The Center for Science in the Public Interest*** (CSPI) announced its agreement with Boiron to improve the labeling on the homeopathic products manufactured by Boiron and sold under the Boiron or other private label brands. The agreement covers the labeling for over 50 homeopathic products.
On Boiron’s Oscillococcinum and two similar products, Boiron will substantially increase the prominence of the words “Homeopathic Medicine” on the front of the box and the disclaimer on the back of the box that says the product’s uses have not been evaluated by the Food and Drug Administration (FDA). These changes will make it easier for consumers to identify that the products are homeopathic products, and are not FDA approved over-the-counter medicines.
For all of the other homeopathic products manufactured by Boiron, consumers will receive much more information on the packages. In addition to increasing the prominence of the words “Homeopathic Medicine,” a new disclaimer in large and contrasting font will be added to the back of the package (endorsed by the American Association of Homeopathic Pharmacists) stating: “Claims based on traditional homeopathic practice, not accepted medical evidence, and not FDA evaluated.”…
“The labeling changes that Boiron has agreed to on all the products covered by the agreement will help consumers more clearly identify that these are homeopathic products and are not FDA approved over-the-counter medicines that have been scientifically proven to be safe and effective,” said CSPI litigation director Lisa Mankofsky. “In addition, the vast majority of the covered homeopathic products will bear a disclaimer clarifying that they are based on traditional homeopathic practice, not accepted medical evidence, and not FDA evaluated. We think that consumers will find this labeling change important when choosing a remedy. We encourage other manufacturers to similarly make their labels more transparent and clear for consumers.”
Clearly a step into the right direction!
But it’s a small step only. It is a long way short of what Dylan Evans suggestied in his book ‘Placebo‘, first published in 2004:
Warning: this product is a placebo. It will work only if you believe in homeopathy, and only for certain conditions such as pain and depression. Even then, it is not likely to be as powerful as orthodox drugs. You may get fewer side-effects from this treatment than from a drug, but you will probably also get less benefit.
***The Center for Science in the Public Interest is perhaps the oldest independent, science-based consumer advocacy organization with an impressive record of accomplishments and a clear and ambitious agenda for improving the food system to support healthy eating.
Guest post by Kevin Smith
A family member of my household has been aghast to receive in the post yesterday a letter suggesting that, if they develop symptoms of coronavirus, they should take homeopathic remedies.
If this had been from some quack pharmacy doing a random mailshot, it would have been bad enough. But, astonishingly, it has come from the NHS! The letter is not on headed notepaper and is unsigned (it is in the format of a ‘factsheet’), thus is doesn’t contain the sender’s address; however, the envelope’s address label displays both my family member’s NHS number and the name of their GP practice. Moreover, the franking refers to a PO Box number that is owned by the NHS teaching hospital in our area. So it has certainly come from the NHS.
I believe that the family member who received it has been targeted because, in the past, a GP referral had been made for them to consult an NHS homeopath at this hospital.
Yes, very sadly, homeopaths have managed to exist within the NHS in the local area. I had assumed that, with the NHS recently cracking down on homeopathy, such quacks would have been excised – but this looks not to be the case, given the sending of this letter.
Here’s the text of the letter. Read it and see if you are as astonished – indeed as enraged – as I certainly am, and as is the family member to whom it was sent.
Guidance on Coronavirus (updated)
Daily probiotics, Regular handwashing, Stat dose of Covid-19 nosode 200c if it becomes available, Vit C & Zinc supplementation
Stress avoidance (Constitutional homeopathic prescribing & lifestyle)
Avoid incidental paracetamol use (ie no symptomatics for stress headaches etc)
Add Ecchinacea, tincture 5 drops in water, twice daily, for no more than 4 consecutive days
Prodromal (ie before symptoms emerge):
Avoidance of incidental paracetamol use.
Stop work. Rest. Isolation. (+ Gelsemium 2 hourly, and/or Covid-19 nosode if it becomes available)
If you develop symptoms of Coronavirus: then avoid Paracetamol, Ibuprofen or Aspirin and take one of the following every hour, sucked in the mouth:
Camphora 30c (tablets or pillules) chills, cough, changeable fever
Bryonia 30c (tablets or pillules) fever, painful dry cough
Arsenicum album 30c (tablets or pillules) washed out feeling, chilliness, restless or agitated
Veratrum album 30c (diarrhoea, chills and fatigue)
Bryonia and Camphora are the most commonly indicated for Covid-19 from experience so far. Order them directly from one of the UK Homeopathic Pharmacies listed.
