evidence
Norbert Hofer is the former leader of the Austrian right-wing FPÖ party who almost became Austria’s President. Currently, he is the 3rd member of the National Council. Hofer is a man full of surprises; he stated, for instance, that the Quran was more dangerous than COVID-19 during a speech held at a 2020 campaign event. As a result, he was sued for hate-speech.
Hofer’s latest coup is not political but commercial: Hofer is launching his own dietary supplement on the market. It is called “Formula Fortuna” and contains:
- L-tryptophan; a Cochrane review concluded that “a large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5‐HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia‐Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5‐HTP and tryptophan is limited at present.”
- Hydroxypropylmethylcellulose, a common delivery system.
- Rhodiola rosea extracts; human studies evaluating R. rosea did not have sufficient quality to determine whether it has properties affecting fatigue or any other condition.The U.S. Food and Drug Administration (FDA) has issued warning letters to manufacturers of R. rosea dietary supplement products unapproved as new drugs, adulterated, misbranded and in federal violation for not having proof of safety or efficacy for the advertised conditions of alleviating Raynaud syndrome, altitude sickness, depression or cancer.
- Ginseng root extract. Although ginseng has been used in traditional medicine for centuries, modern research is inconclusive about its biological effects. Preliminary clinical research indicates possible effects on memory, fatigue, menopause symptoms, and insulin response in people with mild diabetes. Out of 44 studies examined between 2005–2015, 29 showed positive, limited evidence, and 15 showed no effects. As of 2021, there is insufficient evidence to indicate that ginseng has any health effects. A 2021 review indicated that ginseng had “only trivial effects on erectile function or satisfaction with intercourse compared to placebo”. The constituents include steroid saponins known as ginsenosides, but the effects of these ginseng compounds have not been studied with high-quality clinical research as of 2021, and therefore remain unknown. As of 2019, the United States FDA and Federal Trade Commission have issued numerous warning letters to manufacturers of ginseng dietary supplements for making false claims of health or anti-disease benefits, stating that the “products are not generally recognized as safe and effective for the referenced uses” and are illegal as unauthorized “new drugs” under federal law. Concerns exist when ginseng is used chronically, potentially causing side effects such as headaches, insomnia, and digestive problems. Ginseng may have adverse effects when used with the blood thinner warfarin. Ginseng also has adverse drug reactions with phenelzine, and a potential interaction has been reported with imatinib, resulting in hepatotoxicity, and with lamotrigine. Other side effects may include anxiety, insomnia, fluctuations in blood pressure, breast pain, vaginal bleeding, nausea, or diarrhea.
- Zinc gluconate which has been used in lozenges for treating the common cold. However, controlled trials with lozenges which include zinc acetate have found it has the greatest effect on the duration of coldsInstances of anosmia (loss of smell) have been reported with intranasal use of some products containing zinc gluconate. In September 2003, Zicam faced lawsuits from users who claimed that the product, a nasal gel containing zinc gluconate and several inactive ingredients, negatively affected their sense of smell and sometimes taste. Some plaintiffs alleged experiencing a strong and very painful burning sensation when they used the product. Matrixx Initiatives, Inc., the maker of Zicam, responded that only a small number of people had experienced problems and that anosmia can be caused by the common cold itself. In January 2006, 340 lawsuits were settled for $12 million.
- Pyridoxine hydrochloride (vitamin B6) is usually well tolerated, though overdose toxicity is possible. Occasionally side effects include headache, numbness, and sleepiness. Pyridoxine overdose can cause a peripheral sensory neuropathy characterized by poor coordination, numbness, and decreased sensation to touch, temperature, and vibration.
‘Formula Fortuna’ allegedly is for lifting your mood. If I, however, tell you that you need to pay one Euro per day for the supplement, your mood might even change in the opposite direction.
What next?
I think I might design a dietary supplement against stupidity. It will not carry any of the risks of Hofer’s new invention but, I am afraid, it might be just as ineffective as Hofer’s ‘Formual Fortuna’.
