MD, PhD, FMedSci, FSB, FRCP, FRCPEd

A recent article in the Guardian revealed that about one third of Australian pharmacists are recommending alternative medicines with little-to-no evidence for their efficacy, including useless homeopathic products and potentially harmful herbal products.

For this survey of 240 Australian pharmacies, mystery shoppers were sent in to speak to a pharmacist at the prescription dispensing counter and ask for advice about feeling stressed. The results show that three per cent of the pharmacists recommended homeopathic products, despite a comprehensive review of all existing studies on homeopathy finding that there is no evidence they work in treating any condition and that ‘people who choose homeopathy may put their health at risk if they reject or delay treatments’. Twenty-six percent of all pharmacists recommended Bach flower remedies to relieve stress. A comprehensive review of all existing studies on Bach flower remedies found no difference between the remedies and placebos. Fifty-nine per cent of people were just told the complementary and alternative product recommended to them worked, and 24% were told the product was scientifically proven, without any evidence being provided to them.

Asked about these findings, Dr Ken Harvey, a prominent Australian expert, said they demonstrated that some pharmacists were failing in their professional duty to consumers. “Pharmacists are giving crazy advice, and it is dangerous in some cases,” he said. “My view is that pharmacists, if they are going to sell these products, need to have a big shining sign over the shelves of the complementary and alternative medicine section that says ‘these products have not been assessed by the government regulators to see if they work, please talk to pharmacist’.Pharamacists are giving poor advice and they clearly have a conflict of interest,” Harvey said.

If you had hoped that in other countries pharmacists behave more responsibly, I must disappoint you. The information available shows that, when it comes to alternative medicine, pharmacists across the globe act much more like shop-keepers than like health care professionals. They are in the habit of putting profit before their duty to abide by the rules of evidence-based practice. And, in doing do, they violate their own ethical codes so regularly that I ask myself why they bothered to even implement one.

On this blog I have written so often about this issue that one could come to the conclusion that I have a bee under my bonnet:

The truth, however, is not that I am the victim of a bee.

The truth is that this is a very important public health issue.

The truth is that pharmacists show little signs of even trying to get to grips with it.

The truth is that pharmacists who sell bogus medicines put profit before professional ethics.

The truth is that such behaviour is not that of health care professionals but that of shop-keepers.

The truth is that I intend to carry on reminding these pharmacists that they are behaving like charlatans.

61 Responses to Profits before ethics: pharmacist continue to recommend and sell bogus treatments

  • ‘The truth is that I intend to carry on reminding these pharmacists that they are not behaving like charlatans.’

    Well said Edzard.

    I know several pharmacists and they are all intelligent and caring people. Possibly the reason that they are happy to stock CAM is not purely for financial benefit; perhaps they are open to the possibility that herbs, nutritional supplements, Bach drops, aromatherapy oils, homeopathic remedies (Lord forbid this one!) etc may actually have something health promoting to them. This gives their customers, who they respect as intelligent consumers, the right to choose.

    If the pharmacists recommends a product then I agree that they should know the product that they are recommending and why it is appropriate for a particular customer.

    The truth is that people are able to make choices based on their own beliefs and research, and thus assume responsibility for their health. Taking responsibility for one’s health is part of the ‘alternative’ way of thinking. Being dependent on the doctor and a little red or blue pill to maintain one’s health is part of ‘conventional’ thinking.

    • ‘taking responsibility for one’s health’ is often no more rhan an adult- sounding smokescreen phrase that is used to camouflage gullible people’s dislike of Medicine and Science. And as to how a pharmacist is supposed to discuss whether this or that unproven wingwang is more appropriate for the ‘patient’ or ‘customer’ defeats me. The very fact that a company like Boots sells such potions gives them a credibility that they do not deserve in the first place. I too know a couple of pharmacists, one of whom served on Ethics committees and told me I would fall about laughing if I’d heard some of the ‘evidence’ she’d had to sit through.

    • I see that you corrected the ‘not’ typo. My quote was copy pasted from your article moments after it appeared.
      I preferred the ‘original’ version.

      Pharmacists are not behaving like charlatans!

  • As I mentioned previously, a Boots spokespuppet, name of Paul Bennett, was ridiculed when he told a Parliamentary select committee that his company sold homeopathic ‘medicines’ not because they work, but ‘because they sell’.

  • We are at least seeing fewer pharmacies advertising ear-candling but we have an over-saturation of pharmacies in most urban areas, and they are competing with “chemist warehouse” chains selling heavily discounted non-prescription medications, soaps, dental hygiene, beauty and vitamin products.
    Sadly also they are mixing up homoeopathic/herbal remedies with genuine pharma remedies on their shelves. I was appalled to find that I’d bought a cold/flu symptomatic relief box that was absolute garbage rather than the pharmacy generic label that I thought I’d selected.
    I did make a comment about a pharmacy advertising junk product on their counter and they looked embarrassed but didn’t take it down.

    My only strategy is to support pharmacies that don’t go in for this stuff.

  • Pharmacies selling Homeopathic Remedies can definitely be a problem — no doubt about it — but, not a huge problem, in my opinion. For one thing, everything “behind the counter” that pharmacists dispense throughout a typical day are labelled (dangerous) medications. That’s most of what pharmacists do — check a prescriber’s order for these drugs, the technician’s work when filling them, and counsel patients about their prescription when they’re dispensed. This is primarily what a pharmacist does, almost to the exclusion of anything else.

