Dispensing with Homeopathy: A Proposal

teethingtrouble Let’s run with an idea and see where it goes.

The 10:23 campaign has now had loads of publicity and Boots have failed to address any of the central concerns: mainly, that homeopathy is a daft pseudoscience. Moreover, the pharmacy profession and the drugs regulator have remained silent.

In all likelihood, Boots will not withdraw their sugar pills and pharmacists will continue to take your money in exchange for pseudo-medicine. An immediate capitulation was never on the cards – the world does not work like that. But the Boots brand has been damaged as thousands of people have become aware of just what they are prepared to sell you in order to make money.

And let us also take on board the homeopaths argument that banning homeopathy would ‘restrict customer choice’. (Even though 10:23 did not seek to ‘ban’ homeopathy, only remove it from the pharmacy counter and, perhaps, into the health food shop next to the crystals.)

The campaign was really about making sure people understood what homeopathy is: it is not a herbal medicine, as herbs are often not used and any content gets diluted to the point where there is often nothing left. You are buying sugar pills that have had ritual magic performed on them.

As I have said, the villains here are the medicine regulators who allow deceptive labelling of these products. The MHRA say that they test the labels to make sure the public understand what they are buying. This is not true, as their recent submission to the House of Commons revealed. Nothing in their testing asked if customers understood they were buying pills that stated they contained an ingredient but that actually contained nothing, and that there was no reason to believe the pills did anything other than act as a placebo.

The legal blogger Jack of Kent has done a superb job of deconstructing the language on the labels.

Other industries have to battle with the problem with how to convey important information to the consumer that may affect buying considerations based on health: notably the food industry. In the last few years we have seen ‘traffic lights’ highlighting, for example the amount of salt in a ready meal.

Why shouldn’t the packaging of items in the pharmacy not be subject to the same clear labelling requirements?

As Edzard Ernst, Professor of Complementary medicine, has said,

My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying. These treatments are biologically implausible and the clinical tests have shown they don’t do anything at all in human beings. The argument that this information is not relevant or important for customers is quite simply ridiculous. If [pharmacists] are unable to stick to their ethical code, then they should change their code and be clear that it is alright to put profits before patients.

If we were expecting pharmacists to be honest, what would a typical homeopathic product label looks like? I suggest the following:

labelling meds

This quickly gets the key facts across that distinguish the product from others that might have survived some testing. After reading this, most people ought to be able to make an informed decision, and if you are the sort of person who uses crystals for deodorant then you still have your ‘right’ to buy this stuff. Everybody is happy.

Could we ever see such labelling? Somehow I doubt it, for a number of reasons.The government appears to be incapable of taking a position on pseudoscience. Indeed it has recently said that “The government does not find it helpful to define pseudoscience.”

I am sure the businesses behind the pharmacies would resist such a move fiercely as it might be difficult to see how any reasonable person would purchase a product labelled as such. The pharmacists would undoubtedly resist it as it would expose them as having being flogging worthless shit for years. Plus, their ranks appear to be filled with supporters of pseudomedicines. The recently departed president of the Royal Pharmaceutical Society of Great Britain, the regulatory body of pharmacists, is now doing this. (Please empty your mouth of liquids before clicking link as otherwise your screen will get wet.)

Plus, and this is a big one, I would imagine that the majority of products for sale in a pharmacy such as Boots, homeopathic, complementary or regular, would be more likely to have red circles than green ones.

The fact that we could, in principle, have such a scheme and the distance we appear from being able to adopt something like this tells us how little our modern pharmacies have progressed from the quack’s apothecary of old.

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Update

Thanks to Richard’s suggestion in the comments that the homeopathy in Boots simply be moved to a section labelled ‘Placebos’.

Of course we get into a dilemma then when the professionals tell you they are giving you a placebo as is so well observed in the (hugely underrated) Smack the Pony sketch…

On this theme…

25 Comments on Dispensing with Homeopathy: A Proposal

  1. Oh, and I should add that this would still be a brilliant idea even if homeopathy weren't involved. Pharmaceutical labels are ridiculously complex, and a simple scheme to highlight the efficacy and safety of all medicines is long overdue.

  2. Actually, I feel that label would be very useful. For example paracetamol:

    Evidence: Some (maybe?) as a painkiller.
    Safety: Do not exceed stated dose, otherwise usually safe.
    Contains 500mg of paracetamol per tablet.

    Or whatever. Friendlier labels are always a good thing.

  3. Good, but I think even your label does not go far enough. The public perception of "no evidence" is that the jury is out on the subject of efficacy. The message that needs to be got across is that hundreds of RCTs have been performed and the results are consistent with the hypothesis that homeopathy doesn't work.

    The "no evidence" label almost gives credibility for Boots' support for "more
    scientific research to help customers make an informed decision". This position is bullshit: the research is out there, they are merely hiding it from their customers as it does not support the sale of their product.

  4. Dearest folk- the NHS prescribing software lists all the medicines on the BNF in it alongside the majority of homeopathic remedies and herbals- as someone might have once said- we're doomed….all doomed!!!!

