10:23, Homeopathy and the Shame of the Pharmacy Profession

apothecary This Saturday, hundreds of people, in many cities,  will be demonstrating outside Boots the Chemists about their selling of homeopathic remedies. Each volunteer will be taking a homeopathic ‘overdose’ of a Boots homeopathy product to demonstrate that there is nothing in the tablets but sugar.

Out of all the volunteer ‘overdosers’ and their supporters in the 10:23 campaign, there may well be many reasons for taking part. The homeopaths think this is a conspiracy by Big Pharma and that the demonstration proves nothing. They are entirely missing the point. But the main point, and the one I would emphasise, is that this mass overdose is designed to embarrass the pharmacists who sell these pills to the public in the full knowledge that they are useless.

The pharmacy profession has been granted statutory privileges to dispense medicines to the public.

Perhaps the biggest effect of the demonstration will be to raise some awareness of what your local ‘scientist on the high street’ is prepared to sell you.

They do so under a code of practice that insists they do act with ‘honesty and integrity’, that they do not ‘exploit the vulnerability or lack of knowledge of others’, and that they “provide accurate and impartial information to ensure that [they] you do not mislead others or make claims that cannot be justified”

When pharmacists on the high street accept cash for homeopathic pseudo-medicines that promise to relieve their customers of hay fever symptoms, help insomnia, or sooth a baby’s teething pain, they appear to be ignoring their professional standards in the pursuit of profits.

The pharmacists have evolved from the ancient protected trade of apothecaries. Since the middle ages, the state has afforded certain privileges to apothecaries to formulate and dispense medicines. Historically, these privileges have been seen as a restraint on trade by outsiders wishing to cash in on people’s desires for medicine, and as a necessary state by their supporters against rogues, quacks and charlatans.

Indeed, Samuel Hahnemann, the founder of homeopathy had a very unhappy relationship with apothecaries. He felt he was being persecuted by them for allowing people to dispense their own cures. But deeper than that, his philosophy of homeopathy made it impossible for a person to simply walk into a high street store, select a remedy they required and ask an apothecary to make it up for them. Homeopathy had to be ‘individualised’ to the patient, and this was something only a skilled homeopath could do – and not some mere dispenser of medicines.

Indeed, in an exam paper that Hahnemann set for a doctor who wanted to practice Homeopathy, the tenth question, in leading terms, made this quite clear,

10. Why can the homoeopathic medicines never be dispensed by the apothecary without injury to the public?

Any true homeopathic practitioner should object strongly to the idea of a mere dispensing chemist handing out homeopathic cures.

But his objections also recognised the direct conflict between both the financial needs of the apothecary and the nature of their beliefs and training.

In a letter to a friend, Hahnemann wrote,

I do not wish to go to the town of Altenburg itself, to be in the way of you, dearest friend, and of your colleagues. I only wish to be able to settle in some country town or market village, where the post may facilitate my connexion with distant parts, and where I may not be annoyed by the pretensions of any apothecary, because, as you know, the pure practice of this art can only employ such minute weapons, such small doses of medicine, that no apothecary could supply them profitably, and owing to the mode in which he has learnt and has always carried on his business, he could not help viewing the whole affair as something ludicrous, and consequently turning the public and the patients into ridicule.

For these and other reasons it would be impossible to derive any assistance from an apothecary in the practice of homoeopathy.

As is often the case, Samuel Hahnemann is spectacularly wrong in the most interesting ways.

Firstly, Hahnemann appears to believe that you can only sell a medicinal product in proportion to the amount of substance you are vending. Indeed, as the amount of substance is proportionate to its effects, then this would be a common sense view. However, the absurdity of homeopathy is that it subverts the obvious. Hahnemann postulated that the more dilute a substance, the greater the effects. (A claim never substantiated, of course).