    That’s not to say that those pharmacies that do carry Homeopathic Remedies or herbal products on their “front store” shelves don’t present the problem we’re talking about for the pharmacist. Sometimes, a customer WILL ask for a recommendation for what ails them. When this happens, based on a quick interview, a pharmacist will either make a referral or recommend an OTC product to be used for a trial period. A problem might occur when the pharmacist doesn’t know much or anything about Alt-Med, or worse, if they’re “the enemy within” and actually believe in this stuff. Then the consumer is at risk for making a “bad choice.”

    There’s not much that can be done when a customer diagnoses themselves and brings their OTC selections to the register to be “rung out” by a technician along with their greeting cards and batteries. With Alt-Med, self diagnosing with a “homeopathic” versus a “chiropractic” versus an “acupuncture” versus an “aromatherapeutic” versus a “colonic” problem, let’s say, is a related and larger issue that might be reserved for another thread. In these cases, the damage has already been done.

    I can only speak from my own experience, but when a customer asked me about a Homeopathic Remedy, either out in the aisles or if my “techs” have gone home for the day and I’m at the register, I can and do discourage the purchase. I ask them what they’re using it for and suggest it won’t do any good since there’s no medicine in it. I show them the label if they don’t believe me. If they’re already convinced or hold a medico-political or psychological conviction, even this argument will fail. If it’s for something I think needs checking out, I tell them that, although typically, their denial and/or medical psycho-aesthetic rules, no matter.

    Pharmacies typically don’t care about what they sell. Like drug companies selling drug, they’re unabashed. Let me put it this way, a pharmacy will sell cigarettes … with I.D., of course … so they’re “not about” the best health care choices. They really don’t care what or why. Pharmacies are only interested in the bottom line. For the most part, though, a pharmacist works independently from this “profit” incentive, even in the corporate context of what’s euphemistically referred to as “community pharmacy.” Pharmacists “own” and rule their pharmacy on the day they work and can say “no” whenever, in their professional judgement, there’s risk to a patient or consumer. And, if they know better and think a product is therapeutically meaningless and/or inappropriate, they can say so without fear of reprisal from their employer.

    There are considerably more serious concerns for the pharmacist related to profit in “retail” pharmacies than having a homeopathic product available on the shelves. Often, I felt I had to protect the patient-consumer from “corporate.” But yes, pharmacies shouldn’t carry H-Remedies anymore than they should have cigarettes available … with I.D., of course 🙂

    ~TEO.

    • there is DIRECT HARM from homeopathic remedies:
      1 financial exploitation
      2 some low potencies can contain toxic amounts of ingredients
      3 poor quality control means that they can contain other toxic molecules
      there is also indirect harm:
      1 if we make consumers believe in homeopathy, they will inevitably use it for serious condition
      2 if we make them believe in homeopaths, they will follow their advice to treat or prevent illnesses with their useless placebos
      3 if we give credibility to homeopathy, we undermine EBM and impede progress
      4 if we believe in absurdities, we are prone to commit atrocities (Voltaire)
      to deny any of this is a significant disservice to public health, in my view.

      • Edzard

        You mis-represent facts purposely! Did you try comparative analysis with the allopathic system to see where the problem really is? I have tried to define your glass house for the same references. Look at the MESS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

        1 financial exploitation : you have some figures to define extent of problem created by the homeopathic system?
        Check out the allopathic system:
        “In the last few years pharmaceutical companies have agreed to pay over $13 billion to resolve U.S. Department of Justice allegations of fraudulent marketing practices, including the promotion of medicines for uses that were not approved by the Food and Drug Administration.”
        http://projects.propublica.org/graphics/bigpharma
        And,
        “First, it was Valeant Pharmaceuticals and its 300% and 700% price hikes on two crucial heart medications. Then, it was Turing Pharmaceuticals and its 5,455% price increase on a lifesaving anti-parasitic medicine. And now, it’s Mylan and its 548% boost in the prices of EpiPens, meaning people with severe allergies may not be able to afford the tools that keep them alive.”
        and http://www.cbsnews.com/news/whats-behind-the-sharp-rise-in-prescription-drug-prices/
        http://time.com/4475970/stop-immoral-drug-prices/
        And
        http://www.outlookindia.com/website/story/prices-of-coronary-stents-fixed-rates-down-by-80-per-cent/297939
        How many billion US$ can you count? Are these values increasing every year?

        2 some low potencies can contain toxic amounts of ingredients
        Is this your assumption “can contain” or fact? You make assumptions to just run down alternative medicine: and everyone seems(?) to believe you? After all you were the HEAD of COMPLEMENTARY MEDICINE!!!!!!!!
        Do you have some information on better results from allopathic toxcity:
        “Between 2004 and 2010, major drug companies paid out $7 billion in fines, penalties and lawsuits — just a drop in the bucket when compared with soaring profits. No one seems to care that every day, Americans are injured or killed by dangerous prescription drugs.”
        https://www.drugwatch.com/dangerous-drugs.php
        And
        Aluminum and Mercury in Vaccines (now in the process of being taken off!) or, or, or …….
        Can you name one drug that has no adverse effects? The rationale was: to be effective, it has to show adverse effects. In the near future, homeopathic medicines would startto become effective based upon your analysis and you will not need to fudge figures (Dr Hahn!!!).