7 grammes / 8 grammes = 60 tablets or pillules
14 grammes / 15 grammes = 120 tablets or pillules
That’s the front page of the letter. Overleaf, it lists 11 homeopathic suppliers (across the UK), complete with contact details.
Additionally, the letter was accompanied by a pink slip, containing the following text:
If you find that you need to use any of the treatments outlined here, it is very important that you provide detailed feedback to us, so that we can adapt and improve our advice to others if necessary. Email (feedback only) firstname.lastname@example.org
What to make of this communication? Remember, this was from the NHS! What to do about it? COMMENTS WELCOME!
I am currently studying DD Palmer’s TEXTBOOK OF THE SCIENCE, ART, AND PHILOSOPHY OF CHIROPRACTIC. It is a 1 000 page volume full of ignorance, repetition, allegation, pomp, overstatement and utter nonsense. I strongly advise everyone to stay well clear of it.
However, skimming through this accumulation of flimflam, I was repeatedly reminded of the origin of the anti-vax stance to which so many chiropractors still subscribe. Yes, I did mention this before: Far too many chiropractors believe that vaccinations do not have a positive effect on public health.
In his book, originally published in 1910, Palmer tried (unsuccessfully, I fear) to explain the basic principles of chiropractic. Most chiropractors would have read at least some of this ‘textbook’. It therefore stands to reason that Palmer’s views still colour those of today’s chiropractors.
Here are a few quotes about immunisation directly from the book:
- On May 14, 1796, Jenner first committed the crime of vaccination…
- No person is improved by being poisoned by either smallpox or vaccination.
- [Vaccination] is the biggest piece of quackery and criminal outrage ever foisted upon any civilized people. Medical ignorance by which criminal outrages are murdering our children all over this country…
- Vaccination and inoculation are pathological; Chiropractic is physiological.
- Compulsory vaccination is an outrage and a gross interference with the liberty of the people in a land of freedom.
The question is, where did Palmer get this from? What is the reason for his anti-vax attitude? Reading the book, I get the impression that it might have been based on two main pillars: 1) his amazing ignorance and blinkered view on most things and 2) his deep antipathy of conventional medicine. To show you a little of the latter, here are just two further quotes:
- It is a pity that the medical profession are possessed of arrogance instead of liberality; that instead of encouraging and fostering advanced ideas, they stifle and discourage advancement; that they only adopt advanced ideas when they are compelled to do so by public opinion.
- The physician believes in his prescriptions; the pharmacist in the hidden power of drugs – superstitious therapeutics.
To this, I am tempted to add: … and chiropractors believe in the drivel written by DD Palmer over 100 years ago.
If homeopaths can make the Berlin Wall into a homeopathic remedy, they can use anything!
That’s true; I am not aware of any material that could not be used by clever manufacturers of homeopathics to make a fast buck. But I did not think that they would venture as far as visiting the vagina. This website taught me that I was wrong. VAGIN is a homeopathic remedy made by Boiron out of vaginal mucosa (tempting to make all sorts of bad taste jokes, but I will resist):
4C 5C 7C 9C 12C 15C 30C same as 4CH 5CH 7CH 9CH 12CH 15CH 30CH
Dilutants with known effect: lactose, saccharose
Do not use
Do not use the homeopatic remedy if you are allergic to some sugars
To be taken
The Muqueuse Vaginale pillules have to be taken orally
Instructions for Use of Muqueuse Vaginale
For adults and children over 6 years, allow to melt under the tongue.
For children under 6 years, dissolve in a small quantity of water.
Tube of homoeopathic pillules.
Approximately 80 to 90 pills per tube.
About Laboratoires Boiron
Laboratoires Boiron, a French pharmaceutical company, produces and distributes homoeopathic drug preparations both within France and overseas.
So far, so good!
But what is VAGIN good for?
I tried to find out, but unfortunately was not very successful. To be absolutely honest, I haven’t got a clue. I suspect, it might be good for Boiron’s profits, but for what ailments do homeopaths recommend VAGIN?
Perhaps someone could enlighten me?
