic medicines

These may include herbs, vitamins, minerals, nutritional supplements and homoeopathic medicines Top selling supplements include krill oil, sports nutrition products (including protein powders) as well as calming and sleeping products

The Pharmaceutical Society of Australia does not support the sale of homeopathy but the peak body representing pharmacy owners does not tell its members not to stock it.

"No, at the end of the day it's the pharmacy owner's decision, based again on the demographics, and making sure that when you do have any homeopathy products on your shelf that you make it clear that the evidence is scant," said the Pharmacy Guild's president George Tambassis.

The success of discount chains like Chemist Warehouse has made complementary medicines more pervasive, said Professor Stephen King.

Professor King is leading a Federal Government review of the regulation and remuneration of Australian pharmacies, which is due to release its draft report later this month.

"The discount model is around 70 or 80 per cent of the revenue coming from front of shop — the complementary medicines, the vitamins, the perfumes and so on — and only about 30 per cent from behind the counter," he said.

"That's the big change that the discounters have brought. So they're certainly putting pressure on the traditional community pharmacy."

Should chemists stock complementary products?

Chemist Warehouse director and founder Damien Gance said pharmacists should give customers what they want.

"I think in order to survive modern pharmacies in Australia have to listen to its consumers … [and] to provide the retail pharmacy offer that the consumer wants, demands and probably deserves," he said.

"So if a retail pharmacy consumer wants complementary medicines then by all means pharmacies should provide complementary medicines."

Chemists' reliance on retail sales has gradually increased since 2007 when the Federal Government introduced "price disclosure" rules to the Pharmaceutical Benefits Scheme.

The changes slashed pharmacists' taxpayer-funded rebates for prescription medicines, as they stopped receiving generous rebates for generic medicines they were able to purchase cheaply.

"A lot of community pharmacies are trying to get more revenue out of 'front of shop', and 'front of shop' means the complementary medicines, the vitamins, the perfumes, the other products that they supply there," Professor King said.

"We have had passionate community pharmacists decrying their fellow pharmacists for stocking complementary medicines … for stocking products that have little if any medical credence.

"We've also had many other pharmacists asking: 'What's wrong with this? At least we can give some medical advice'."

Buyer beware

Some complementary medicines have been proven to work, but many of the products sold in Australia do not match the dosages that have been clinically proven.

And if they do, says women's health specialist Associate Professor John Eden, it's virtually impossible for consumers to distinguish them.

"There really is a chemical found in cranberry that really does help prevent urinary tract infections and yet ... many of the Australian products don't contain enough of the chemical to have an effect," he said.

Last year fewer than 500 complementary medicines out of 11,000 on the market in Australia were checked for compliance by the regulator, the Therapeutic Goods Administration (TGA). Eighty per cent of those tested had compliance breaches.

"The most common problem is actually that of the companies not holding the efficacy data," the TGA's chief Dr John Skerrit said.

"Many companies do, and they all are required to, but when we've gone looking for the efficacy data in some of those reviews, the efficacy data is missing."

The TGA is pushing for a reform that would create a new class of TGA-tested complementary medicines — a change Complementary Medicines Australia's director Carl Gibson says he welcomes.

But the industry is resisting a labelling system that would explicitly identify unproven products.

"We have a growing international trade. So if you're an Asian consumer and you pick up two identical products and the NZ product doesn't have that disclaimer and ours does, I think you're actually disadvantaging the Australians," Mr Gibson said.

Watch the Four Corners program Swallowing It online.