        3 poor quality control means that they can contain other toxic molecules
        Again an assumption. Do you ever read:
        “The ubiquitous problem of contamination of pharmaceutical products is well known to anyone involved in drug manufacture, control, or distribution. In fact, the types of contaminants, their relative hazard to human health, the sources of contamination, and the methods for prevention and detection such contamination are so varied and numerous as almost to defy compilation.”
        http://onlinelibrary.wiley.com/doi/10.1002/jps.2600670104/abstract
        “A 2009 study indicated that half of all lab scientists fail to check for the presence of Mycoplasma in their cell cultures, which is problematic, as this contamination can disrupt patterns of human gene expression.”
        http://www.sgs.com/en/news/2015/12/detection-of-mycoplasma-in-biopharmaceuticals-vaccines-and-gene-cell-therapies
        And the bonus from the allopathic system: contaminating the environment with drugs:
        “Most drugs were measurable in drinking or river waters and sediments, suggesting that pharmaceutical products are widespread contaminants, with possible implications for human health and the environment.”
        http://www.sciencedirect.com/science/article/pii/S0140673600022704
        And the mess created by the un-imaginable toxicity from antibiotics:
        http://martinblaser.com/excerpt.html “ “The reasons for this disaster are all around you, including overuse of antibiotics in humans and animals, Cesarian sections, and the widespread use of sanitizers and antiseptics, to name just a few. While antibiotic resistance is a huge problem—old killers like tuberculosis are increasingly resistant and making a comeback—there now seem to be separate ones, affecting people with such scourges as Clostridium difficile (C. diff), bacteria of the digestive tract resistant to multiple antibiotics, a potential danger in the hospital, and a spreading pathogen, methicillin-resistant Staphylococcus aureus (MRSA), which can be acquired anywhere. The selective pressure of antibiotic use is clearly increasing their presence.”

        I am positive that the medical degrees that you flaunt and the title of Head of Complementary medicine are only being misused by you for commercial gains.

        Next time you make general statements, it would be wise to support these with proper data or reference-not your own article.

        • “I am positive that the medical degrees that you flaunt and the title of Head of Complementary medicine are only being misused by you for commercial gains.”
          Thanks
          THIS IS YOUR MOST STUPID AND WRONG ARGUMENT YET.

          • I’m absolutely sure that occasionally something that Iqbal says makes sense, if only when he’s telling the bus driver where he wants to go. Mostly, he just seems to throw some words up in the air and then post them in the order they come down. He’s grim fun though.

        • @Iqbal

          What a hate-filled rant! And seemingly devoid of any real knowledge of the things you talk about.

          I followed just one of your links, because the quote (“The ubiquitous problem of contamination of pharmaceutical products is well known to anyone involved in drug manufacture, control, or distribution…”) struck me as the very opposite of what I’ve heard about FDA manufacturing inspections. Sure enough: the paper was published in 1978 Iqbal! Things have changed just a tad in the subsequent 40 years. Good Manufacturing Practice (GMP) regulations, for a start. FDA inspections are the dread of every pharma company, because they are so stringent (and not just restricted to the USA: any company wishing to sell pharma products in the USA has to undergo FDA inspection). If you imagine the inspections are limited to what you call ‘allopathic’ medicine, you’re dead wrong: your homeopathic pals are not immune from bad manufacturing practice. Try this link (from 2011) for a start: http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2011/ucm255074.htm. (Other examples have been highlighted elsewhere in comments on this blog.

          “un-imaginable toxicity from antibiotics”?!! Please discuss this with patients whose deaths have been avoided with antibiotics.

          “I am positive that the medical degrees that you flaunt and the title of Head of Complementary medicine are only being misused by you for commercial gains.” This is just about libellous: I don’t know Professor Ernst personally, but have read enough about him, his (former) sources of funding and his contribution to the medical literature to be confident what you state is simply untrue.

          You come over as a venomous, hate-filled individual who can’t face up to the simple truth that homeopathy is complete bunk. You deeply resent a highly competent individual who has decided to spend much of his retirement time arguing for truth, reason and evidence in medicine, so you vent your resentful bile by slandering the man and his blog. Your simple-minded equation of medicine with the pharmaceutical industry is way off target.

        • Edzard

          You mis-represent facts purposely! Did you try comparative analysis with the allopathic system to see where the problem really is? I have tried to define your glass house for the same references. Look at the MESS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

          there is also indirect harm:

          1 if we make consumers believe in homeopathy, they will inevitably use it for serious condition.

          You have spent over 20 years to make people NOT believe in alternative medicine: and year on year alternative medicines are becoming more popular. Remember your alma mater: introduced course on homeopathy!
          “The story of CAM cannot be considered a transient phenomenon—it must be considered a sustainable need of the population. The prevalence of CAM is high and will constantly increase with the health awareness of the population. The reasons for CAM utilization are complex and include the costs of traditional therapies, a desire for a more holistic approach to treatment, the integration of CAM in therapy decisions, and dissatisfaction with current therapies.”
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307506/

          (you as usual fudge facts???? https://www.ncbi.nlm.nih.gov/pubmed/10743298)

          Incidentally the customers using CAM are found to constitute: more educated, wealthy(Steve Jobs?) and women(careful?). Homeopathy is being used by many hospitals to control effects of chemotherapy.