Homeopathy has had a long and profitable ride in France; nowhere else in Europe is it more popular, nowhere in Europe are the profit margins higher, and nowhere have I seen pharmacists pushing so hard to earn a few extra Euros on useless homeopathic remedies.
But, since a few months, sceptics have started to raise their voices and object to homeopathic reimbursement (currently at the rate of 30%) and to homeopathy in general.
- A group of doctors protested against homeopathy by publishing an open letter in ‘Le Figaro’.
- The French Academies of Medicine and Pharmacy published a report confirming the lack of evidence for homeopathy.
- The medical school in Lille suspended its degree in homeopathy.
The French health secretary, the oncologist Dr Agnès Buzyn, reacted wisely, in my view. She initially stated that the effect of homeopathy is ‘probably a placebo effect‘. Subsequently, she asked the regulator, La Haute Autorite de Sante (HAS), to look into the matter and prepare a full analysis of the evidence. This report has now been published.
An article in ‘FRANCE INFO’ reports that HAS found no good evidence in support of the ~ 1 200 homeopathic remedies currently on the French market. The document is currently being considered by Dr Buzyn who will announce her decision about reimbursement in June. It is considered to be highly likely that she will stop reimbursement.
If so, consumers will soon have to pay in full for homeopathic preparations out of their own pocket. In addition, they would have to pay the VAT, and it is foreseeable that this change would signal the end of the French consumers’ love affair with homeopathy. This development is bound to seriously hurt Boiron, the world’s largest producer of homeopathics. The firm has already announced that they suspended its trading on the stock market and is now arguing that the move would endanger its sizable workforce.
The question I now ask myself is whether Boiron is powerful enough to do something about all this. Personally, I have been impressed by the rational approach of Dr Buzyn. She will no doubt see through Boiron’s bogus argument of saving a form of obsolete quackery in the name of employment. Therefore, I expect that the days of homeopathy’s reimbursement in France are counted.
(For those who can read French, I add the original ‘ FRANCE INFO’ article below.)
Avis définitif en juin
Cet avis avait été réclamé par la ministre de la Santé il y a plusieurs mois face à la montée de la polémique entre médecins pro et anti-homéopathie. 124 médecins avaient relancé le débat l’an dernier en qualifiant les homéopathes de “charlatans”.
Désormais, lors d’une phase contradictoire, les laboratoires vont pouvoir répondre à la HAS, qui rendra son avis définitif en juin. La ministre de la Santé, Agnès Buzyn, avait par le passé annoncé qu’elle se rangerait à cet avis.
1 000 emplois menacés, selon Boiron
Les pro-homéopathie eux, s’insurgent. Selon eux, les granules ne coûtent que 130 millions d’euros par an à la Sécurité sociale, contre 20 milliards pour les médicaments classiques. Et il existe d’après eux, au minimum, un effet placebo. Pour les laboratoires Boiron, leader mondial du secteur, si l’homéopathie n’est plus remboursée, ce sont 1 000 emplois qui sont directement menacés.
Par ailleurs, dans un communiqué commun, trois laboratoires (Boiron, Lehning et Weleda) s’émeuvent de découvrir à travers un média la teneur d’un avis d’une agence indépendante qui devait être tenu confidentiel. Les laboratoires Boiron précisent à franceinfo qu’ils n’ont pas encore reçu le projet d’avis de la Haute autorité de santé. Boiron, entreprise française cotée, annonce “suspendre” son cours de bourse.
Samuel Hahnemann invented homeopathy about 200 years ago. His placebos were better than (or not as bad as) the ‘heroic’ medicine of his time which frequently was more dangerous than the disease it aimed to cure. Thus, homeopathy took Germany by storm. When, about 100 years ago, medicine finally became scientific and was able to offer more and more effective treatments, the popularity of homeopathy began to wane. Yet, before its natural demise, during the Third Reich, it received a significant boost from Nazi-greats such as Hess and Himmler. After this nightmare was over, German homeopathy went into another slow decline. But when the New Age movement and the current boom in alternative medicine reached Germany, homeopathy seemed to thrive once again.
