MD, PhD, FMedSci, FSB, FRCP, FRCPEd

I have always wondered how pharmacists might justify using or recommending or selling homeopathic remedies. So far, I have not come across a pharmacist who would want to stick his/her neck out for homeopathy. Many pharmacists earn money by selling homeopathic preparations – but most seem to be embarrassed by this fact and don’t want to defend it.

Therefore, I was pleased when I found this interview with the pharmacist Christophe Merville. He got introduced to homeopathy as a 11 year old boy suffering from hay fewer; after using homeopathy, “the crises became less severe and less frequent”. Later, he studied to become a pharmacist in France and, in 1990, he joined Boiron, the world’s largest manufacturer of homeopathic remedies. The following is an extensive excerpt (I did not want to cite him ‘out of context’) from his interview about his views on homeopathy.

I remember attending the delivery of a woman and the contractions were very strong, and painful. She had some homeopathic medicine to take just at that time to make those contractions more regular and useful: less intense but longer and less brusque. I saw that happening within minutes, and I was thinking, “That’s very impressive.” That’s probably the time when I concluded that there is something to it. 

I witnessed the action of homeopathic medicines on pets also, on young children. I had enough personal anecdotes that I could say there is something more than just suggestion, or placebo, or just the simple act of being cared for. My attitude is to say, “There are enough signs to say that it’s really worth exploring more why it works, how it works, when does it work.” We are past the stage where we can say, “No, there is nothing.” It has been around for a long time and if was just mere placebo effect, it would have gone away, as so many different techniques did. 

If you look at the history of science, you find many instances where people first said, for example, “The theory of gravity explains everything.” And when some things are discovered that show it didn’t work in certain very narrow cases, there’s an understanding that we have to adjust. But every time you have to make that adjustment, there is a great body of people who say, “No, it cannot be.” 

The main argument against homeopathy is that a remedy is very, very diluted, so it cannot work. My reaction to that is to examine what happens when you dilute something. The act of dilution is not very simple. Those molecules are interacting together, they are interacting with the walls of the container, they are interacting with the solvent, and this interaction does not adhere to a precise mathematical law. The skeptics say, “You divide the number of molecules by 100 each time, so after awhile, there is less than one chance to find one single molecule.” They have their math right, but they have their physics wrong. 

Chemists try to use very pure substances. When you buy your reagent, you buy it at 99.999 percent pure. But you don’t have anything that’s 100 percent pure. It would take an infinite amount of energy to get rid of the last impurity. What I think we should explore is the fact that after a certain number of dilutions, the process is not very efficient at removing the last molecules. So there is always something that stays. That’s one thing. 

The second thing is in pharmacology for years, we were interested in the ability of large quantities of substances. But what about small ones? I always use the example of butterflies that can sense pheromones at great distances, salmon finding their way back to their native creek from far away, to sharks being able to detect blood in a huge amount of water. Biology uses very small quantities. In cells, you have communication between cells using a few molecules of a certain substance—and it works. 

I don’t pretend that I’ve put A and B and C together, and I’m able to provide you with a complete explanation. But I would say those are things to explore. Already the research that exists points to possible action of homeopathic dilution on activation or deactivation of genes. I won’t go into details, but I welcome the skepticism, I think it’s very constructive. But what I don’t really like is people whose mind is set on their misconception of what exactly a dilution is. Of course homeopathy doesn’t violate the laws of physics and chemistry, because that’s absurd. 

My first role is pharmacy development. I look at what are the tools that allow pharmacists to know what homeopathy is and for a certain number of them, how to use homeopathy. I consider how to train them, how to have them integrate homeopathy in their practice, because the goal isn’t about replacing other medicines with homeopathy. My first role is to say to pharmacists, “You have to know what it is because these are drugs. If you don’t believe in them, you don’t have to use them, but at least you need to be able to answer customers, your patients.”

