MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

I have argued since many years that pharmacists should not be selling or promoting homeopathic and other remedies for which there is no proof of efficacy – the last time I published my view on this matter is even less than a week ago: Personally, I would go another step further and remind pharmacists who sell homeopathic remedies to the unsuspecting public that it is unethical to pretend they are more than placebos.

Despite my insistence and despite the fact that many agree with me (at least privately), there are precious few pharmacists who actually do something meaningful about the current situation. And there is very little visible change: in the UK, it is currently hard to find a pharmacy where homeopathic remedies are not on the shelves, and certainly all the major chains seem to put money before health care ethics.

I am, of course, speaking about the situation in the UK, France, Germany and some other European countries. Perhaps elsewhere things are different?

A NZ website seems to indicate that ‘down under’ the pharmacists are getting more active. Some strongly argue against unproven or disproven remedies in pharmacies:

Firstly, …it’s not a case that “pharmacists ‘should’ only be selling health products for which there is credible evidence of efficacy” (alterations mine, emboldened) but that they are obliged to—but choose not to. Their ethical guidelines state –

[PHARMACISTS] MUST:… Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.

…Secondly, the argument that ‘other businesses sell junk remedies therefore we shall’ is unsound. One of the key points about the ethical regulations for pharmacies is that customers should be able to walk into a store and have an expectation that the remedies within the store are basically sound. If other businesses elect to be unsound, that’s poor health practice, but no justification to do likewise. On the face of it, it would seem that the profit motive is ruling over sound and ethical practice.

Thirdly, that some GPs subscribe placebos should have no standing in this. There is some arguments for GPs to prescribe placebo remedies in some cases; others would argue that education is a better response in most cases. Either way—and just my opinion—it seems to me that GPs prescribing homeopathic remedies encourages people to think these have real remedial effects. I don’t work within the industry, but I am sure are ways of offering placebos that avoid using off-the-shelf commercial products. One might be that patients only get placebo ‘treatments’ via prescription.

…Fourthly, Pharmacy Today encourages that “pharmacies need to reconsider their stance in the light of this report”***. While this is an excellent idea, and one I thoroughly support, I suspect the underlying driver isn’t the report, but media presence on the topic. There is a long trail of evidence over many years showing that homeopathic remedies are not effective for anything.

The Australian study*** that prompted the latest round of interest drew this statement,

Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective.

Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner.* Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.

The National Health and Medical Research Council expects that the Australian public will be offered treatments and therapies based on the best available evidence.

…Why were the relevant professional bodies not onto this evidence sooner?…

GOOD QUESTION!

I might add another one: why are the European professional bodies of pharmacy doing so little about this ongoing breach of their own ethical codes?

(*** the report that the author refers to is the one by the Australian National Health and Medical Research Council we discussed on this blog a few days ago.)

29 Responses to When will pharmacists finally stop selling homeopathic remedies?

  • I’m going to this on Thursday evening.

    http://www.sciencefestival.cam.ac.uk/events/homeopathy-science-fact-or-science-fiction

    Note who the speaker is.

  • Unfortunately, at least here in Toronto, the situation has become worse in the last years, not better. Homeopathics are showing up everywhere. I guess some argument could be made to allow them in the candy department, because that’s what they are, although they should probably come with a warning that they contain lactose and that overconsumption can help worsen obesity.
    .
    We should therefore be grateful for small favours, I guess. Shoppers Drug Mart used to have a warning about homeopathy on its website. It disappeared some years ago, but this post reminded me of that and I just verified. There is now once again a warning on Shoppers Drug Mart’s website:
    .

    A word of caution
    .
    Many homeopathic dilutions are not regulated as closely as prescription medications and may contain other substances that could be harmful to certain people. Look for the DIN-HM, or Homeopathic Medicine number, on products sold in Canada. A product with a DIN-HM indicates that Health Canada has assessed the product for safety, quality, and effectiveness under its health claim. Some critics caution that the concentration of active substance in a particular homeopathic dose is too dilute to have any health benefits. Homeopathic remedies should not replace traditional treatments for serious illnesses.