I recently came across this editorial from the NEJM. I find it extremely relevant to the many discussions we have about so-called alternative medicine (SCAM) we have on this blog. I, therefore, take the liberty to copy a small section of it here without further comment, and encourage everyone to read the full paper:
…expertise and authority are increasingly seen as means for elites to establish and support existing hierarchies. There is, of course, some substance to this argument: although orthodox doctors may believe that their dominance and privilege are attributable to the rigor of the methods they use and that other schools of medicine were vanquished because of the superior results achieved by science-based practice, another version of the story sees the suppression of other approaches to healing (e.g., naturopathy, homeopathy, or chiropractic) as the result of ruthless actions by the American Medical Association and other forms of organized medicine. These critiques aren’t new; as Lewis Grossman writes in Choose Your Medicine, “medical freedom” arguments have long been used to oppose institutions intended to protect consumers, such as medical licensure and the FDA.3 The difference today is that the antiexpertise perspective has moved into the mainstream. With Google and Amazon having created a world in which people can frictionlessly obtain both information and nearly any product they want, it’s not hard to portray expert gatekeepers as barriers to patients’ ability to exercise choice.
Perhaps the most substantial threat to expertise is that members of the public are coming to believe that facts don’t exist — that all facts are political and therefore a matter of opinion. This mindset is fundamentally incompatible with the scientific practice of medicine, which depends on a shared commitment to backing up hypotheses with empirical evidence. Indeed, modern medicine owes much of its privileged position to a broad acceptance that the methods it uses can be relied on to make medical choices that are likely to do more good than harm.
A 1902 Supreme Court case, American School of Magnetic Healing v. McAnnulty, offers an instructive example of what could happen if all medical facts were seen as purely matters of opinion. The American School of Magnetic Healing in Nevada, Missouri, received 3000 pieces of mail every day, largely consisting of checks, money orders, and cash to purchase the healing services that the school advertised in newspapers throughout the United States. Patients who sent payments were instructed to lie down at a specified time wherever they were, and the healers at the magnetic school would, from Nevada, channel the healing energy of the universe into their bodies to heal them.3 The Post Office Department (which predated the Postal Service) concluded that this practice was a fraudulent operation using the mail and, after a hearing conducted by the postmaster general, stopped delivering mail to the school. The school sued, and the case went to the Supreme Court, which found in its favor.
Writing for the Court, Justice Rufus Peckham essentially rejected the existence of medical facts. “Just exactly to what extent the mental condition affects the body,” he wrote, “no one can accurately and definitely say.… Because the [school] might or did claim to be able to effect cures by reason of working upon and affecting the mental powers of the individual… who can say that it is a fraud?… Those who might deny the existence or virtue of the remedy would only differ in opinion from those who assert it. There is no exact standard of absolute truth by which to prove the assertion false and a fraud.”4 Although this decision was never expressly overruled, both Congress and the courts have since rejected the premise that the efficacy of treatments is purely a matter of opinion.
Differences of opinion within medicine are necessary for progress, and both licensing and certifying boards must therefore be careful to leave room for the expression of divergent views. Moreover, there is ongoing debate regarding the extent to which free-speech protections cover professional speech. But despite the existence of divergent views and areas for legitimate debate, there are some opinions that have been so thoroughly repudiated by existing evidence as to be considered definitively wrong.5 Constructive debates are possible only within a shared epistemic framework and with a commitment to the idea of verifiable facts. It’s incumbent on licensing and certifying boards to defend the existence of facts and to give the public a way to know when practitioners are making claims that are incompatible with reality.
When it comes to disciplining doctors, boards haven’t always lived up to public expectations — but that’s not a reason they should fall short yet again, especially during a lethal pandemic. Although there are many gray areas in medicine, some propositions are objectively wrong. For example, when a licensed physician insists that viruses don’t cause disease or that Covid-19 vaccines magnetize people or connect them to cell towers, professional bodies must be able to take action in support of fact- and evidence-based practice.