In the 1990s evidence-based medicine (EBM) grew into one of the central concepts of medicine. In Germany, however, EBM had a relatively hard time to get established. This might be one of the reasons why homeopathy continued to prosper, despite the arrival of ever clearer evidence that highly diluted homeopathic remedies are pure placebos. While, in the UK, we had an increasingly lively debate about the uselessness of homeopathy, Germany remained the promised land of homeopathy. Sales figures of homeopathics continued to increase steadily and reached a level of about half a billion Euros per annum.
The golden age of German homeopathy had dawned:
- The media, often sponsored by homeopathic interest groups, kept on promoting homeopathy largely unopposed.
- The mighty Carstens Stiftung worked tirelessly to promote it.
- Homeopathy became established in many medical schools.
- Homeopathy was available and often advertised in almost all pharmacies.
- The public was convinced that homeopathy worked.
- The Heilpraktiker adopted homeopathy fully.
- The medical and other conventional healthcare professions embraced it to a large degree.
- The adult education institutes (Volkshochschulen) offered courses.
- Politicians were squarely on the side of homeopathy,
- Health insurances, paid for it.
Of course, there were also some (and always had been) opposing voiced and organisations, such as the GWUP (the German sceptic organisation), for example. But somehow, they remained relatively low-key. When, every now and then, courageous journalists dared to think of a critical take on homeopathy, they had to search far and wide to find a German-speaking expert who was willing or able to tell them the truth: that homeopathy is neither biologically plausible nor evidence-based and therefore an expensive, potentially harmful waste of money that makes a mockery of EBM. During this period, journalists (far too) often asked me for some critical comments. I hardly ever published my research in German, but they nevertheless would find me via my Medline-listed papers. I often felt like a very lone voice in a German desert.
For the German homeopathic industry, I evidently was more than just a lone voice. Unbeknown to me, they clubbed together and financed a PR-man/journalist (at the tune of Euro 30 000/year) to write as many defamatory articles about me as he could muster. First, I was bewildered by his activity, then I tried to communicate with him (only to get mis-quoted), and eventually I ignored his writings. Yet, a German investigative journalist found Fritzsche’s one-sided activities offensive and started investigating. His research and subsequent article disclosed the fact that he was being paid by the homeopathic industry. Once I learn about this scandal, I wrote to some of the financiers directly and asked for an explanation. As a result, they discontinued their sponsorship. Shortly afterwards, Fritzsche committed suicide.
At heart, I have always been an optimist and strongly believe that in medicine the truth, in this case the evidence, will always prevail, no matter what obstacles others might put in its way. Recent developments seem to suggest that I might be right.
In the last few years, several individuals in Germany have, from entirely different angles, taken a fresh look at the evidence on homeopathy and found it to be desperately wanting. Independent of each other, they published articles and books about their research and insights. Here are 5 examples:
In Sachen Homöopathie: Eine Beweisaufnahme, Norbert Aust, 2013
Homöopathie neu gedacht: Was Patienten wirklich hilft, Natalie Grams, 2015
Inevitably, these individuals came into contact with each other and subsequently founded several working-groups to discuss their concerns and coordinate their activities. Thus the INH and the Muensteraner Kreis were born. So, now we have at least three overlapping groups of enthusiastic, multidisciplinary experts who voluntarily work towards informing the German public that paying for homeopathy out of public funds is unethical, nonsensical and not in the interest of progress:
- the GWUP,
- the INH
- and the Muensteraner Kreis.
No wonder then, that the German homeopathic industry and other interested parties got worried. When they realised that (presumably due to the work of these altruistic enthusiasts) the sales figures of homeopathics in Germany had, for the first time since many years, started declining, they panicked.
Their reaction was, as far as I can see, similar to their previous response to criticism: they started a media campaign in an attempt to sway public opinion. And just like before, they have taken to employing PR-people who currently spend their time defaming all individuals voicing criticism of homeopathy in Germany. Their prime targets are those experts who are most exposed to activities of responsibly informing the public about homeopathy via lectures, publications social media, etc. All of us currently receive floods of attack, insults and libellous defamations. As before (innovation does not seem to be a hallmark of homeopathy), these attacks relate to claims that:
- we are incompetent,
- we do not care about the welfare of patients,
- we are habitual liars,
- we are on the payroll of the pharmaceutical industry,
- we aim at limiting patient choice,
- we do what we do because we crave the limelight.
So, what is going to happen?