However, Boots the Chemist, and other modern day apothecaries understand that what it is in the pill is irrelevant. What the pharmacists in Boots are selling is not the substance of the pills (as there is quite simply nothing in homeopathic remedies bar the sugar), but a promise based on both the trusted brand of Boots and the professional standing of pharmacists.

boots teething powders And with that trust in the Boots brand and the authority of the pharmacist nearby behind the counter, you can charge quite a lot for worthless sugar pills. Boots homeopathic Teething Pain Relief powders contain less than 1 part in a trillion of active ingredient (and there is not even any evidence that the active ingredient does anything). They sell for nearly £5. This pseudo-medicine will do nothing for a distressed baby apart from make the parent think they are doing something and make Boots shareholders a little richer.

The professional code of ethics of a pharmacists would suggest that they are required to provide the customer with all the “necessary and relevant information”. It is surely necessary to inform someone that they are buying a worthless product that cannot work as described and there is no reason to suppose it does. Pharmacists must fall into two camps here: those that believe that homeopathic preparations do work as described, in which case they are simply incompetent, and those that shut up for fear of their jobs and for an easy life.

As David Colquhoun noted some time ago, the real villains here are the regulators of the pharmacy trade, the Royal Pharmaceutical Society of Great Britain. They issue advice to their members about how to interpret their code of ethics when selling homeopathic quackery (under the ironic heading ‘Pharmacists – the scientists in the high street’), and what advice to give to the public. Nowhere does it suggest that you ought to tell the customer that they are buying magic pseudo-medicine.

To add to the rogues’ gallery we must also add the Medicines and Healthcare Products Regulatory Agency (the MHRA) who grant licenses to homeopathic sellers to make claims for their products that cannot be justified by any form of evidence or rationale. They preside over a regime that has allowed the pseudo-apothecaries, such as Neal’s Yard Remedies to sell homeopathic pills for the prevention of malaria. Their light touch on the issue appears to almost offer a wink to the sellers that they can get away with anything.

The 10:23 campaign will almost certainly not stop Boots selling this quackery. There is too much money in it. Perhaps the biggest effect of the demonstration will be to raise some awareness of what your local ‘scientist on the high street’ is prepared to sell you. This should make you angry that your trust is being abused. If you cannot trust them to tell the simple truth about such obvious nonsense as homeopathy, why should you trust them on more important matters, such as the side effects of real medicines?

I shall leave my last words to repeat those Samuel Hahnemann, who showed some unusual insight when he said that,

he [the pharmacist] could not help viewing the whole affair [homeopathy] as something ludicrous, and consequently turning the public and the patients into ridicule.

And that is the pharmacists’ shame: using their trusted position to make fools of the public.

31 comments for “10:23, Homeopathy and the Shame of the Pharmacy Profession

  1. skepticat
    January 27, 2010 at 1:08 am

    Fantastic post.

    I agree that the main effect of the demonstration will be to raise public awareness of what homeopathy really is. It's doing that already. This week thousands more people know the truth than did last week thanks to the 10:23 campaign. So up yours, homeoquacks.

  2. rajan
    January 27, 2010 at 8:33 am

    What if Boots decides to selectively contaminates the pills being swallowed by the volunteers? The 'overdose' may have an adverse effect in that case.

  3. rajan
    January 27, 2010 at 8:37 am

    …what I meant is..you should be prepared to counter it.

  4. r
    January 27, 2010 at 8:46 am

    …what I 'mean' is…. :-(

  5. Anonymous
    January 27, 2010 at 8:47 am

    rajan, I'd think they'd have to be crazy to do that. A lot of the volunteers have pre-bought the pills, not trusting branches to have enough stock. Furthermore, even if buying on the day, how would Boots seperate the "overdoser" and "normal" stock on the shelves?

  6. rajan
    January 27, 2010 at 9:26 am

    Ok…All the best.

  7. Mike
    January 27, 2010 at 11:02 am

    Pharmacists are just glorified grocers.

  8. Steve H
    January 27, 2010 at 1:52 pm

    Mike, not *all* Pharmacists are glorified grocers. Just 99% of them! Some work in hospital which usually means they're a bit more trustable to have a sceptical head, and some work in Medicines Information departments in hospitals like I do, but I'd still only trust half of them. Any pharmacist that isn't scathing of homeopathy is an ignorant disgrace.