The public relies on the medical profession in times of grievous vulnerability and need. For the profession to earn and maintain the public’s trust — along with the privileges associated with the status of being licensed practitioners — medical boards must be able to differentiate practitioners who are providing fact-based advice from those who are not.
Kratom (Mitragyna speciosa) belongs to the coffee family. It’s found in Southeast Asia and Africa. Traditionally, people have:
- Chewed kratom leaves.
- Made kratom tea to fight tiredness and improve productivity.
- Used kratom as medicine.
- Substituted kratom for opium.
- Used kratom during religious ceremonies.
Low doses of kratom can make you more alert, and higher doses can cause:
- Decreased pain.
- Pleasure.
- Sedation.
The mechanism of action seems to be that two of the compounds in kratom (mitragynine and 7-hydroxymitragynine) interact with opioid receptors in your brain.
Kratom is thus being promoted as a pain remedy that is safer than traditional opioids, an effective addiction withdrawal aid, and a pleasurable recreational tonic. But kratom is, in fact, a dangerous and unregulated drug that can be purchased on the Internet, a habit-forming substance that authorities say can result in opioid-like abuse and death.
The Food and Drug Administration (FDA) warned that kratom possesses the properties of an opioid, thus escalating the government’s effort to slow the usage of this alternative pain reliever. The FDA stated that the number of deaths associated with kratom use has increased. Now further concerns have emerged.
This review enumerates seven outbreaks of kratom (Mitragyna speciosa) product adulteration and contamination in the context of the United States Dietary Supplement Health and Education Act (DSHEA).
At least seven distinct episodes of kratom product contamination or adulteration are known:
- (1) krypton, a kratom product adulterated with O-desmethyltramadol that resulted in at least nine fatal poisonings;
- (2) a suspected case of kratom contamination with hydrocodone and morphine;
- (3) a case of kratom adulteration with phenylethylamine;
- (4) contamination of multiple kratom products with heavy metals;
- (5) contamination of kratom products by multiple Salmonella enterica serotypes;
- (6) exposure of federal agents raiding a synthetic cannabinoid laboratory to kratom alkaloids;
- (7) suspected kratom product adulteration with exogenous 7-hydroxymitragynine.
The authors concluded that inadequate supplement regulation contributed to multiple examples of kratom contamination and adulteration, illustrating the potential for future such episodes involving kratom and other herbal supplements.
I had all but forgotten about these trials until a comment by ‘Mojo’ (thanks Mojo!) reminded me of this article in the JRSM by M.E. Dean. It reviewed these early trials of homeopathy back in 2006. Here are the crucial excerpts:
The homeopath in both trials was a Dr Herrmann, who received a 1-year contract in February 1829 to test homeopathy with the Russian military.3 The first study took place at the Military Hospital in the market town of Tulzyn, in the province of Podolya, Ukraine.4 At the end of 3 months, 164 patients had been admitted, 123 pronounced cured, 18 were convalescing, 18 still sick, and six had died. The homeopathic ward received many gravely ill patients, and the small number of deaths was shown at autopsy to be due to advanced gross pathologies. The results were interesting enough for the Russian government to order Herrmann to the Regional Military Hospital at St Petersburg to take part in a larger trial, supervised by a Dr Gigler. Patients were admitted to an experimental homeopathic ward, for treatment by Herrmann, and comparisons were made with the success rate in the allopathic wards, as happened in Tulzyn. The novelty was Gigler’s inclusion of a ‘no treatment’ ward where patients were not subject to conventional drugging and bleeding, or homeopathic dosing. The untreated patients benefited from baths, tisanes, good nutrition and rest, but also:
‘During this period, the patients were additionally subjects of an innocent deception. In order to deflect the suspicion that they were not being given any medicine, they were prescribed pills made of white breadcrumbs or cocoa, lactose powder or salep infusions, as happened in the homeopathic ward.’3 (page 415)
The ‘no treatment’ patients, in fact, did better than those in both the allopathic and homeopathic wards. The trial had important implications not just for homeopathy but also for the excessive allopathic drugging and bleeding that was prevalent. As a result of the report, homeopathy was banned in Russia for some years, although allopathy was not.