And the second thing is that for those who are interested in knowing more, I translate books from France, I design trainings, activities, interactions, so they are placed in a situation of recommending and deciding if it is appropriate to recommend homeopathy, and what treatment is adapted to that particular person. 

“Before coming to the conference, I researched what homeopathy is, and you will have a hard time telling me that it can work.” I talk with them to explore a little bit more what it is. We speak the language of pharmacology together, and what strikes me is that very soon, they are into it. They say, “Okay, we see the logic of it.” They realize that they have a tool where they can relieve without doing any harm, without interactions, so their interest is piqued. And they recognize that the mode of action of conventional medicines is not as clear as we thought.

Pharmacists are very pragmatic people—you cannot tell them fairy tales. When they see it, explore it, and use it, then when I meet them later, they tell me, “That stuff works.” And I ask, “Yeah, but do you know how it works?” They don’t, but they see the patient coming back happy. 

Of course, they are interested in the research and knowing how it works, but I just give them what we know in clinical research and we discuss it. They see that there is ongoing research and one day we’ll find more. But meanwhile, they are using the product. 

 You have two approaches. What I call “the user approach” is when people may not really completely understand how a medicine works, but they’re interested in taking it for stress or for allergies, whatever it might be, to see if it works for them. They’re interested in how this medicine will affect them, how should they take it. If it works for them, then great. 

Then you have what I call the “intellectual approach”—which is concerned about more cultural, philosophical, and social questions: what is the place of homeopathic medicine in today’s medicine, what are its principles, its history, its perspective. Is it a philosophy, is it a cult, what is it? My role is to try to give context for what homeopathy is. It’s a simple tool in the toolbox—we don’t exactly know all the details of how it works. And this is what we know, and this is what we don’t know, and this is what we speculate might be the way it works. People educate themselves. 

 Every day, I say, homeopathy doesn’t vaccinate, homeopathy doesn’t cure cancer, homeopathy doesn’t cure diabetes. It can relieve some of the symptoms or side effects of the treatments, but it has limits like every therapy. I fight against those outrageous claims and sometimes people that are really fanatical advocates for homeopathy do much worse for the cause. And I have to tell them: You cannot say that. It is untrue and it is dangerous. This is why I think pharmacists listen to me, because I’m not telling them to change their practice and their ethics. I’m telling them, this is another tool and this is how to use it properly. But there are fundamentals that are still there and will be there for a long time. You cannot replace vaccination by any other techniques—it’s unethical, it’s dangerous, it’s deadly. So we don’t do that. I’m completely against these kinds of claims.

 Let’s explore that: a patient suffering with AIDS, advanced infection with HIV, with immunity that decreases. Or a patient treated with antiretroviral therapy, they still have sometimes diarrhea, because their immune system is not able to fight everything. They still have side effects or anxiety. We want their treatment to be as comfortable as possible, because we want them to keep using the treatment. The same thing with cancer. The patient says, “I don’t want to have chemotherapy because it’s hurting me, it’s very difficult and uncomfortable.” We have with homeopathy ways to reduce nausea, for instance, then we increase the comfort of the patient, and the outcome is always better. That’s the framework. Someone who would say, “Oh, you have AIDS, throw away your antiretrovirals, I’m going to treat you with homeopathy”—that person would be a murderer

We develop tools to help people self-medicate. We say, “Okay, you’re stressed out, you need to sleep a little bit, you’re lacking sleep. Take this for a certain period of time—if it works for you, fine. If it doesn’t, doesn’t, stop it.” For people with what we call “self-limiting conditions”— a cold or a cough—we have good tools with warnings and precautions and things like that for them to self-medicate. And in the warnings, we tell them, “If you experience that kind of fever, if you have that symptom, see a doctor.” We don’t say see a homeopath, we say see a doctor. And among these doctors, there are doctors who have added in different techniques and some of them are using homeopathy when appropriate. For me, what is most important, is that a patient sees someone who is medically qualified.  