  9. Zetetic
    January 28, 2010 at 5:52 am

    I hope no diabetics swallowed whole bottles of homeopathic pills – way too much sugar!

  10. Jeremy
    January 28, 2010 at 1:33 pm

    What a waste of time. You guys must live bloody boring lives.

  11. BillyJoe
    January 29, 2010 at 11:20 am

    And you, Jeremy? What are you doing here? ;)

  12. Jeremy
    January 29, 2010 at 11:38 am

    Reading blogs.

  13. NHS Pharmacist, Wales
    February 1, 2010 at 9:11 pm

    A tad harsh I think, tarring all pharmacists with this particular brush.
    Our glorified organ (!) (the Pharmaceutical Journal) has been awash with letters about homeopathy in recent years as well as the opinion column being used to have a go at the society for failing to condemn it. Lots of criticism of homeopathy and of the PharmSoc. I think most pharmacists disagree with both the science of homeopathy and selling 'remedies', but the owners (usually multiples) want the hard cash (margins must be immense!).

    Certainly in my 25+ yrs experience as an NHS pharmacist I have not met any homeopathy proponents. I don't know many retail pharmacists.

    I think that the MHRA should expose the scam of homeopathy and that the PharmSoc should add something to our code of ethics to make it clear that homeopathy is baloney and we should not sell it. The problem is that most people on the Council are retail pharmacy owners who make money out of this (and other daft science – you should see some of the things that our past Presidents sell! – http://www.glovers-health.co.uk/index.htm)

    Please don't think we are all the same – most of us despise this pseudoscience.

  14. Dr Andrew Sikorski
    February 1, 2010 at 10:35 pm

    Bless thee all, but my, how ignorant of you that are SO anti-homeopathy. Proving a remedy took 4-8 weeks of a tds consumption of a product- Dare you to do it properly?

  15. Le Canard Noir
    February 2, 2010 at 12:33 am

    Isn't it funny Dr Sikorski, but I was reading the minutus discussion board today where homeopaths were saying a proving could be done reliably with only one pill.

    It is easy to make any assertion you like when you do not feel constrained by evidence and reason.

    Do you have any evidence that provings have to be done over 4-8 weeks? What data backs up your belief?

    I think I know the answer.

  16. Dr Andrew Sikorski
    February 3, 2010 at 10:24 am

    At 10.23 on the 3.2.10, having been awake at 01.23 I laugh and laugh and laugh! Your beef being with homeopaths your tacit support and approval of tained and regulated medical practitioners using CAM, including homeopathy under the aegis of the Faculty of Homeopathy, is laudable. Numerous NHS medical practitioners use Homeopathy alongside usual conventional treatment to optimise patients'healing experiences, and all medical practitioners optimise care and raise hope alongside their interventions- whether evidenced based or not- as medical teaching has emphasised over the ages and continues to emphasise today. The argument suggesting medical care should be reduced to dispassionate scientific gesture is reductionist, shortsighted , crass and positively harmful. As a scientist I do not have a belief in homeopathy, nor acupuncture, nor conventional medicine- I use what works for the best interest of the individual seeking my advice, taking due consideration of Evidence, guidelines and the patient's preference. Iatrogenesis shows we have a long way to go to better understand illness and healing. NICE considers RCT's to have limited usefullness in clinical settings, so we struggle on and the larger the toolkit the more options a patient can choose from. Research does show outcomes of illness are better when the intervention is chosen by the patient rather than dictated by the doctor. Regarding your enquiry re the duration of provings- I would love to know your opinion to your rhetorical question. You certainly know how to make assertions and as for evidence and reason, well……lets meet up for a chat? Thought you were doing an 'overdose', not a proving?

  17. Le Canard Noir
    February 3, 2010 at 10:49 am

    So, Dr Sikorski. I will take your answer as meaning you have no evidence that provings can only happen over 4 to 8 weeks.