… A well-known opponent of homeopathy, Carl von Seidlitz, witnessed the St Petersburg trial and wrote a hostile report.5 He then conducted a homeopathic drug test in February 1834 at the Naval Hospital in the same city in which healthy nursing staff received homeopathically-prepared vegetable charcoal or placebo in a single-blind cross-over design.6 Within a few months, Armand Trousseau and colleagues were giving placebo pills to their Parisian patients; perhaps in the belief that they were testing homeopathy, and fully aware they were testing a placebo response.7,8 A placebo-controlled homeopathic proving took place in Nuremberg in 1835 and even included a primitive form of random assignment—identical vials of active and placebo treatment were shuffled before distribution.9 Around the same time in England, Sir John Forbes treated a diarrhoea outbreak after dividing his patients into two groups: half received allopathic ‘treatment as usual’ and half got bread pills. He saw no difference in outcome, and when he reported the experiment in 1846 he added that the placebos could just as easily have been homeopathic tablets.10 In 1861, a French doctor gave placebo pills to patients with neurotic symptoms, and his attitude is representative: he called the placebo ‘orthodox homeopathy’, because, as he said, ‘Bread pills or globules of Aconitum 30c or 40c amount to the same thing’.11
References:
Alzheimer’s is a devastating disease against which conventional healthcare has little to offer. No wonder, therefore, that so-called alternative medicine (SCAM) claims to have a wide range of effective treatments. But how good are they really? The present review aimed to explore the role of SCAM in the treatment of Alzheimer’s disease (AD).
Literature searches were conducted using Ovid MEDLINE, CINAHL, Cochrane, and PubMed databases and reference lists up to November 30, 2021. Only randomized clinical trials were included and appraised using the National Institute of Health framework. Data analysis showed that herbs like Gingko Biloba, Melissa Officinalis, Salvia officinalis, Ginseng, and saffron alone or in combination with curcumin, a low-fat diet, NuAD-Trail, and soy lecithin showed significant positive effects on AD. Moreover, the combination of natural and pharmaceuticals has far better effects than only allopathic treatment. The authors concluded that different herbal remedies in combination with FDA approved drugs are effective and more promising in the treatment of AD.
To these findings we need to add a study that is too recent to have been included in the review:
The aim of the randomized clinical trial (RCT) was to investigate the effects of fenugreek seed extract on memory, depression, quality of life, blood pressure, and serum malondialdehyde (MDA) and total antioxidant capacity (TAC) levels in adult AD patients. The study participants included 82 AD patients with mild-to-moderate memory deficits. Patients in the intervention group received 5 cc of fenugreek seed extract for 4 months and subjects in the control group received a placebo. Memory, depression, quality of life, and BP levels, as well as serum MDA and TAC, were assessed before and after the intervention.
There was a significant increase in serum levels of TAC (p < 0.001) and a reduction in serum MDA status (p < 0.001) after 4 months of fenugreek seed extract supplementation. In addition, increasing levels of memory (p < 0.001) and quality of life (p < 0.001), as well as reduction of depression (p = 0.002), systolic BP (p < 0.001), and diastolic BP (p < 0.001) levels were detected in the intervention group compared with baseline.
The authors concluded that Fenugreek seed extract supplementation in AD patients shows promising positive effects on memory, quality of life, BP, and selective oxidative indices levels.
So, there is hope! Some of the evidence is promising but far from convincing. What we need – obviously – is more and better research.
Kourtney Kardashian believes that vaginal health is an important but not sufficiently talked about part of women’s well-being. So, why not make a bit of money on the subject? A recent article explains in more detail:
The reality TV star recently launched a vitamin sweet called Lemme Purr to boost the health of your vagina. On her Instagram channel, she says these gummies use pineapple, vitamin C, and probiotics to target vaginal health and pH levels that “support freshness and taste”.
