The parapharmacy: business, health, and safety of the patient and the public

Parapharmacie - a 'new' word noted on the streets of Arles, a lively, walled French town in south Provence, near the Camargue coast, and echoed in many variants in the medieval Besancon, within a tight meander of the Doubs, near the Swiss border. Parapharmacie sounds more professional than the English 'Health and Beauty' variant. This in fact not so new idea seems to go back at least to the early 1980s, with deregulation of certain aspects of French pharmacy sales. Instances of 'Parapharmacie' include local provision as stand alone stores, as well as sections of a conventional pharmacy or a designated area in a supermarket - as well as an international presence within online parapharmacie outlets.
Unlike for pharmacists, there is no formal specific qualification for the parapharmacist, whose shop window offers a range of health care and personal hygiene-associated provision, including phytotherapy and dietary supplements. Medicines, dressings and herbal remedies listed in the pharmacopeia require pharmacy training, however 34 plant extracts can be sold by parapharmacists - but not as combinations. These include extracts of bramble, camomile, violets and mauve. An attractive business model, with reportedly a 30-40% profit margin permitted - more attractive than the 15-20% for prescription only medicines; and without the training overheads of conventional pharmacies. But the concept raises similar concerns to OTC (over the counter medicine) outlets in general. And what about drug interactions between herbals and conventional medicines? And the problem that intake of nutrients above the recommended daily intake can be harmful? In practice a parapharmacy may work alongside a pharmacy, with professional pharmacist available. However even by 2009 around 250 parapharmacies were operating online. Hence this is now a well-established international approach to engaging the public in new ways to access health care and hygiene products. I'm sure that it goes without saying that the vast majority of parapharmacies are highly professional in their activities. The message for the public is to ask for professional advice when seeking health care products, and in particular to seek reassurance that remedies bought 'over the counter' from non-pharmacy sources, including parapharmacies, do not pose a risk from interactions with prescribed medicines or because of known medical problems. To paraphrase Benjamin Franklin (from another context) 'keep your eyes wide open', however professional sounding the source of aids to health and hygiene.