Table 4 Quotes from participants supporting the key themes and the variation within key themes

Approach to complementary medicines

1

Pharmacists are becoming more involved than before. People are trusting pharmacists more. They always check their complementary medicine. I think, from what I remember five years ago, people were just picking it up. They were thinking that, “That’s just a supplement,” but I think the awareness is more than before among people. So they always come and ask, “Oh, is this one safe?” or, “What should I take?” I think now, lots of pharmacists are always checking things for them. (D1P1-I)

2

I work in a small community pharmacy. I probably consider myself a integrated pharmacist. We have complementary medicines in three different areas similar to the rest of your medicines, like S2s, S3s [in Australia schedule 2 (S2) products are “pharmacy only” products and S3 products are “pharmacist only” products]. So we’ve got some out in the front shop, which I consider your [day-to-day] vitamins, like your supermarket lines. They’re more lines that are more for patients to choose and that sort of thing if they want to self-select. If they go for advice from a pharmacist or staff member, we’d probably go for something a bit better quality. So we’ve got some in the S2 section which are, I guess, better quality practitioner ranges. And then we’ve got your other ones in your S3 areas which are ranges that do require a consult or a prescription. So a lot of them are prescribed by some of our doctors as well. (D7P13-F)

3

I suppose it’s not as big a focus in my professional practice…. I think it’s probably because of lack of knowledge, to be honest, and confidence, where you feel a lot more secure at the back counter or in a dispensary than you do out in the vitamin section. (D5P8-F)

4

Yeah. I think at the moment, I don’t think we have much role to play in selling or providing any counselling for complementary medicine because first, working in community pharmacy, our main role is actually just dispensing. And then pharmacies, I think, we should follow more like evidence-based medicine practise…. All this supplementary of complementary medicine and all, they’re not evidence-based. (D5P6-F)

Approach to evidence

5

[W]e shouldn’t just be selling things because someone… says, “Oh, this turmeric is great for the sake of curing cancer.” I think there has to be some level of evidence… And it’s hard in certain conditions because you’re just never going to have the trials. (D4P5-I)

6

If we, I think, perhaps as an industry, move towards more– well, what is the evidence? Do I feel that your needs will be met by what I’m recommending today? Is there evidence to support what it says on the label, or what it says in the marketing material? And if not, then maybe we, as an industry, could push the emphasis of companies bringing things to market, being more about actual evidence. More money going into these studies of N equals 50. (D5P9-F)

7

So how I would actually interpret [guidance to only sell complementary medicines that have evidence of effectiveness], and this is where placebo effects comes in. So hey, if it’s not doing them any harm and they think it’s better for them and they’re going on in their life and happy days, you just let them go. (D5P7-F)

8

So I see a lot of people really—a lot of people want to use it. I’ve talked to a lot of customers, and they do feel the result. Every time they come back, I always ask, “Is this working for you?” And a lot of times, they say, “Yes, I know it’s working because when my bottle ran out, I started feeling it.” So then they came back to get a new bottle. So regarding your first question where you say, “What’s our perspective regarding purchase of natural medications?” I think they really work. I think they work depending what the situation is. There are some situations where you obviously need something more potent. But even in those situations, I think there’s always a place for natural medication, either as a stand-alone treatment or in combination. This is just based on what I’ve seen, not just what I think, what I’ve seen from what people say. (D9P16-F)

9

I would think in the most part people are very reactive. I don’t know that people would proactively engage in conversations a lot in my experience. But I think if they were asked, then they would provide evidence-based information to the best of their knowledge. (D6P10-I)

Navigating practice in a retail environment

10

I own a pharmacy… I still work in the shop on a daily basis. So I still come across on a daily basis having to chat to people about this. But then I am also going to come at it from the side [that complementary medicines] prop up half of the bank loan. So I guess we are going to go both ways on this a little bit. (D5P7-F)

11

If a pharmacy’s going to lose money for the sake of a sale, that isn’t a good enough reason for the sake of giving something out. We should always be having a look at evidence-based treatments,… (D4P5-I)