Kourtney continues with the selling words “Give your vagina the sweet treat it deserves (and turn it into a sweet treat)”. One of the claims she makes is that the vitamin sweet supports a healthy vaginal microflora. As a researcher specialising in the role of vaginal microflora for women’s health, I was curious and wanted to find out which active ingredients this claim is based on.
Lemme Purr contains pineapple extract (probably for its taste), vitamin C (not really needed if you have a balanced diet), and a clinically tested probiotic (Bacillus coagulans). According to the product description, the probiotic has been shown in clinical studies to support vaginal health, freshness, and odour. This surprised me – I should know about these studies and effects as this is my primary research field.
A healthy vaginal microflora is composed of lactobacilli that keep the pH low and protect us from infections. My colleagues and I never identified Bacillus coagulans as being important for the health of vaginas, even though we have analysed thousands of samples during recent years. From other research groups and our own results, we know that Lactobacillus crispatus is the species that is associated with vaginal health and female fertility.
As I may have missed something important, I immediately checked what has been published on that probiotic in scientific journals. I found one systematic review and meta-analysis (a type of analysis where many individual studies are taken together) that mentions Bacillus coagulans. Apparently, it may improve stool frequency and symptoms of constipation, although the authors conclude that more research is needed.
On the topic of women’s vaginal health, I could only find a single study. There, 70 women with vaginal discomfort reported symptom relief after direct vaginal administration of the probiotic. There is nothing published on the oral administration of the probiotic that could support the claims made by Kourtney.
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I was not entirely sure where women are supposed to put Kourtney’s gummies. So, I watched a video where Kourtney applies one of these items herself. I am very pleased to report that, in the video, she put one in her mouth!
After this relief, I ran a few Medline searches to get an impression of what the evidence tells us. In contrast to the author of the above article, I found plenty of literature on the subject and quite a few clinical trials. So, maybe Kourtney is on to something?
Somehow, I doubt it. I did not find a study with her product. Call me a skeptic, but I do get the feeling after looking at Kourtney’s website that she is much more interested in money than vaginal health.
A recent article in ‘The Lancet Regional Health‘ emphasized the “need for reimagining India’s health system and the importance of an inclusive approach for Universal Health Coverage” by employing traditional medicine, including homeopathy. This prompted a response by Siddhesh Zadey that I consider worthy of reproducing here in abbreviated form:
… Since the first trial conducted in 1835 that questioned homeopathy’s efficacy, multiple randomized controlled trials (RCTs) and other studies compiled in several systematic reviews and meta-analyses have shown that there is no reliable and clinically significant effect of non-individualized or individualized homeopathic treatments across disease conditions ranging from irritable bowel syndrome in adults to acute respiratory tract infections in children when compared to placebo or other treatments. Even reviews that support homeopathy’s efficacy consistently caution about low quality of evidence and raise questions on its clinical use. The most recent analysis of reporting bias in homeopathic trials depicted problematic trial conduction practices that further obscure reliability and validity of evidence. Homeopathic treatments have also been linked to aggravations and non-fatal and fatal adverse events.
The Lancet has previously published on another kind of harm that uptake of homeopathy encourages in India: delay to evidence-based clinical care that can lead to fatality. Authors have pointed out that evidence for some of the alternative systems of medicine may not come from RCTs. I agree that more appropriate study designs and analytical techniques are needed for carefully studying individualized treatment paradigms. However, the need for agreement on some consistent form of evidence synthesis and empirical testing across diverse disciplines cannot be discounted. Several other disciplines including psychology, economics, community health, implementation science, and public policy have adopted RCTs and related study designs and have passed the empirical tests of efficacy. Moreover, the ideas around mechanism of action in case of homeopathy still remain controversial and lack evidence after over a century. On the contrary, biochemical, molecular, and physiological mechanistic evidence supporting allopathic treatments has grown abundantly in the same period.