          2 if we make them believe in homeopaths, they will follow their advice to treat or prevent illnesses with their useless placebos
          You have tried your best for over 20 years. You should realize people have better understanding than to accept the drivel that you continue to state: everyone goes along with their own experience or advise of someone they rely upon. For example, the case of Indian industrialist, who saw the comparative benefits from homeopathy for treatment of his children. He runs a US$ 3 billion company and surely can see and evaluate results.
          “Sometime in 2002, Bajaj noticed that his son, four years old then, would fall ill every two or three months. So would the son’s friends. ……But what was the solution? The usual prescription of paracetamol, antihistamine, antiobiotics and, in acute cases, cortisone could not be sustained for long….Today, everyone in Bajaj’s immediate family, extended family, friends and colleagues is on homeopathy. …….It is said of homeopathy that it does not benefit those who do not have faith in it. But with Bajaj the benefits came first, then the faith.”
          http://www.businesstoday.in/magazine/cover-story/india-best-ceo-automobiles-rajiv-bajaj-leadership/story/201398.html or
          the Chief of Indian Army Medical service: http://thecyber.in/indian-army-to-appoint-homoeopathy-doctors/

          3 if we give credibility to homeopathy, we undermine EBM and impede progress

          EBM and allopathic system of medicine!!!!!!!!!!!!! You are out of your mind. Since when did allopathic system become evidence based?
          “We believe that the vast majority of what physicians do is backed by solid science. Their diagnostic and treatment decisions must reflect the latest and best research. Their clinical judgment must certainly be well beyond any reasonable doubt. ……because these beliefs are based more on faith than on facts for at least three reasons, each of which we will explore in detail in this section. Only a fraction of what physicians do is based on solid evidence from Grade-A randomized, controlled trials; the rest is based instead on weak or no evidence and on subjective judgment. When scientific consensus exists on which clinical practices work effectively, physicians only sporadically follow that evidence correctly.”
          https://www.scientificamerican.com/article/demand-better-health-care-book/

          “Overall, physicians correctly estimated 11% of the benefit expectations (89% error) and 13% (87% error) of the harm expectations. Most participants overestimated benefit and underestimated harm.
          https://sciencebasedmedicine.org/how-accurately-do-physicians-estimate-risk-and-benefit/

          Check with Dr. David Eddy. He coined the term EBM. I am doubtful if you even understand the meaning of the term EBM:
          “The goal of this movement is to pierce the fog that envelops the practice of medicine — a state of ignorance for which doctors cannot really be blamed. “The limitation is the human mind,” Eddy says. Without extensive information on the outcomes of treatments, it’s fiendishly difficult to know the best approach for care. The human brain, Eddy explains, needs help to make sense of patients who have combinations of diseases, and of the complex probabilities involved in each. “
          What update do you have on the “limitation of the human mind”? And the numerous illogical interventions believed in by EXPERTS. Read the lament
          https://sciencebasedmedicine.org/peanut-allergy-prevention-advice-does-a-180/
          How many such articles would you like to see?

          4 if we believe in absurdities, we are prone to commit atrocities (Voltaire)
          Very well said: How do you define atrocities? Killing and maiming patients who come to doctors and pay for getting well:

          Medical error—the third leading cause of death in the US: http://www.bmj.com/content/353/bmj.i2139
          “While 23% of European Union citizens claim to have been directly affected by medical error, 18% claim to have experienced a serious medical error in a hospital and 11% to have been prescribed wrong medication. Evidence on medical errors shows that 50% to 70.2% of such harm can be prevented through comprehensive systematic approaches to patient safety.”
          http://www.euro.who.int/en/health-topics/Health-systems/patient-safety/data-and-statistics
          and off course: “A paradoxical pattern has been suggested in the literature on doctors’ strikes: when health workers go on strike, mortality stays level or decreases…….The strikes lasted between nine days and seventeen weeks. All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods.”
          https://www.ncbi.nlm.nih.gov/pubmed/18849101
          Voltaire would be turning in his grave seeing you misuse his statement. You should use your own definition that justifies atrocities as scientific learning for allopathic system!!!!

          You are no rational PhD: you are a low level sales man, selling a doctrine that has zero content, using misleading and incorrect information and flawed arguments as actual facts show. Would be good idea to return the degrees back to the institutions if you cannot understand medicine after so long time.

          All references provided above are from the allopathic system.

          • I am worried about your mental health!
            go and see someone competent for your problem.

          • Edzard

            Assuming things and ad hominem argument.

            You should try refuting references using your PhD training and years of experience of understanding real medicine.

            Remember, I have only collected these references and put here to show the hollowness of your arguments and your mis-representation of facts!!!!!!!!!!!!!

          • ad hominem??? after what you wrote, my reply is merely light banter, I think.
            refuting your nonsense? no thanks, I have better things to do.
            BTW: I do think you should consult someone for your mental health; this is not ad hominem at all.

          • All references provided above are from the allopathic system.

            Out of curiosity I had a look at many of the arguments and citations and found all of them already refuted before here in this blog as fallacious, erroneous and/or irrelevant. The rants are too long and deranged for any serious evaluation and much less a detailed response.
            I also agree with Prof. Ernst that Iqbal, whoever that is, is not making much sense and one is starting to suspect it might be something serious.

          • Edzard

            “refuting your nonsense.

            “Nonsense” here is for references taken from Lancet, BMJ, Pubmed, Science based medicine, Times?

            I agree. But this is ALL that YOU have stood for. As I mentioned, a poor sales man.

            “no thanks, I have better things to do.”

            I suggest a shorter version of reply: “I can’t”.