    Reference: http://www1.shoppersdrugmart.ca/en/health-and-pharmacy/health/homeopathy/157/1

  • I guess as long as there are customers willing to part from their money in order to gain posession of that stuff, as long there will be agents to sell them. The problem is the popular belief, that homeopathics really are effective remedies. Selling them in pharmacies adds to this notion.

    Imagine, grown up persons in full possession of their mental powers have to get a warning on each and every single pack of cigarettes, that smoking is dangerous, causes desease and untimely death – at least over here in Germany this is the case. Who the heck does not know of this, unless he just came out of the jungle or crawled from beneath a stone? But for homeopathy and other CAM-treatments, the evidence is much more complex to check. And the consequences of a wrong decision may be as crucial.

    My proposition would be to force manufacturers and vendors of homeopathy, Schuessler salts, Bach flowers and maybe others by legislation to print a note like this onto their products:

    “Warning: This remedy is highly unlikely to offer any long term beneficial effect for this would be impossible for all we know about science!”

    I am not sure, if this would stop the business of Boiron, Heel and such – but maybe ….

    • Always the same contradictional purely ideological arguments against homeopathy which runs against the vested interest of the pharmaceutical industry and medicines by possibly leading to less consumption of expensive drugs with scientifically proven (worse personally experienced) and listed side effects which are often worse than the original problem.
      Anybody knows, and many leaflets for homeopathic remedies, say that if symptoms persist or are severem eg. chestpain or what have you, you should immediately seek medical attention by a doctor or A&E.
      However, I have gotten rid of many a cystitis, tonsillitis (with puss visible), bronchitis, sinusitis, severe cold with fever with homeopathic remedies within 2 days, despite my GPs (in various countries) telling me that this definitely needs a 2 week course of antibiotics. Went to see them on the 3rd day. Even IF this is just placebo effect of a completely ineffective remedy, I prefer to be called stupid than battle with the diarrhea, stomach pains, intestinal and vaginal fungus infections which antibiotics would (and have when I took those) given me.
      The fact that it works, even if the pharmaceutical industry and hardline conventional doctors/surgeons who think our scientific methods can explain everything in the world and what it cannot explain on a biochemical basis or through known lab tests does not exist, many highly-qualified but less ideologically indoctrinated and narrow minded doctors (ie not medical scientists) use homeopathy a first gentle or a complimentary approach,. In particular with psychosomatic issues (the real radicals of course deny any connection of emotional distress and the onset and type of medical symptoms) or even anxiety/depression/etc. Nobody claims that homeopathy can replace necessary medication, e.g. beta-blockers, antibiotics in severe cases, but the way some doctors, pharmacists and the pharmaceutical industry raves against homeopathy is actually…pathetic, and shows, to my mind just how threatened they feel (without having to be). And on the other sides, some of the pharmaceutical companies actually try to cash in on selling homeopathic remedies (always much cheaper than some conventional ones) through pharmacies. Now that’s what I call hypocrisy.
      Having suffered from terrible toothache for a prolonged period (I was being treated by a dentist), I took ibubrufen for days on end to no avail which only added stomach problems and a rise in bloodpressure (which I do have anyway and it is medicated, conventionally) that I had to go into A&E. I tried with several related homoepathic pills, which got rid of it within half a day. Have gone through this experience several times, starting with brufen and then going homeopathic, it helps for me. And if it my imagination, that certainly has less side effects as normal medivcation which I take for chronic illness (blood pressure) but avoid for smaller issues if possible. I have not come across anyone using homeopathic remedies more seriously with advice who uses them otherwise thereby threating a person’s health.