Owing to lack of evidence on its efficacy and safety, the World Health Organization had previously warned against the use of homeopathic treatments for severe diseases. Additionally, multiple countries, including Germany where the practice originated, have initiated mechanisms that discourage uptake of homeopathy while others are considering banning it. Homeopathy doesn’t work, could be harmful, and is not a part of Indian traditional medicine. While we should welcome pluralistic approaches towards UHC, we need to drop homeopathy.
(for references, see original text)
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Yes, in the name of progress and in the interest of patients, “we need to drop homeopathy” (not just in India but everywhere). I quite agree!
In my very small way, I tried to issue challenges to those who believe in unbelievable stuff before, e.g.:
- A CHALLENGE FOR ALL HOMEOPATHS OF THE WORLD
- My new challenge to the ‘defenders of the homeopathic realm’: name treatments that are as useless as homeopathy
- My challenge to the homeopaths of this world
- Exercise improves cognitive function + a challenge to fans of alternative medicine
- MORE GOOD THAN HARM? I herewith challenge my critics
But I never had any success; no contenders ever came forward. One reason was, of course, that I did not offer much by way of an award. So, in case you have been waiting for the big one, the one to get rich by, this is your chance:
The Los Angeles-based Center for Inquiry Investigations Group (CFIIG) $250,000 Paranormal Challenge is the largest prize of its kind in the world—or at least it was.
It has been announced that the science-based skeptics’ organization has now raised the stakes for those making wild claims about extraordinary powers, doubling the prize offer to $500,000 for anyone who can demonstrate paranormal abilities under scientific test conditions.
“A quarter-million dollars just doesn’t go as far as it used to, apparently,” said CFIIG founder and chairman James Underdown. “This is our way of creating extra incentive for people who make farfetched claims to put up or shut up.”
CFIIG has been offering money for definitive proof of “superpowers” for more than twenty-three years; the Paranormal Challenge was modeled after the James Randi Educational Organization’s Million Dollar Challenge, which ceased operations in 2016.
Underdown says CFIIG typically receives more than 100 applications and administers roughly half a dozen tests each year. Among those who’ve been tested are self-proclaimed telepaths, dowsers, clairaudients, healers, remote viewers, and telekinetics. To date, no applicant has ever passed even the first portion of a test, and the prize money has never been claimed.
Underdown believes this should come as no surprise. “We don’t anticipate awarding this money, because we watch these folks pretty closely,” Underdown says. “Science recognizes neither the paranormal nor the supernatural. Anyone with the ability to provably demonstrate why it should would have certainly earned the prize by now.”
Anyone interested in applying for CFIIG’s Paranormal Challenge may apply online to begin the process. Applicants must pass a two-part test of their alleged ability. The tests must be performed in a controlled environment to prevent trickery, and any expenses incurred during testing must be borne by the applicant.
________________
How about it?
Don’t you feel tempted?
Dana?
Heinrich?
Anyone?
This review investigated the characteristics, hotspots, and frontiers of global scientific output in acupuncture research for chronic pain over the past decade. the authors retrieved publications on acupuncture for chronic pain published from 2011 to 2022 from the Science Citation Index Expanded (SCI-expanded) of the Web of Science Core Collection (WoSCC). The co-occurrence relationships of journals/countries/institutions/authors/keywords were performed using VOSviewer V6.1.2, and CiteSpace V1.6.18 analyzed the clustering and burst analysis of keywords and co-cited references.
A total of 1616 articles were retrieved. The results showed that:
- the number of annual publications on acupuncture for chronic pain has increased over time;
- the main types of literature are original articles (1091 articles, 67.5 %) and review articles (351 articles, 21.7 %);
- China had the most publications (598 articles, 37 %), with Beijing University of Traditional Chinese Medicine (93 articles, 5.8 %);
- Evidence-based Complementary and Alternative Medicine ranked first (169 articles, 10.45 %) as the most prolific affiliate and journal, respectively;
- Liang FR was the most productive author (43 articles);
- the article published by Vickers Andrew J in 2012 had the highest number of citations (625 citations).