  18. Dr Andrew Sikorski
    February 3, 2010 at 1:30 pm

    So…you don't want to catch up and have a chat? It appears provings were conducted to amass data and sift through symptoms which could be ascribed to the remedy being proved- initially these tests were in material doses- the first one being Quinine (Chinchona bark) which Hahnemann took himself being curious. He developed symptoms resembling malaria which ceased when he stopped the dosage after a number of days and returned when, after a wash out period, he restarted. This occurred on a number of occasions, was replicated when members of his family performed the same experiment and again subsequently with medical colleagues. Having stumbled on this observation, as the true scientist and chemist he was, he took his investigations further. Using material doses of the contemporary medicines such as arsenic, mercury and sulphur differing symptoms were noted with each. Initial treatment of patients was with material doses. Side effects were significant. To reduce side effects the medicines were diluted with succussion. It was then observed, whilst side effects diminished, the beneficial effect was not only preserved, but increased. Not even Hahnemann could explain why, yet he noted this finding. Do you know why 007 prefers his dry martinis shaken, not stirred? Are you going to tell me? I think I know the answer. So the duration of a proving tends to be for 4-8 weeks to gather data. Treatments with homeopathy are advised to be limited to a month with regular doses to avoid the proving symptoms of a remedy. Some provers are reputed to be extra sensitive and may pick up data more speedily, but this is a tiny minority. You omit to mention the weird woo practice of dream provings which I quite understand as they do not fit my comprehension either. I'm glad you knew this was going to be my answer- you must be an extra sensitive woo yourself. Do you have evidence on the effects of aspirin?

  19. Le Canard Noir
    February 3, 2010 at 1:58 pm

    …and still no evidence.

  20. Dr Andrew Sikorski
    February 3, 2010 at 5:55 pm

    …and still no evidence.

    Though some proving symptoms were available from toxic effects of medication- regretably. How long do I need to take a medicine to start getting side-effects? Any evidence?

    And Graphites miners developed skin complaints – how long did they need to mine to get their symptoms? Any evidence?

    No evidence required for the duration of a proving as obviously some people will never develop symptoms and, similarly to my patients on 4 or 5 antihypertensive agents (and no homeopathy) with continued raised blood pressures, 10% of patients do not respond to treatmnets. Your question re evidence for the required duration of a proving is dumb. Afraid there is no evidence required in answer to your question – ergo you will find none. But do feel free to mock- you obviously need an outlet for your woo. Please do let me know your evidence?-I'll try to post this as near to 21.03 having been otherwise occupied treating the sick at 13.20 and 3.12. Tata, tata, Tata.

  21. Le Canard Noir
    February 3, 2010 at 6:58 pm

    That message was brought to you from GP, Dr Andrew Sikorski.

  22. Dr Andrew Sikorski
    February 3, 2010 at 9:30 pm

    so…you don't want to catch up and have a chat…….and still no evidence from you……..

  23. Le Canard Noir
    February 3, 2010 at 10:03 pm

    What on earth would be talk about? The total lack of evidence for your assertions?

  24. Dr Andrew Sikorski
    February 4, 2010 at 10:00 am

    we would find out- how about meeting up for a chat- until then you and I would be postulating about the unknown- meeting would be a scientific exploration of what could happen- interested- or scared?

  25. February 20, 2010 at 3:20 pm

    Quinine (cinchona) is used effectively for indigestion, pain, nervousness, anxiety, fever and more.

  26. Michael Kingsford Gray
    March 20, 2010 at 8:39 am

    March 20, 2010AD and Andrew Sikorski (I still cannot believe that he is a GP) has presented not only zero evidence, but by his puerile sophistry, has presented negative evidence.
    Is a “Sylvia Brown” type countdown in order?
    Or will it suffer from overflow before the end of the next millennium?

  27. Gordon Rolfson
    August 20, 2012 at 6:26 am

    It is my belief that mesothelioma is definitely the most fatal cancer. It has unusual attributes. The more I actually look at it the greater I am assured it does not react like a true solid flesh cancer. If mesothelioma is a rogue virus-like infection, so there is the prospects for developing a vaccine plus offering vaccination to asbestos uncovered people who are open to high risk involving developing potential asbestos related malignancies. Thanks for revealing your ideas about this important ailment.

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