          • Björn Geir

            “I also agree with Prof. Ernst that Iqbal, whoever that is, is not making much sense and one is starting to suspect it might be something serious.”

            Is there a circus in your country? Check for the position of the “Joker”.

            You will be quite a success.

          • Björn Geir-I know that EE has made a request for politeness, and for people to be addressed by their stated names, which is something I now adhere to-albeit a little reluctantly, since there was fun to be had with people like Not-A-Doc Dale.But-weirdly amusing and off the scale though Iqbal is, surely some of his wilder claims about crookedness and lying etc are astep too far?
            I can see the problem though. Iqbal’s hysteria, Colin’s silly delusions, And Greg’s manipulation of facts, Logos-Bios’s Trumpistt obsession with the ‘leftist media, the occasional person who goes away in a huff because any criticism is perceived as ‘aggression’ or ‘impoliteness’ all serve as comical, though depressing, reminders of the kind of dark forces that are out there.I share others’ concern about Iqbal’s mental state though.

          • Barrie,

            I fully understand that which Edzard, Björn, and you are questioning in the context of the mental state that some people, such as Iqbal Krishna and Colin, are so very apparently in, at the very least, at the times when they write their asinine flying-in-the-face-of-evidence / science-denialist comments.

            In my small way, I try my utmost to de-stigmatize mental health problems because I understand some of them far more than any human (or any other animal) ever should. My determination to always be highly-vocal on issues of mental health started many years ago when a dear friend and mentor took his own life due to the stigma of mental health problems preventing him from discussing his problems with his own family, let alone his friends and his GP.

            I respectfully implore everyone to, firstly understand, then to always remember, The Goldwater Rule: Why breaking it is Unethical and Irresponsible

            The “Goldwater Rule”:

            “On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”
            — Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry.

            “Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.” — Maria A. Oquendo, MD, PhD.

            https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/08/the-goldwater-rule

            See also:
            https://en.wikipedia.org/wiki/Goldwater_rule

          • As I have often pointed out, I always maintain respect for the person, the fellow human being – even those yelling and screaming belligerently from behind a silly pseudonym. I do however not feel or express respect towards the fake and fraudulent potions or practices with unfulfillable promises that some persons promote and peddle. I have seen enough death, and despair in my life to be able to keep quiet about useless fake medicine such as homeopathy. I am fully and earnestly verbal about my views on homeopathy and chiropractic to name two common subjects of my criticism. I attack fully and frontally the beliefs and bullshit but I try to avoid expressing judgement about the persons or their character. The persons on the receiving end of my disapproving reviews are usually the most deluded victims of their unreason and they often take my salvo’s personally. That can hardly be avoided, for obvious reasons.
            When I seconded Edzard’s concern that our friend was showing increasing signs of unreason, I said I was “starting to suspect it might be something serious”. That does not mean I was offering a diagnosis of a mental disorder. I am not a psychiatrist and do not pretend to be one. I was simply expressing my view that the signs and symptoms are worrisome. Of course mental disorder of the psychiatric kind can be at play, but many other serious conditions may be involved. One of the more likely is simply extreme religious fervour. Homeopathy certainly fulfills all criteria and constructs of a religious worship. The devotion of Hahnemann’s disciples can appear in the most bizarre behaviour, like that exhibited by this vigilant warrior of shaken water. (This is not even one of his lower performances). Such behaviour might, for all I know, also be the consequence of a severely traumatic experience causing disabling anger and resentment. Who knows what goes on in the minds of people who resort to believing the unbelievable.
            Whatever the problem is, I feel for such persons and have no reason to belittle or vilify them, only the consequences of the fake health care they promote, with all its potential for false hope, wastefulness and harm.

          • Björn Geir

            “Out of curiosity I had a look at many of the arguments and citations and found all of them already refuted before here in this blog as fallacious, erroneous and/or irrelevant.”

            I have used 18 reference links. Give me connecting links refuting the arguments in this blog or keep off replying in place of Edzard in future.

          • Björn Geir

            “Out of curiosity I had a look at many of the arguments and citations and found all of them already refuted before here in this blog as fallacious, erroneous and/or irrelevant.”

            I have used 18 reference links. Give me connecting links refuting the arguments in this blog or stop lying in future.

          • No my dear Iqbal, the onus is on you to stop dragging in tired old arguments all over again. You will have to come up with something new and groundbreaking to support the hitherto unproven and unlikely belief in shaken water soaked sugar pills’ supposed action against sickness. Until then we will just have cursory looks a your comments and go about more fruitful pastimes than try force-feeding you with information. We have better things to do than help you understand that homeopathy is make-believe medicine.

            Apart from being both misrepresented and irrelevant to the subject, your rants against real medicine, or “allopathic system” as you like to name-call it to satiate your chagrin, have all been repeatedly explained and refuted, here and elsewhere. I think I have myself addressed each of them at some point.
            If you cannot find the unadulterated truth yourself, the problem is not lack of accessible information here in this blog and elsewhere, it lies in your lack of cognitive and analytical abilities or rather (I hope) in your religious blindness.

          • Björn Geir

            “Out of curiosity I had a look at many of the arguments and citations and found all of them already refuted before here in this blog as fallacious, erroneous and/or irrelevant.”

            Changed to:

            “No my dear Iqbal, the onus is on you to stop dragging in tired old arguments all over again.”

            Exactly the response, I expected. As I wrote earlier for you, once a liar, always a liar.