Recently, “acupuncture” and “pain” appeared most frequently. The hot topics in acupuncture for chronic pain based on keywords clustering analysis were experimental design, hot diseases, interventions, and mechanism studies. According to burst analysis, the main research frontiers were functional connectivity (FC), depression, and risk.
The authors concluded that this study provides an in-depth perspective on acupuncture for chronic pain studies, revealing pivotal points, research hotspots, and research trends. Valuable ideas are provided for future research activities.
I might disagree with the authors’ conclusion and would argue that they have demonstrated that:
- the acupuncture literature is dominated by China, which is concerning because we know that 1) these studies are of poor quality, 2) never report negative findings, and 3) are often fabricated;
- the articles tend to be published in journals that are more than a little suspect.
As we have seen recently, the reliable evidence that acupuncture remains effective is wafer-thin. Therefore, I feel that we are currently being misled by a flurry of rubbish publications that have one main aim: to distract from the fact that acupuncture might be nonsense.
I have featured the ‘Münster Circle‘ before. The reason why I do it again today is that we have just published a new Memorandum entitled HOMEOPATHY IN THE PHARMACY. Here is its summary which I translated into English:
Due to questionable regulations in German pharmaceutical law, homeopathic medicines can be given the status of a medicinal product without having to provide valid proof of efficacy. As medicinal products, these preparations may then only be dispensed to customers in pharmacies, which, however, creates an obligation to also supply them on request or prescription. Many pharmacies go far beyond this and advertise homeopathic medicines as a useful therapy option by advertising them prominently in the window. In addition, customers are recommended to use them, corresponding lecture events are supported, and much more. Often, homeopathic preparations are even produced according to pharmacies’ own formulations and marketed under their own name.
For pharmacists and pharmaceutical technical assistants (PTAs) to perform their important task in the proper supply of medicines to the population, they must have successfully completed a scientific study of pharmacy or state-regulated training. This is to ensure that customers are informed and properly advised about their medicines according to the current state of knowledge.
After successfully completing their training or studies, PTAs and pharmacists are undoubtedly able to recognize that homeopathic medicines cannot be effective beyond placebo. They do not have any significant content of active ingredients – if, for example, the high potencies that are considered to be particularly effective still have any active ingredients at all. Consequently, pharmacists and PTAs act against their better knowledge to the detriment of their customers if they create the impression through their actions that homeopathic medicines represent a sensible therapeutic option and customers are thereby encouraged to buy and use them.
Although homeopathics have no potential for direct harm in the absence of relevant amounts of pharmacologically active substances in the preparations, their distribution should nevertheless be viewed critically. The use of homeopathy can mean losing valuable time and delaying the start of effective therapy. It is often accompanied by criticism, even rejection of scientifically oriented medicine and public health, for example when homeopathy is presented as the antithesis to a threatening “pharmaceutical mafia”.
The Münster Circle appeals to pharmacists and PTAs to stop advertising homeopathic medicines as an effective therapeutic option, to stop producing and marketing them themselves, and to advise their customers that homeopathic preparations are not more effective than placebo. The professional organizations of pharmacists and other providers of further training are called upon to no longer offer courses on homeopathy – except for convincingly refuting the often abstruse claims of the supporters.
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I have pointed out for at least 20 years now that pharmacists have an ethical duty toward their clients. And this duty does not involve misleading them and selling them useless homeopathic remedies. On the contrary, it involves advising them on the basis of the best existing evidence.
When I started writing and talking about this, pharmacists seemed quite interested (or perhaps just amused?). They invited me to give lectures, I published an entire series of articles in the PJ, etc. Of late, they seem to be fed up with hearing this message and the invitations have well and truly stopped.
They may be frustrated with my message – but not as frustrated as I am with their inertia. In my view, it is nothing short of a scandal that homeopathic remedies and similarly bogus treatments still feature in pharmacies across the globe.