For people who want to further explore the possibilities that homeopathy offers, I recommend that they see a physician who is skilled in homeopathy but will not use homeopathy for everything. And is able to diagnose. A physician will tell you, “In this case, I can do something with homeopathy, or, in that case, I cannot use homeopathy.”

As I have once worked as a junior doctor in a homeopathic hospital (the full story is here), I knew of course all these arguments and fallacies. Nevertheless, I still ask myself: HOW CAN PHARMACISTS GET CONVINCED IN THIS WAY? ARE THEY REALLY CONVINCED? OR DO THEY JUST DO IT FOR THE MONEY?

I do not feel like prejudging these questions just now. But I do hope to hear from my readers, particularly from the pharmacists amongst them, what they think.

35 Responses to A pharmacist’s defence of homeopathy

  • I liked that getting rid of the final impurity, because homeopaths do not tell how they get rid of it in the water in the first place?
    OK, my drinking water is full of carbonates and iron, because pipes are over hundred years old and part of them clay, but dilutions used to prepare magic water are very big and, as far as I know, the impurities contained in normal water are also used by homeopaths ….

  • The same way nurses, doctors, and other healthcare professionals do. Pharmacists are humans like all other professions. As a pharmacist I’ve seen completely barmy things in hospices and maternity units carried out by other groups that the pharmacists used to roll their eyes at. At least pharmacists have not been wasting NHS money on this nonsense, that has been prescribed by doctors.

    Of course some pharmacists do get involved with this rubbish. Some believe it, and some might be cynically making money. The ones who run homeopathic practices with £95 consultation fees are probably a mix of believers, cynical money makers, and those who just found real healthcare too difficult. Some in the specific homeopathic practice are possibly attracted to the hour long consultations, rather than the hurried NHS contact in normal practice.

    But as has been said MANY TIMES BEFORE, the majority of pharmacists do not believe in homeopathy, but work in large companies who decide to stock homeopathy in their stores. Pharmacists do not have control of what is stocked, and while you might want them to resign in disgust, they have mortgages to pay, see the homeopathy as a small section out of their control (they are too busy giving out real drugs safely, vaccinating people etc) and do not want to get into a major dispute with their employer over what they see as a peripheral issue.

    I’m on the English National Board of The Royal Pharmaceutical Society, and support the recent view expressed by our chief Scientific Officer that these products have no place in pharmacies and am campaigning for this to be the case. It would therefore be helpful to have you on side in our fight to do this in a constructive way. I think the focus should be on arguing that selling quack remedies is as unprofessional as selling cigarettes.

    Might I suggest that:

    HOW CAN PHARMACISTS GET CONVINCED IN THIS WAY? ARE THEY REALLY CONVINCED? OR DO THEY JUST DO IT FOR THE MONEY?

    Is not a constructive an approach to engage with a profession?

    Would you write a blog about the minority of homeopathic prescribing doctors with:

    HOW CAN DOCTORS GET CONVINCED IN THIS WAY? ARE THEY REALLY CONVINCED? OR DO THEY JUST DO IT BECAUSE THEY ARE IDIOTS?

    I would hope not. Because that would be a massive general slur which would achieve little.

    Best Wishes

    Dr Anthony Cox

    • It would therefore be helpful to have you on side in our fight to do this in a constructive way. I think the focus should be on arguing that selling quack remedies is as unprofessional as selling cigarettes.

      Might I suggest that:

      HOW CAN PHARMACISTS GET CONVINCED IN THIS WAY? ARE THEY REALLY CONVINCED? OR DO THEY JUST DO IT FOR THE MONEY?

      “Is not a constructive an approach to engage with a profession?”
      I have engaged with pharmacists since ~20 years, and it is not least to my pestering that some of you are finally speaking out (see my series of articles, for instance, in the PJ many years ago)

      “Would you write a blog about the minority of homeopathic prescribing doctors with: HOW CAN DOCTORS GET CONVINCED IN THIS WAY? ARE THEY REALLY CONVINCED? OR DO THEY JUST DO IT BECAUSE THEY ARE IDIOTS?”
      I have written articles and posts to that extend – just read on this blog.
      the thing is: for many years, I have been ‘tiptoeing through the tulips’ politely – with little effect. now I try a little more drastic language and measures.