I cannot read tea leaves but am nevertheless sure of a few things:
- The German homeopathy lobby will not easily give up; after all, they have half a billion Euros per year to lose.
- They will not argue on the basis of science or evidence, because they know that neither are in their favour.
- They will fight dirty and try to defame everyone who stands in their way.
- They will use their political influence and their considerable financial power.
AND YET THEY WILL LOSE!
Not because we are so well organised or have great resources – in fact, as far as I can see, we have none – but because, in medicine, the evidence is invincible and will eventually prevail. Progress might be delayed, but it cannot be halted by those who cling to an obsolete dogma.
The UK Royal Pharmaceutical Society have published a quick reference guide on homeopathy. In it, they make the following 5 ‘key points’:
- The Royal Pharmaceutical Society (RPS) does not endorse homeopathy as a form of treatment because there is no scientific basis for homeopathy nor any evidence to support the clinical efficacy of homeopathic products beyond a placebo effect.
- The RPS does not support the prescribing of homeopathic products on the NHS.
- Pharmacists should ensure, wherever possible, that patients do not stop taking their prescribed conventional medication, if they are taking or are considering taking a homeopathic product.
- Pharmacists must be aware that patients requesting homeopathic products may have serious underlying undiagnosed medical conditions which may require referral to another healthcare professional.
- Pharmacists must advise patients considering a homeopathic product about their lack of efficacy beyond that of a placebo.
This publication is a few months old, but I only saw it recently. It could not be clearer and it is much more to the point than the General Pharmaceutical Council’s ‘Standards for Pharmacy Professionals‘ which state:
People receive safe and effective care when pharmacy professionals reflect on the application of their knowledge and skills and keep them up-to-date, including using evidence in their decision making. A pharmacy professional’s knowledge and skills must develop over the course of their career to reflect the changing nature of healthcare, the population they provide care to and the roles they carry out. There are a number of ways to meet this standard and below are examples of the attitudes and behaviours expected.
People receive safe and effective care when pharmacy professionals:
- recognise and work within the limits of their knowledge and skills, and refer to others when needed
- use their skills and knowledge, including up-to-date evidence, to deliver care and improve the quality of care they provide
- carry out a range of continuing professional development (CPD) activities relevant to their practice
- record their development activities to demonstrate that their knowledge and skills are up to date
- use a variety of methods to regularly monitor and reflect on their practice, skills and knowledge
The two statements together should suffice to finally get some sense into UK pharmacies when it comes to the sale of homeopathic remedies. What is needed now, I think, is an (under-cover?) investigation to see how many UK community pharmacists abide by this guidance.
If anyone has the means to conduct it, I would be delighted to advise them on the best methodology.
On 4 September 2018, during the FIP (78th FIP World Congress of Pharmacy and Pharmaceutical Sciences), a meeting took place intended to give an opportunity to practising pharmacists to voice their opinions on the question whether pharmacies should stop selling homeopathic products. Attendees were provided with voting materials to allow them to express their views in a spontaneous and powerful manner, and for FIP to ascertain genuine opinions about this important matter. The debate and subsequent voting is likely to influence FIP policymaking and statement formulation. Here is the outline of the meeting:
12:30 – 12:34 Introduction by the chairs
- 12:34 – 12:57 For the motion
Geoff Tucker (University of Sheffield, UK)
- 12:57 – 13:20 Against the motion
Christine Glover (Glover’s Integrated Healthcare, UK)
- 13:20 – 13:25 Ethical considerations related to homeopathy
Betty Chaar (The University of Sydney, Australia)
- 13:25 – 13:35 Responses and summary
Facilitator: Andy Gray (University of KwaZulu Natal, South Africa)
- Against the motion
Christine Glover (Glover’s Integrated Healthcare, UK)
- For the motion
Geoff Tucker (University of Sheffield, UK)
- Against the motion
- 13:35 -14:00 Open forum – Questions from the audience with speakers and chairs as panel/ Vote and concluding comments
The German ‘Pharmazeutische Zeitung‘ just published a report about the outcome of the meeting:
“Bei der Abstimmung im Anschluss sprachen sich fast zwei Drittel der im Auditorium anwesenden Pharmazeuten gegen eine Distribution von homöopathischen Produkten durch Apotheken aus. Mehr als ein Drittel stimmte für den Erhalt der Produkte in den Apotheken. Das Ergebnis habe keine bindende Wirkung für den Entscheidungsprozess des FIP, machte der Moderator der Sitzung, Andy Gray von der Universität KwaZulu Natal in Südafrika, deutlich. Es gebe aber einen Hinweis, in welche Richtung sich die Organisation orientieren sollte. (ch).”