      Pharmacies also sell ineffective cosmetics etc. pp. for huge sums with allegedly proven beneficial effects – the proof is the claim of some users that they work, just like in homeopathy – and nobody made a fuss that they are sold in pharmacies. The same applies to tooth pasts and “personal care products” advertised and “proven” to be effective not by science (though they blatantly claim this sometimes), but by testemonies of happy customers. And what is effective in one person, does not necessarily work for everybody.

  • That code of ethics, the Safe Effective Pharmacy Practice Code of Ethics 2011, is a really thing to have here in New Zealand. It was written by the Pharmacy Council, which has a legal duty to set the ethical standards to which pharmacists should be held, and it is abundantly clear on this point. Section 6.9, quoted in the post above, very clearly states that pharmacists must not promote or sell any healthcare products unless there is credible evidence of efficacy.

    The Society for Science Based Healthcare is an advocacy organisation in New Zealand that’s been pressing this point. The NHMRC’s findings certainly don’t come as a surprise, but they are an opportunity for pharmacists to accept that the homeopathic products they’re selling are not supported by credible evidence of efficacy, and to stop selling them.

    There was an article in the New Zealand publication “Pharmacy Today” yesterday about this, if anyone is interested in reading more: Pharmacists’ homeopathy stance disappointing, professor says

  • I’m not sure (purely on the basis of the following anecdote) that New Zealand is particularly praiseworthy in the struggle against Big Witchcraft.
     
    Last autumn I visited a pharmacy in Auckland International Airport. I was about to return to the UK and wanted to buy some cough sweets. I made my purchase then the counter assistant recommended I might like to buy a product called “No Jet Lag”. This proudly billed itself as homeopathic jet lag prevention, and a stack of the boxes was prominently displayed under a sign saying “this really works”.
     
    As it happened, I’d already read a piece (it may even have been elsewhere on this site — I surf a lot and my memory’s not perfect!) about the New Zealand Advertising Standards Authority upholding a complaint about the way this product was promoted (http://www.3news.co.nz/nznews/advertising-complaint-upheld-against-no-jet-lag-pill-2014101319 gives details). I asked the pharmacist how she dared — right there in an airport — not just to display such unsupported claims but also to push a homeopathic product on clients. She fell into silence. I had a plane to catch and a wife waiting.
     
    If you want to see the power of the post hoc fallacy, just google ‘no-jet-lag’ and read the massive database of positive endorsements.

    • That’s frustrating to hear. I’m the person who made the complaint against the No-Jet-Lag display. To their credit, the pharmacy that was involved in the complaint promised to stop selling it if the complaint was upheld. As you noted, the complaint was upheld, for the unsurprising reason that the claims made were not supported by evidence. Unfortunately, that pharmacy has since closed.

      No-Jet-Lag’s website claims that *most* New Zealand pharmacies stock their product. Quite frankly, I think it’s disgraceful that even after this complaint was upheld so many pharmacists still sell it.

      • Congratulations on making the complaint and seeing it through. Sadly it seems that complaints about advertising never achieve either a lot or anything long-term. Until sanity strikes our politicians in large numbers, so that selling of any product claimed to affect health is made illegal until robust evidence is provided for efficacy and safety, we’ll always live alongside scam artists — most of whom don’t even seem to realize that’s what they are!

        • Don’t write off advertising complaints too quickly 😛

          I agree that individual complaints don’t result in long term changes, but they are a useful tool in that they reduce misinformation and generate media attention. Focused campaigns can result in lasting change too.

          Over 2012 and 2013, I focused on complaining about amber teething necklaces. It’s not all I complained about but I complained about them a lot. As well as having many misleading ads removed, it also resulted in changes to the regulation in the form of a new advertising guideline. Some details of this, and a link to the guideline, can be found on the Society for Science Based Healthcare website.

  • the ‘double speak’ of the Pharmaceutical Society of Australia:
    “Consumers have the right to choose to use complementary medicines if they so desire. Where appropriate, PSA does not oppose the use of such products provided consumers can be assured of access to high quality, safe and efficacious products as well as relevant information concerning their use.