      • If pharmacists are genuinely unable to prevent the widescale promotion and sale of homeopathy in pharmacies (except at great personal cost), I’m surprised to see so many taking offence at Edzard’s questions, especially on Twitter. The question of “how pharmacists might justify using or recommending or selling homeopathic remedies,” is one that is in the public interest – but it doesn’t apply to those who have no choice in the matter.

        As Dr Anthony Cox, above, confirms, some pharmacists sell homeopathy because they believe it, some are probably cynically making money from it and those who work for large companies don’t think the dishonesty of selling homeopathy as a treatment is important enough to make waves about and they’re too busy anyway. That’s two of Edzard’s perfectly reasonable questions answered. Obviously it raises a few more but there’s no need to get defensive.

  • From my experience, the pharmacist is just an ordinary person, lacking in critical thinking, prone to the middle-ground fallacy, has not fully grasped the scientific method, and, lastly, can rationalise any beliefs inconsistent with their profession or studies with fuzzy thinking (much like religious beliefs from a scientist).

    They are probably regarded as a “nice” person, mostly because they don’t upset people with rigorous thought and a propensity to advocate. It is the sort of person I would regard as a nonentity, stands for nothing, an educated one nonetheless, but someone who is so inoffensive, I would find them offensive for that trait alone. His arguments are so ridiculous but couched in “soft” language so it could not be construed as a strong stance, unlike the one you take, for instance, prof.

    If he was Australian, he would win a “bullshit artist” award (a common theme in alt-med, it seems).

  • This pharmacist makes the all too common mistake of confusing and conflating ‘homeopathy’ with ‘homeopathic remedies’.
    He fails to distinguish between the therapist and the therapy/remedy. The practitioner and the practice. Style and substance.

    We know that ‘homeopathy’ works in the sense patients report they ‘feel better’. We know that is due to placebo effects of being in a constructive therapeutic relationship – and patients auto-hypnotise themselves to believe it is so.
    But that type I effect should be distinguished from any type II effect the actual homeopathic remedy has on specific conditions.
    And there is no reproducible plausible evidence of any such effects when using homeopathic remedies.
    So, homeopaths should set aside the remedies (and the profits their sale brings) and concentrate on caring for those in need.

  • So what has convinced him is personal experience and anecdotes and we know both of those are reliable. And it’s definitely not a placebo but should only be used in situations where a placebo would have exactly the same effect as homeopathy.

    Funny, that.

  • What I think we should explore is the fact that after a certain number of dilutions, the process is not very efficient at removing the last molecules.

    That is a bizarrely confused statement.

    Either molecules are infinitely divisible or you get rid of them.

    The fact that effectively nothing is 100% pure is not a counter-argument to the effects of dilution.

  • I also note the limits he sets on the powers of homeopathy. In essence he says it ‘works’ only when it doesn’t matter.

    Yet many sources claim homeopathy is a ‘complete system of medicine’ . Those who wish to limit their claims have no systematic way of defining those limits.

    • They don’t really have a systematic way of doing anything – other than by following preordained rituals without questioning their validity.

      “I don’t pretend that I’ve put A and B and C together, and I’m able to provide you with a complete explanation. But I would say those are things to explore.”

      Explore? Homeopaths don’t ever explore the unknowns in their business. They don’t appear to have the slightest interest in doing so, or any idea of how to actually investigate anything. Whenever I see language like the above, it’s usually surrounded (as here) by context which reveals that these “unknowns” are actually held as talismans of belief. As long as there are mysterious unknowns, they can believe that what happens there, happens the way they think it should. No wonder that they have no interest in actually exploring them.

