Background: Although dietary supplements (DS) are widely sold in pharmacies, the legal, ethical, and practice responsibilities of pharmacists with respect to these products have not been well defined. This systematic review of pharmacists' attitudes, knowledge, and professional practice behaviours toward DS is intended to inform pharmacy regulators' and educators' decision making around this topic.

BackgroundNatural health products (NHPs) such as herbs, vitamins and homeopathic medicines, are currently available for sale in most Canadian pharmacies. However, most pharmacists report that they have limited knowledge about these products which have been regulated in Canada as a specific sub-category of drugs. In this paper, consumers' and practicing pharmacists' perceptions of pharmacists' professional responsibilities with respect to NHPs are examined.MethodsA total of 16 focus groups were conducted with consumers (n = 50) and pharmacists (n = 47) from four different cities across Canada (Vancouver, Edmonton, Toronto, and Halifax).ResultsIn this paper, we illustrate the ways in which pharmacists' professional responsibilities are impacted by changing consumer needs. Many consumers in the study utilized a wide range of information resources that may or may not have included pharmacists. Nevertheless, the majority of consumers and pharmacists agreed that pharmacists should be knowledgeable about NHPs and felt that pharmacists should be able to manage drug-NHPs interactions as well as identify and evaluate the variety of information available to help consumers make informed decisions.ConclusionThis paper demonstrates that consumers' expectations and behaviour significantly impact pharmacists' perceptions of their professional responsibilities with respect to NHPs.

The Internet has become a popular medium in which to advertise and sell medications and dietary supplements directly to consumers. The National Association of Boards of Pharmacy (NABP) has identified approximately 200 Web sites that dispense prescription drugs in the US alone. 1 Legitimate Internet pharmacies, which require consumers to have a valid prescription sent to them before an order may be filled, offer many advantages, such as competitive prices, consumer convenience, avoidance of embarrassment, timely access to drug information, and improved access for consumers in rural and remote areas. 2 By contrast, rogue pharmacies, which allow consumers to purchase drugs without prescriptions, may increase inappropriate use of medications and the risk of adverse events. 3Several studies have shown that prescription drugs are available online. In 1999, 77 Web sites were found to offer sildenafil directly to consumers without a visit to a physician. 4 Forty-two of these sites (55%) required consumers to undergo an online medical evaluation in the form of a questionnaire; 4 sites (5%) offered, but did not mandate, such an evaluation; and 31 sites (40%) did not offer any evaluation. 4 However, when compared with the traditional primary care system of prescribing, the Internet-based system of prescribing phosphodiesterase inhibitors was found equally safe and had superior medication counseling. 5 Other studies indicated that it is possible to obtain medications such as hormonal contraceptives and dextropropoxyphene from the Internet. 6,7

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