In plain English: two thirds voted for the motion and against homeopathic products remaining on sale in pharmacies. The vote has, however, no binding effect on FIP policy. It is nevertheless likely to determine the direction in which FIP will decide.
I think this is long-overdue (I have been trying to persuade pharmacists to do something like this since ~15 years). I now applaud the FIP for raising the issue. Bravo!
The vote needs to be translated into policy.
Other healthcare professionals – not least doctors – must follow suit.
A few days ago, I published an article in the ‘Sueddeutsche Zeitung’ (a truly rare event, as I have never done this before) where I argued that German pharmacists should consider stopping the sale of homeopathic remedies. It violates their ethical code, I suggested.
While this discussion has been going on for a while in the UK (British pharmacists have stopped inviting me to their gatherings because I get on their nerves with banging on about this!), it is relatively novel in Germany.
After I had submitted my copy to the SZ, an article was published which is highly relevant to this subject. Here I first copy an extract of the German original, and below I try to briefly explain its content to those who do not read German.
In vielen Apotheken werden Kunden nicht hinreichend gut zu Homöopathika beraten. Zu diesem Ergebnis kommt Professor Tilmann Betsch, an der Universität Erfurt Leiter der Professur für Sozial-, Organisations- und Wirtschaftspsychologie, der mit seinem Team 100 zufällig ausgewählte Apotheken in Stuttgart, Erfurt, Leipzig und Frankfurt auf Herz und Nieren geprüft hat. Im Mittelpunkt der Kundengespräche stand eine Beratung zu einem erkälteten Familienmitglied.
“Zum einen zeigen unsere Ergebnisse, dass im Falle eines grippalen Infektes die überwiegende Mehrzahl von ihnen zu schulmedizinischen Präparaten rät, die mit hoher Wahrscheinlichkeit zu einer Linderung der Symptome führen”, erläutert Betsch. Was die Wirkung von Homöopathika betreffe, so zeichne das Untersuchungsergebnis ein eher düsteres Bild, ergänzt er. Denn in nur fünf Prozent aller Beratungsgespräche sei gesagt worden, dass es für die Wirkung von Homöopathie keine wissenschaftlichen Belege gäbe. In 30 Prozent sei dagegen behauptet worden, die Wirkung von Homöopathie sei entweder in Studien nachgewiesen oder ergebe sich aus dem Erfahrungswissen.
“Nach den Leitlinien der Bundesapothekenkammer soll jedoch die Beurteilung der Wirksamkeit von Präparaten nach pharmakologisch-toxikologischen Kriterien erfolgen. Zumindest was die Begründung ihrer Empfehlungen betrifft, folgte die überwiegende Mehrheit der von uns befragten Apotheker diesen Leitlinien nicht”, so Betschs Fazit. Während die Empfehlungen der Apotheker in der Regel nachweislich wirksame Medikamente enthalten hätten, habe sich ihr Wissen über die Wirkung von Homöopathie mehrheitlich nicht von Laien-Meinungen unterschieden.
Professor Tilmann Betsch has conducted a study showing that German pharmacists fail their customers when advising them on homeopathy. His team went under cover as patients with flue-like symptoms to 100 randomly selected pharmacists. Only 5% of the pharmacists admitted that homeopathics have no proven efficacy, while 30% claimed homeopathics have been proven to work in studies and through experience. This behaviour, Betsch explains, violates the current guidelines for pharmacists.
I am delighted with these findings; they confirm my arguments perfectly.
Since, in Germany, homeopathics are sold only in pharmacies, German pharmacists have a pivotal role here. They are ethically bound to inform their customers based on the current best evidence. So, in my day-dreams, I imagine a dialogue between a customer and an ethical pharmacist:
CUSTOMER: I have a flu, is there a homeopathic remedy against it?
PHARMACIST: Yes, there is.
CUSTOMER: Can I have it please?
PHARMACIST: If you insist; but I must warn you: it has been shown not to work, and there is absolutely nothing in it that could possibly work.