      Sure, there is no plausible mechanism for homeopathy. But what is clearer and more telling, is that homeopaths have no interest in actually knowing whether homeopathy has an effect, any more than Ken Ham is interested in learning the actual geology of the Grand Canyon. Which renders all grand hypotheses about nano bubbles etc, moot.

      Our computers contain millions of transistors, which work on quantum effects. It is true that transistors were made and used before quantum effects were well understood. However, that was made possible by many thousands of hours of careful investigation and real exploration of actual devices. It was not done by putting some alleged quantum in a box, then shaking it, while saying “Radio, Radio, Radio”, and then believing that the result was a transistor radio, whilst cooing disingenuously that we need to explore things, someday.

      • “It was not done by putting some alleged quantum in a box, then shaking it, while saying “Radio, Radio, Radio”, and then believing that the result was a transistor radio, whilst cooing disingenuously that we need to explore things, someday.”
         
        Brilliant!

        • Greg Smith did indeed make a brilliant statement.

          Let us not forget the previous invention of the thermionic diode (circa 1906), operating by quantum mechanics of which the inventor was unaware, that quickly led to the development of vacuum tubes being developed for signal amplification; the in-home display of motion pictures via the cathode ray tube (television); radar; and both analogue and digital computers.

          Vacuum tubes are still in use today for specialist applications because, unlike homeopathy, they actually work!

          • Thanks for that – indeed I have a guitar amp with tubes in it. And, looking into it, it seems that the “thermionic effect” was being investigated even before we knew about electrons. Eventually turned out to be Not Actually Magic. Funny how that keeps happening.

            Also, *waves back to Skeptical Pharmacist* 🙂

        • To complete the analogy, we also need to construct an alternate framework of interpreting sound – perhaps “new ways of hearing” – to help believe that the shoebox of dirty gym socks, wet leaves, appelstrudel [*], live crickets, dust jackets from remaindered Deepak Chopra books, and paperclips is actually functioning in some way as a radio. My uncle’s neighbour’s florlst uses one to listen to Elvis.

          [*] Appelstrudel is to provide the essence of semiconductor (“German yum”).

          • Many thanks, Greg, that was priceless 🙂

            In order to understand electrical equipment we use circuit diagrams. In order to understand alt-med we need to use circus diagrams.

            When voiced, the following two terms are indistinguishable: schematic; scheme attic.

  • “Of course homeopathy doesn’t violate the laws of physics and chemistry, because that’s absurd. ”

    Drop the bomb, run away, let’s not explain how homeopathy doesn’t violate those laws.

    Follow the usual stuff “if you don’t believe me you are close-minded or wrong”.
    And not a word about the absurdity of the “like cure like”, well this one is harder to justify I guess.

    “Pharmacists are very pragmatic people—you cannot tell them fairy tales”

    Actually this one makes me laugh out loud !

    Thanks you Edzard !

    • “Of course homeopathy doesn’t violate…”

      I suspect the logic here is no more than, “well, it can’t violate them, or it wouldn’t work, would it? Obviously”.

  • A response to the nonsense by Guy Chapman: A skeptical critic answers a homeopath answers to skeptical critics.

    Guy and I have also left comments there. I wonder if they’ll be answered…

  • As a pharmacist of more than 25 years (and a friend of Greg Smith *waves to Greg*) I’ll just say that you can’t cherry pick your science, discarding what doesn’t confirm your biases (ie, “Of course homeopathy doesn’t violate the laws of physics and chemistry, because that’s absurd”), in favour of an alternate reality where water has memory, shaking has magical powers, and Avogadro’s number doesn’t exist. In fact, for a pharmacist to hold such pseudoscientific beliefs to the extent that it actually affects his professional practice is unethical. How can you trust him to have the judgement to determine when a patient’s treatment isn’t working, or a dosage adjustment is required, when he doesn’t understand such basic concepts as the waxing/waning nature of some chronic diseases?

  • I agree with Dr Anthony Cox’s post.

    People can convince themselves to believe in anything, including the efficacy of homeopathy.

    The perceived effect of homeopathy may be as a result of the placebo effect. A randomised double blind trial is needed.