            Forget the circus part. The spectators will see through the fake clown act. The right opening suited for you is to participate in the future episodes of “The Moment of Truth”, if it comes on air. The part will be right up your street and beating a lie detector with your experience here should be a cake walk. The money coming in is unbelievable. Answer to 21 questions give you US$ 500,000.

            “…your religious blindness.”
            If I remember correctly, you used a similar term for Dr. R Hahn when he questioned Edzard’s ideology influencing the outcome.
            “Researchers claiming the opposite rely on extensive invalidation of studies, adoption of virtual data, or on inappropriate statistical methods. The reader of this literature must be aware that ideology plays a part in these meta-analyses. For example, Ernst makes conclusions based on assumed data when the true data are at hand . Ernst invalidates a study by Jonas et al. that shows an odds ratio of 2.19 (1.55–3.11) in favor of homeopathy for rheumatic conditions, using the notion that there are not sufficient data for the treatment of any specific condition”.

            Not enough imagination either.

          • are you able to think at all?
            if so, do you know that calling someone a liar is insulting and ad hominem?

          • Yes, dear Iqbal.
            Your memory is not altogether broken. I did argue that Dr. (real one actually – and a bona fide authority on genuine, important scientific matters) Hahn is afflicted with religious zealotry just as you seem to be. The difference between him and you seems to be that he is extremely gifted and can make practical use of his intelligence despite the adherence to religious fantasies, which unfortunately spill over into a paradoxical fancy for the possibility of shaken water having mystical effects.
            If you continue addressing me in such a derogatory manner and accusing me of untruthfulness, I will have to stop showing you the respect of responding personally to your remarks and consider you one of the impertinent trolls not worthy of attention or respectful dialog.

          • “are you able to think at all?”

            Careful. Chastising an insult with an insult could get you banned from commenting:
            http://edzardernst.com/2017/01/my-new-years-resolution-for-2017-more-respect-please/

    • I mostly agree with your comments here, John. I have a number of pharmacist friends, every one of whom works for a large pharmacy chain. Some are salaried; some work on salary and bonuses based on store sales. The latter pharmacists also have some managerial responsibilities.

      Many on this site claim to demand evidence-based research in healthcare but perhaps are unaware of “evidence-based” market research. Pharmacies are stores and businesses whose primary goals are profit and customer satisfaction. If customers demand homeopathics for some reason and a pharmacy doesn’t carry them, customers will merely shop at pharmacies which they view as better stocked. Businesses which are better at pleasing their customers are more successful businesses;market research demonstrates this.

  • This by Dr Steven Novella today is worth reading: Regulating Health Care Products – Science-Based Medicine

    I disagree on three major points: that the only important way to deceive the consumer is through packaging or direct marketing claims, that the only harm worth considering is direct toxic harm, and that we should give leeway to preliminary scientific findings.

    Let me start with the point about giving leeway to products that are not inherently unsafe or intended for very serious illness. There is a tremendous amount of indirect harm from health products that are not directly toxic but are essentially worthless. There is financial harm (which the FTC recognizes as sufficient to trigger regulation), there is psychological harm (such as false hope), and there is downstream harm.

    The downstream harm is difficult to quantify, but we see it all the time. One common scenario is this – a consumer purchases a homeopathic product for a self-limiting illness, like a cold. There is no possible benefit from the product, but the consumer is convinced it worked because of placebo effects and other psychological effects (such as wanting to believe they did not waste their money, or convincing their skeptical relatives who thought their purchase was silly). The consumer is now convinced that homeopathy works. That, in my opinion, is harm.

    They are partly convinced because society allows homeopathic products to be packaged as if they are real medicine, with names and claims that imply that they are real medicine. They are sold in pharmacies alongside real medicine. The products are afforded the trappings of legitimacy. This also contributes to placebo effects.

    Because of all this, when the hypothetical consumer eventually develops a serious illness, they will be more inclined to seek treatment from a practitioner of homeopathy. That is a choice that may cost them their life. That is harm that was contributed to by the lax regulation of homeopathic products. I don’t think that this connection is too tenuous to influence our regulatory policy.

  • Sorry for your latest blog knocking our good friends: the pharmacists. The news coming out this morning is that vitamin D supplementation aids to prevent colds and respiratory infections.

    ‘Professor Adrian Martineau, who led the study at Queen Mary University of London, said: This major collaborative research effort has yielded the first definitive evidence that vitamin D really does protect against respiratory infections.”

    http://www.telegraph.co.uk/science/2017/02/15/take-vitamin-d-supplements-prevent-common-cold-landmark-study/

    Clearly, if vitamin D can contribute to the reduction of the mentioned illness, that is less business and ‘profits’ (dirty word) for homeopaths to dispense Allium, Aconite etc and our friends, the doctors, to dispense their medicines. I hope you will come out singing praises for Vit D and how it is going to put ethics before profits.

    Mind you though, people have been singing Vit D praises for years but getting this EVIDENCE took some time huh?

    • try to make some sense please

    • @Greg
      Apart from your argument regarding vitamin D vs. homeopathy constituting a foolish logical fallacy, you should have had a look at what is behind this news item, which I doubt you have the skills to evaluate anyway.

      I happened to have read this study yesterday and I do not agree with its interpretation and presentation.
      This “landmark study” is seriously overhyped in my opinion and the conclusions of the authors are wrong. This is a review that only confirms what was already known, that significant vitamin-D shortage leads to increased susceptibility for infections. To say it finds vitamin D supplementation ‘protective’ or ‘preventive’ is misleading and wrong.