    Consumers are, however, strongly advised to seek medical opinion before ceasing or exchanging prescribed drug therapy for complementary medicines.”
    [ http://www.psa.org.au/policies/complementary-medicines ]

    • I’ve asked the PSA about this;
      **********************************************************************
      Your policy on so-called complementary medicines is this;
      “PSA does not oppose the use of such products provided consumers can be assured of access to high quality, safe and efficacious products”
      Since there is no evidence (in Cochrane) for any alt-med being efficacious or necessarily safe, how can the PSA have such a policy?
      Specifically in relation to homeopathy, I assumed pharmacists knowledge of Avogadro’s number and the effects of dilution would have them understand that homeopathy is little more than sugary water.
      Please advise how such nonsense can be tolerated by highly qualified science professionals? I would like to post your response on Edzard Ernst’s website, or advice of lack of it.
      ********************************************************************
      `
      I’ll let you know if I get a response.

      • Excellent.

        It’s the word ‘quality’ that I see as a problem here and elsewhere. The talk is frequently about making sure the public can be assured of the ‘quality’ of the homeopathy they buy. By that they mean that it is not contaminated or adulterated and has been manufactured to appropriate standards. But I think the public see the word as conferring efficacy. As an analogy, if a car is described as being of a high quality, you might expect it to be a Rolls Royce, but if it doesn’t actually run then it’s useless, regardless how much care was taken in polishing the veneers.

      • The answer from the PSA is directly below followed by my response:
        ~
        PSA, 31 March 2015
        “Thank you for your email raising your concerns about complementary medicines. It appears you have grouped all complementary medicines under the one umbrella of none having any evidence of efficacy but there are several arms within that broad category, and with varying degrees of evidence of efficacy, ranging from none up to those with some evidence of their effectiveness. PSA is in the process of reviewing its position statement on complementary medicines and this will be uploaded onto our website when the work is completed.
        Homeopathy is a particular segment of the complementary medicine sector and has recently undergone a review which found there was no evidence to support these products and as you will see from our attached media release we support these findings.
        Our code of ethics shows we are evidence-based profession. Principle 4 of the PSA Code of Ethics states: Pharmacists commit to responsible and accountable control and supply of therapeutic goods and to contribute to public health and enhancing the quality use of medicines in partnership with individuals and the wider community. All aspects of pharmacy practice are underpinned by quality use of medicines principles and evidence-based practice.
        ~
        I hope this clarifies and eases your concerns.
        ~
        Grant Kardachi
        National President”
        ~
        My response, 13 April 2015;
        ~
        “You raise an interesting question; that is, the efficacy of so-called complementary medicines, though how they supposedly complement real medicine defies my understanding.
        ~
        What I would like to know is, which of these alternate “medicines’ or types on alternate “medicines” have any evidence of efficacy? Are there any that have RCTs in Cochrane to show they are as effective as real medicines in treating the claimed conditions? The next obvious question is; if they are shown to be efficacious, why then are they still classed as “complementary medicines”?
        ~
        As someone who regularly reads Professor Edzard Ernst’s blog, I have yet to see any such alternate medicines described as efficacious by him. Professor Ernst was head academic in this area at Exeter University so he has great experience, knowledge and skills in this field.
        ~
        As for “I hope this clarifies and eases your concerns.”, no it doesn’t. All I can see is obfuscation. My question stands;
        “Please advise how such nonsense can be tolerated by highly qualified science professionals?”
        ~
        I’ll post any response, on receipt. Don’t hold your breath though.

  • I’m the author of the linked article Edzard’s post refers to. (Thanks for the shout-out.) Just a few clarifications:

    I’m not a pharmacist. (I’m a computational biologist.) The quoted portion in Edzard’s piece is my response to a section of what was written in a New Zealand magazine, Pharmacy Today. In my article, Pharmacy Today’s words are immediately above the passage quoted in Edzard’s post. I agree with Pharmacy Today’s statement that “pharmacists should only be selling health products for which there is credible evidence of efficacy”, but felt what they suggested could (or should) go further and elaborated on that.