  • Somewhat lazy to leave *ALL* the fallacies as an exercise for the readers… 😉

    The guy isn’t really a pharmacist, so your title isn’t as precise as it might be. He trained as a pharmacist, but now makes/sells homoeopathic remedies. You seem to be referring more to high-street chemists.

    My 2p:
    – purification of a solution to 100% is not analogous to dilution per homoeopathic preparation. It’s an invalid comparison
    – the guy isn’t doing homoeopathy. IME in discussion with a homoeopath s/he will flip-flop between arguing that homoeopathy treats the person vs treats the disease (depending on which point they’re floundering on at the time), in fact Hahneman claimed you treat the person: but this guy sells remedies for colds, or hay fever.

    In his favour:
    – he’s clear that it’s not a cure for HIV etc
    – he’s clear that if symptoms persist then see a doctor.

    • do you have a point?
      are you sure you are not a bit deranged?

      • You are regarded as something of an authority on CAM with a string of qualifications as long as my arm, and a list of books and papers the size of a large Billy bookcase. Many apparently serious and well-respected people in turn show their respect for you.

        My point, in summary, is that in many of your posts you are using intellectually dishonest approaches which don’t stand up to even my amateur examination. As a result you undermine the “mission” of debunking quackery and establishing the truth of the matter around CAM.

        That you’ve responded to each of my comments with dismissive or ad hominem responses suggests that you’re not entirely engaged with the matter of truth-seeking, and are unwilling even to support your own posts.

        • yes, I think we all got that;
          but your evidence is less than convincing, if I may say so [or do you regard that as ‘ad hominem’ too?]

          • No that’s cool. Asking me if I’m deranged might be seen as ad hom 🙂

            I’m not offering evidence in this thread. I was picking up a couple of the issues with the interview you quoted, as I believe we were invited to do.

            You don’t seem to twig that I’m in agreement with the general thrust of what you’re doing with this blog, just not with some of the sleights and tricksiness you use.

            I’m glad I was never a student under you. 🙂 🙂

            Student: “Hey Prof how does that work?”
            Prof: “Are you some kind of nutter?”

          • you are quite right: as a student of mine, you might not have been very successful!

    • About Rich Lee,
      He lives in Bristol, UK and is a “freelance .NET developer, taoist internal arts student and sometime cycling enthusiast”.
      I don’t quite get Taoism so here is something; https://en.wikipedia.org/wiki/Taoism.

      @Rich Lee,
      “The guy isn’t really a pharmacist, so your title isn’t as precise as it might be. He trained as a pharmacist, but now makes/sells homoeopathic remedies. You seem to be referring more to high-street chemists.”
      So what does it make him; a qualified pharmacist who dilutes compounds to make them stronger, something which is contrary to his training (and established science)? A loon who believes in the supernatural perhaps? An opportunist who is making a lazy quid making nonsense for sale to the gullible? If he isn’t “doing homeopathy”, what is he doing?

      Bluntly, I can’t see your point either.

      • Sweet. Yep, I’m just a bloke in the street. Like the Prof I’ve spent time on both sides of the woo-fence in the pursuit of a little truth and insight. Nothing wrong with that.

        Taoism is far less interesting to me from the religion pov per the linked article than Tai Chi & Qi Gong, which are health-oriented practices. You just do them and see what results you get. You like, you do more. I like to think I take a fairly rational woo-free approach, but that’s obviously relative. The cultural history of Taoism (and other religions) is of interest to me, but that doesn’t imply belief on my part. YMMV and I’m not trying to sell it or build a reputation on it.

        As for Pharmacy Guy – I was adding some comments just as the Prof invited readers to do. I’m largely with the Prof here: I have zero agreement with what the Pharmacy Guy is doing. The only relatively positive aspect is he says his remedies aren’t a cure for e.g. HIV, which is just as well, but differs from some other homoeopaths so is worth highlighting.

  • What utter rubbish

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