      The good professor Martineau and his co-authors find an overall NNT of 33 for supplementation, i.e. that you need to supplement 33 persons to ‘prevent’ one bout of URI -upper respiratory infection of any kind.
      When they look at the subpopulations it becomes obvious that most of this effect is likely due to an NNT=4 in the subgroup with profound shortage of vitD. Instead of excluding this group, they deduce that vitD supplementation is overall preventive for URI. This is logically wrong if I am not mistaken. The correction of vitamin D shortage prevents or corrects an increased susceptibility in those with shortage, not the other way around.
      The fact remains that a good part of the population is low in vitamin D due to poor diet and not enough light. Those who spend all of their time inside or who overdress outside, such as muslim ladies are especially at risk. Fish is no longer the part of the diet in northern regions and so on…
      These population groups should be screened and treated. General supplementation is the wrong conclusion.
      The guy in the video on the page you link to is trying to say this but makes a mess of it. He is correctly telling us we need to eat properly and go outside as much as we can. If you think you still need to supplement, then ask your Dr. to measure vitD, a relatively cheap test that will tell you if you need to supplement or not.

      The fact remains, as with all vitamins, if you don’t need more you don’t need to take extra supplements

      Here’s a link to the full paper in BMJ: http://www.bmj.com/content/356/bmj.i6583
      I recommend scrolling first down to the “What is already known/what does this study add” box at the bottom.

  • More on the Vit D breaking news story:
    Vit D offers the same level of protection as flu vaccines

    ‘Those who take the 2p-a-pill “sunshine vitamin” regularly cut their chances of respiratory infection by 12 per cent — the protection level the flu vaccine offers.’

    https://www.thesun.co.uk/living/2875167/daily-vitamin-d-supplements-can-prevent-flu-just-as-well-as-vaccine-for-just-2p-a-pill-study-shows/

    What was once ‘quackery’ is now scientific medicine. Are there any E.E. articles mocking Vit D?

    • vitamin = ‘vital amin’ meaning they are essential for life. they are in no way ‘alternative medicine’. however, most of us do not need to supplement them, as we get enough via our food. and some vitamins can cause adverse effects when over-dosed.
      BTW: respiratory and flu are not the same.

      • http://edzardernst.com/2015/02/what-do-multivitamins-do-they-render-your-urine-more-expensive/

        Start of quote
        Even the most enthusiastic vitamin fan will find it hard to argue with these findings; they seem rock solid. Vitamins have their name from the fact that they are vital for our survival – we all need them. But, in developed countries, we all get them through our daily food. Any excess of water-soluble vitamins is swiftly excreted via the urine. Any excess of fat-soluble vitamins is stored in the body and may, in some cases, even represent a health risk.

        Exceptions are vulnerable groups such as children, the elderly, pregnant women and patients with certain diseases. These individuals can suffer from hypovitaminoses, the only reason for regularly using vitamin supplements. But for the vast majority of the population, the only effects of regular vitamin supplementation are that we enrich the manufacturers and render our urine expensive.

        End of quote

        Can vitamin D now be considered as an exception to the thesis that vitamin supplementation mainly contributes to profits and expensive urine? Why recommend supplementation with Vit D if we get enough from our diet?

        • @Greg

          Can vitamin D now be considered as an exception to the thesis that vitamin supplementation mainly contributes to profits and expensive urine? Why recommend supplementation with Vit D if we get enough from our diet?

          Please go to classes in comprehension 101. You are flaunting your stupidity again. The post you quote from about vitamins rendering urine more expensive concerned multivitamins. Get it??! It’s there right in the title of the post as well as the text. Not about vitamin D or any other single vitamin, but multivitamins.

          And you correctly pasted part of the article about vitamins in food: “most of us do not need to supplement them, as we get enough via our food.” I’ve bolded the words that seem to have been filtered by your eyeball-brain-comprehension system. You even go on to paste the exceptions that the article spells out: “Exceptions are vulnerable groups such as children, the elderly, pregnant women and patients with certain diseases.” But you are so consumed by your hatred of this blog that you follow this paragraph by posing the inane question I’ve blockquoted above. Since you obviously can’t figure out the meaning of simple English unaided, please let me help: there is no thesis that vitamin supplementation mainly contributes to profits and expensive urine. There is a reasonable thesis that multivitamin supplementation mainly does so.

          Struth! If understanding the role of vitamins in medicine is beyond you, small wonder you’re easy grist to the mills of the advocates of Big Snakeoil.

      • Of course vitamins can be considered alt med depending upon how they’re used. For example, the use of Vit. B6 for CTS and Vits. B1, 3, 6, and 12 for MPS would be considered alt med if they were not used merely to assuage a plasma deficiency of them.

    • @Greg

      You asked

      Are there any E.E. articles mocking Vit D?

      No; why should there be?! Vitamins are dietary essentials, as Edzard has already explained.

      The reason I am writing this comment is because I find your tone unacceptably demeaning when your demonstrable ignorance is taken into account. If you really want to see if there are posts on vitamins in general or vitamin D in particular, you have only to type the words into the search box at the top right of this blog. Do so, and you will find only confirmation of what E.E has told you: vitamins are not in any way alternative medicine, unless they are offered as cures for diseases in the absence of supportive evidence (any vitamin treats the disease(s) caused by a deficiency of that vitamin) or are advocated to be taken in excess of scientifically based recommendations.