CUSTOMER: What? Why do you sell it then?
PHARMACIST: Because some people like it.
CUSTOMER: Even though it does not work?
CUSTOMER: Is it expensive?
CUSTOMER: And some people still buy it?
CUSTOMER: Well, not I! I am not a fool. But thank you for your honest information. Can I have something else that alleviates my symptoms?
PHARMACIST: With pleasure!
The fate of homeopathy in Germany is largely in the hands of pharmacists, it seems.
But, is it in good, ethical hands? Is there hope that progress can be made?
We will see – so far, I have heard of just one!!! pharmacy that has stopped displaying homeopathics on its shelves.
I have written about the ethics of pharmacists selling homeopathic preparations pretending they are effective medicines often – not just on this blog, but also in medical journals (see for instance here and here) and in our recent book. So, maybe I should give it a rest?
I believe that the issue is far too important not to remain silent about it.
A recent article in the ‘Australian Journal of pharmacy’ caught my eye. As it makes a new and relevant point, I will quote some short excerpts for you:
One of the greatest criticisms pharmacists face is the ranging of homeopathic products in pharmacies. It is difficult to deny that ranging homeopathic products provides a level of legitimacy to these products that they do not deserve.
Conclusive evidence now exists  that homeopathy does not work. This is different from a lack of evidence for an effect; this is specific evidence that shows that this modality cannot and does not provide any of the purported benefits or mechanisms of action.
This evidence for lack of effect is important, due to the ethical responsibilities of pharmacists to provide evidence-based medicine. Specifically, from the Pharmaceutical Society of Australia’s Code of Ethics :
Care Principle 1 g)
Before recommending a therapeutic product, considers available evidence and supports the patient to make an informed choice and only supplies a product when satisfied that it is appropriate and the person understands how to use it correctly.
It is not possible to adhere to this principle while also selling homeopathic and other non-EBM products – it is incumbent on pharmacists to always notify a patient that homeopathic medicines cannot work. Ranging homeopathic products therefore opens a pharmacist up to conflict of interest, where their professional judgement tells them that there is no benefit to a product, yet a patient wishes to purchase it anyway, even when advised not to. Not ranging a product is the only method of preventing this conflict.
Pharmacists may also find themselves in position where the pharmacy they work in ranges homeopathic or other non-EBM products, yet they do not want to be involved in the sale or recommendation of these products. In this situation, it is important to remember that the code of ethics requires that a pharmacist does not undertake any action or role if their judgement determines that this is not the correct course of action.
Integrity Principle 2
A pharmacist only practises under conditions which uphold the professional independence, judgement and integrity of themselves and others.
This leads to the professional risk a pharmacist puts themselves in when recommending or selling a product that lacks evidence … any breach of the code of ethics can be the basis of a report to the Pharmacy Board for professional misconduct. If a pharmacist were to be referred to the Pharmacy Board for recommending a non-EBM product, pharmacists will be put in the position of having to justify their decision to supply a product that has no evidence, especially if this supply harms a patient or delays them from accessing effective treatment. In addition, it will not be possible to make a case defending the decision to supply non-EBM products based on pressures from employers wishes, due to Integrity Principle 2.
Clearly, the use of Non-EBM products, including homeopathy, puts consumers at risk due to delayed treatment and the risk of unexpected outcomes. It also puts pharmacists at risk of professional and ethical reprimand. Relying on evidence, and having a working knowledge of how to access and assess this evidence, remains a critical part of the role of pharmacists in all areas of practice.
END OF QUOTE
I find this comment important: we all knew (and I have dwelled on it repeatedly) that pharmacists can put consumers at risk when they sell homeopathic remedies masquerading as medicines (while in truth they are placebos that cure absolutely nothing). What few people so far appreciated, I think, is the fact that pharmacists also put themselves at risk.
Of course, you might say, this is a view from Australia, and it might not apply elsewhere. But I think, because the codes of ethics differ only marginally from country to country, it might well apply everywhere. If that is so, pharmacists across the globe – most of them do sell homeopathics regularly – are in danger of breaking their own codes of ethics, if they recommend or sell homeopathic products. And violating professional ethics must mean that pharmacists are vulnerable to reprimands.
Perhaps we should all go to our next pharmacy, ask for some advice about homeopathy, and test this hypothesis!