Two in five pharmacists believe more expensive dietary supplements are more effective – Malaysia study
Also, they have often recommended more expensive brands to consumers, despite those brands containing similar content as brands that are cheaper.
The study was conducted by researchers from Monash University Malaysia’s School of Pharmacy, Monash University’s Faculty of Pharmacy and Pharmaceutical Sciences, and Al Rafidain University College’s Department of Pharmacy.
A total of 260 pharmacists across Malaysia completed the study which came in the form of an online questionnaire between February to April 2022. This figure represented about 10 per cent of the approximately 2,780 pharmacists practicing in the country.
These pharmacists came from both chain and independent pharmacies. Most were young adults with the mean age of 29.15 ± 5.85 years old, were female (61.2 per cent) and Chinese (73.1 per cent).
The questionnaire comprised of 63 questions, which assessed their background and demographics, knowledge, attitudes, practice in recommending dietary supplements.
The researchers also conducted structured interviews with a representative panel of Malaysian community pharmacists to confirm the validity of the questionnaire.
Published on Exploratory Research in Clinical and Social Pharmacy, the findings showed that 44.6 per cent of the pharmacists believed that there was a correlation between the efficacy and the price of vitamins and supplements.
Of which, 10.4 per cent said they strongly agreed that there is a correlation, while 34.2 per cent said they agreed.
Another 25.8 per cent said that they were neutral, while the remaining 29.6 per cent did not agree that there is a correlation.
This also seemed to have affected the way they recommended dietary supplements to their patients and consumers.
Three in 10 said they preferred recommending more expensive brands, despite those brands containing similar contents as cheaper brands.
In general, most of them (80 per cent) agreed that supplements are a major source of profit for community pharmacies, with 36.9 per cent said they strongly agreed and 43.1 per cent agreeing to the statement. Only 4.6 per cent did not agree with the statement.
Seven in 10 had “average” product knowledge
On the other hand, seven in 10 (73.5 per cent) believed that they have “average” product knowledge. Only 21.2 believed they have “good” knowledge and 5.4 per cent said they have “poor” knowledge about vitamins and dietary supplements.
Pharmacists working in the chain pharmacies also have significantly higher knowledge mean score as compared to those working in independent pharmacies – a trend that is also seen in other countries.
“This is consistent with a study conducted in China, where pharmacists at chain pharmacies had a better knowledge and attitudes towards pharmaceutical care and were able to practise more advanced pharmaceutical care than pharmacists at independent pharmacies.
“This could be because chain pharmacies tend to have more frequent product training and courses for their staff as compared to independent pharmacies, which can then affect their level of knowledge and quality of professional advice given to the patients,” the researchers said.
Knowledge on commonly available products
When it comes to commonly sold dietary supplements, most (83.2 per cent) said they have a good understanding of the clinically proven benefits of milk thistle, saw palmetto, ginkgo biloba, and rooibos tea.
However, more than half (52%) were unaware that St John's wort – used as a medicinal herb due to its anti-inflammatory and antidepressant effects – should be stopped at least two weeks before a scheduled surgery, as it can lead to serious heart complications.
Also, 24 per cent were also unsure about the dosage required for the botanical Labisia pumila, which is popular among local females for inducing childbirth as well as used as a post-partum medicine.
At the same time, about 33.5 per cent of the pharmacists only occasionally refer to reference material, and mostly relied on product label for dosing information.
“Many pharmacists, accounting for 33.5 per cent, reported that they consult their reference materials only occasionally and typically rely on the product label for dosing information.
“This practice may be due to the inconvenience of making a proper referral or the belief that referrals are only necessary when the patient's condition becomes severe,” said the researchers.
Regulations should be strengthened
On the other hand, three in five (60.8 per cent) of the pharmacists believe that laws and regulations regarding the practice of vitamins and supplements should be strengthened.
Only 29.6 per cent did not agree that the laws should be strengthened.
The researchers believe that this first-of-its-kind study could help inform policies that regulate the sales of dietary supplements in Malaysia.
“This is the first study of its kind in Malaysia and will help inform policies that will help regulate these sales as these are popular products used by many Eastern countries.”
In Malaysia, 28.1 per cent of the adult population have reported the use of vitamin and mineral supplements, and researchers said consumers now expect more information about these products from their pharmacists.
“This study shows gaps in the lack of training on indications of new products, managing dosing of specific patients' groups (e.g. children, pregnant women), knowing when to stop medications, referral and follow-up, and bioequivalence of products.
“The study has also shown pharmacists in Malaysia aren't providing enough information on these products, and potentially not matching the growing expectations of the public.
“Further research should see whether the consumers in Malaysia are satisfied with the amount of information provided by the pharmacist to make an informed decision about the purchase, and whether they feel confident the dosing and safety information provided is sufficient,” the researchers said.
Source: Exploratory Research in Clinical and Social Pharmacy
Community pharmacists' knowledge, attitudes, and practices regarding counselling on vitamins and dietary supplements in Malaysia: A study on complementary medicines.
DOI: 10.1016/j.rcsop.2024.100410.
Authors: Xin RKW et al