      You seem to be confusing vitamins with dietary supplements, which mostly do fall within the province of Big Snakeoil. Please do try to educate yourself before you rush to post. The casual reader of this blog will be entitled to conclude that most supporters of the various forms of camistry are desperately ill informed.

    • Here’s a response the BBC received when reported asked for another opinion:

      “Prof Louis Levy, the head of nutrition science at PHE [Public Health England] , said: “The evidence on vitamin D and infection is inconsistent and this study does not provide sufficient evidence to support recommending vitamin D for reducing the risk of respiratory tract infections.”

    • Vit D offers the same level of protection as flu vaccines

      That comment betrays a profound misunderstanding of the difference between the two. As has already been explained to you, vitamin D deficiency renders us more iable to infection. The preliminary suggestion is that for about every 30 people taking vit D supplements, one incidence of flu would be prevented.

      For flu vaccination, the suggestion is that 40 people vaccinated prevents one incidence of flu, but that is so high largely ecause so many are vaccinated that the incidence of flu in society is reduced by a degree of herd imunity. If, as some of the ill-informed ‘experts’ want, vaccination was replaced by vit D supplements, the incidence of flu would rise for everybody.

  • I am a fervent supporter of the theme of this thread, but Dr Novella’s comments surely go too far – unless he has evidence that consumers ARE ‘more inclined to seek treatment from a practitioner of homeopathy’; and that choosing to do so has actually ‘cost them their life’.

    Expressing ‘hypothetical concern’ is shroud waving, detracts from the valid points in the piece, and is not worthy of the good doctor’s excellent work in SBM.
    Evidence please.

  • I instantly stop reading any rubbish such as Greg’s which contains sneering phrases like ‘our African friends’ or ‘the homosexual brigade’-or in his case ‘our good friends the pharmacists’ and ‘our friend the doctors’. So in the unlikely event he went on to say anything intelligent then I’m afraid I missed it.

    • Barrie’s comment is mischievous and perhaps the type of comment to refer to the Police. Maybe they monitor this site for hate speech already?

      His mixing of my phrases:
      ‘our good friends: the pharmacists’
      ‘our friends, the doctors’

      with HIS phrases:
      ‘our African friends’
      ‘the homosexual brigade’

      is something he ought to think about.

      • Greg-learn to read properly, and alongside that, learn to apply and understand logic.
        Although that last one would of course undermine your belief in wingwang.As to your Police references, I believe that if you’re not insane then many of your statements ARE.

      • Greg,

        Yes, well of course that’s just the sort of blinkered, philistine, pig-ignorance I’ve come to expect from you non-creative garbage.

        [Quote from John Cleese, a founding member of Monty Python]

  • “Bogus treatments,” stated Edzard. Clara and Steven Wong have written in Anesthesiology Research and Practice that the commonly performed practice of TrP injections by Pain Management and PM&R doctors are basically placebos. While I don’t agree with their conclusions based, admittedly anecdotally, on my own experience, I offer a quote below:

    “The nonspecific diagnosis and lack of objective clinical measurements for trigger points mean that the evidence for the effectiveness of trigger point injection remains heterogenous. There is so far no strong evidence for the effectiveness of trigger point injections, and many physicians consider trigger point injections a little more than, if not equivalent to, placebo effects.”

    Could it be that tens of millions of dollars are spent on this medical therapy and it is actually bogus? The Wongs seem to think so. Since Edzard DEMANDS strong evidence for everything paramedical, his thoughts on this matter would be welcome since I refer patients for such injections often.

  • It seems that Barrie’s comments on this site go back some time, I found this one interesting:

    http://edzardernst.com/2016/03/homeopathy-masters-degree-to-close-because-of-lack-of-scientific-basis/

    ‘I imagine that there are plenty of homeopathic religionists who think that anyone who believes in the rules of Science is a ‘Science Nazi’. Doesn’t make their stance either correct or indeed very appealing.’

    Clear reference to ‘I imagine’ (remember that Barrie got a prize for English in 6th form) is evidence that Barrie’s imagination is at work in his comments.

    Yet, he demeans homeopaths by referring to them as ‘religionists’. Evidence please.

    Person who quotes demeaning terminology regarding the sexual orientation of a group of people: ‘homosexual brigade’ should expect to have their writings looked at. (or is it ‘A person’?)

    • Greg-the best that can be said is that your comments are becoming as amusingly daft as Iqbal’s. He’sogratuitously insulting that I’m worried we might lose him. But not to worry, it seems there’s a subs’ bench.

      • at present I have no desire to lose either Greg or Iqbal – they are so amusing and often make my day!

      • ‘Two other equally punchable mouths – I speak here as a sometimes hot-tempered but not physically violent type of a man=’

        Barry Lee Thorpe, 13 August 2015 at 00:39

        ‘DISLIKES
        Tights, Tories, Homeopathy, U2, Daily Mail,sensitive singer songwriters, Feminazis’

        Is this you Barry?

        • Is this you Greg?:
          http://www.gregcope.com.au/about.php

          Not that it matters, but if so then we are obliged to feel pity with your predicament in having to support your subsistence selling such a mixture of medical imitations. Dodging the dissonance with reality must be demanding.
          No wonder you are bitter and exasperated at those who pound your precious products.

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