    There have been further articles in Pharmacy Today on this topic, including a ‘defense’, which, in turn, was replied to saying how awful it was. I may find time to write on my blog on these developments later, perhaps including some thoughts on why we see recurring systemic breaches of ethnics.

  • http://www.cbc.ca/news/health/health-canada-licensing-of-natural-remedies-a-joke-doctor-says-1.2992414 It seems pretty easy – at least in canada – to get you product on the pharmacy shelves.

  • This very week we are being urged by the UK government to relieve the burden on GPs by seeking help from pharmacists, who are “highly qualified professionals”. Are we really expected to trust people who try to sell us rubbish? Where I now live in Finland pharmacists don’t stock homeopathic pills or Bach flower “remedies”.

    • That’s great to hear about Finland! Is there any particular regulation that prevents them from doing that, or is it that most or all of them just choose not to? Or something else?

  • I don’t know if the law specifically forbids them selling homeopathic or other quack remedies, but they don’t. However they do have a total legal monopoly on ‘medicinal’ products. If you’ve got a headache or a touch of indigestion outside pharmacy opening hours tough luck. Supermarkets and convenience stores cannot sell painkillers or antacids.

    • Supermarkets and convenience stores cannot sell painkillers or antacids.

      It depends where. When I was still in Belgium, they were allowed to sell beer, wine and liquor, but forbidden to sell analgesics and other medications. To protect the population. Then I came to Toronto, and they were forbidden to sell beer, wine and liquor, but allowed to sell analgesics and other medications. To protect the population.
       
      I prefer the Toronto system. Alcoholic drinks have not been shown to be of benefit to anyone, to the best of my knowledge. However, if you have a splitting headache, an analgesic would most definitely be beneficial.

      • “Alcoholic drinks have not been shown to be of benefit to anyone, to the best of my knowledge.”
        `
        Speak only for yourself. 🙂

    • Patrick George said:

      I don’t know if the law specifically forbids them selling homeopathic or other quack remedies, but they don’t. However they do have a total legal monopoly on ‘medicinal’ products.

      By ‘legal monopoly’ you mean the medicines regulator (the MHRA) issues Marketing Authorisations to manufacturers after they have provided evidence of efficacy and safety, then yes.

      But unfortunately, homeopathic products are also registered and licensed by the MHRA, but they only have to meet an incredibly low standard – not a jot of evidence that they actually work is required.

      If you’ve got a headache or a touch of indigestion outside pharmacy opening hours tough luck. Supermarkets and convenience stores cannot sell painkillers or antacids.

      If you’re referring to the UK then any visit to a supermarket (or their websites), corner shop or petrol station will show how wrong you are.

      • If you read my earlier comment you’d see I was replying to an earlier query from Mark Hannah regarding Finland. I am fully aware of the situation in the UK-

  • 368,379 people killed, 306,096 injured by homeopathy. http://bit.ly/1HUwmnf
    Journal of Patient Safety preventable medical errors, kill as many as 440,000 a year. http://onforb.es/1BDgu1t
    Stupid people kill people.

    • Fair point, except that hospital related deaths are for a problem that has required hospitalisation, not from some minor worry for which people seek alt-med treatment.

      • Frank Collins commented
        Fair point, except that hospital related deaths are for a problem that has required hospitalisation, not from some minor worry for which people seek alt-med treatment.

        Indeed. In my view, this demonstrates typical alternological thinking: why use all the information at your disposal and get a complete picture, if just part of the information can be used to seemingly prove a favourite point?
         
        Obviously, in this context, the correct questions to ask are:
        1. how long would the patients have lived without treatment
        2. how long did they live with treatment
         
        If 1 >= 2 there is a good reason to be displeased
        If not, then not.

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