    • 1) It’s not NHS prescribing software, it’s privately produced software that meets the nebulous NHS requirements.

      2) The only reason that the software contains homeopathicherbal crap is because it’s allowable on the NHS.

      3) Quack items turn up on the system because they’re on the ‘Dictionary of Medicines and Devices’ (DM&D – http://www.ppa.org.uk/systems/pcddbrowserv2_3/mainbrowser.htm), due to the prescribing practices a practitioner can write a script for any drug that’s not on the blacklist. Items turn up as prescribable because some one prescribed them

  5. My head is spinning with dismay at the "recently departed president of the Royal Pharmaceutical Society of Great Britain" being a woo-peddler. Please tell me that the "Royal Pharmaceutical Society of Great Britain" is a Mickey Mouse organisation for wannabees and air-heads and nothing to do with pharmacists, pharmacies and pharmaceutical science? They're a spoof, right? Just with a better than usual spoof website? Without the hidden jokes? What a depressing way to start the day.

    Nice idea about the labels. Pity it won't happen.

  6. As a member of the BMA's Representative Body, in 2008 I successfully got BMA policy to "call for NICE to report on whether homeopathic remedies should be funded by the NHS".

    This has been advised to the Parliamentary Select Committee – and NICE.

    NICE responded saying they would do a review if the government asked them to!

    So in June 2010 I shall propose that " the NHS should cease to fund homeopathy unless and until NICE reports on the cost effectiveness of homeopathic remedies and recommends their use".

    Now, if NICE says such nostrums are OK, then of course Evidence Based Medicine, and indeed Science goes out of the window. We who follow this web site can create 'The Honorable Company of Woo' to promote and sell "Tripe, Piffle, Poppycock and Balderdash" – and to lobby the NHS to pay for it on the grounds that it's what we want.

    Note: I do not expect the BMA, or NICE, to deny homeopathy to those who want it. The issue is that tax payers should not be expected to pay for un-proven remedies where there is no or scant credible evidence of efficaciousness.

    Simples.

    I call for Boots to move these products to a new section in its stores clearly marked "Placebos".

    Nothing wrong with them.There is plenty of evidence that placebos "work" in the sense that a number of folk taking them do report they feel "better". Particularly if the pillule is coloured red.

    And they have been shown to work as well as homeopathic remedies!

    Boots must restore its reputation for honesty.

    "Keep Label Laws based on Science" say I.

    Dr Richard Rawlins MBA FRCS
    Chairman, UK Consultants Conference.

  7. Yes please – as others have said – for all medicines and healthcare products. It'd be great to have a summary of the evidence for the product (at the concentration being sold) and each indication that it's being suggested for. Maybe the Cochrane reviews would be a good gold standard for these.

    Homeopathy is easy – it's a degenerate case – but for products that contain stuff (herbal, synthetic, or whatever) one can't tell without a review of trials. It might even increase public awareness of evidence-based medicine.

  8. “The message that needs to be got across is that hundreds of RCTs have been performed and the results are consistent with the hypothesis that homeopathy doesn't work.” —Simon Perry.

    Hundreds of pointless exercises in pathological science which could not have been interpreted as inconsistent with that hypothesis no matter what their results.

  9. Many thanks for the "Smack the Pony" clip.

    The REALLY funny thing is that placebos "work" (on a statistically proven basis) even when the patients/supplicants are told they are placebos!

    They do of course "work" better if patients are misled and not told. But Magic is like that! So is homeopathy. (On the balance of probabilities, allegedly, M'Lud.)

    Richard Rawlins
    Member, The Magic Circle.

  10. Placebo's can cause harm, M'lud- as evidenced in the recent study comparing SSRI's to placebo- the safest SSRI being Lustral- it remains my preferred prescription.

    Prof Ellis CBE FRCS, by whom I had the privelege of being educated both in lectures and whilst holding a retractor for him and occasionally 'closing up' was particularly aware of nocebo effects- those nasty things which get in the way of helping a patient recover. It became clear that whilst the sutures held the skin together it was the wisdom of the body which healed the scalpels' wounds. This amazing ability of each of our bodies to heal is close to being ignored by being derogatorily coined a placebo effect. Research and conversation with pharmacists has shown the industry's awareness of the enormous power of the placebo effect which chemists have exploited through the ages by developing the appearance of the pill/ mixture as well as its consistency, odour, flavour and packaging. Indeed generic medication may harm the patient by providing a less potent placebo effect, despite being cheaper. Have you ever wondered at the colour, shape and presentation (on edge with a suggestive reclining angle) of the humble VIAGRA pill- originally an anti-hypertensive with a particularly notable side-effect, and not red in colour!

    The patients to whom GPs prescribe homeopathy often have conventional medication on the same NHS FP10 prescription. 60% of GPs in Scotland have had training in Homeopathy and blend it in effortlessly with their daily repertoire for the greater good of their populace. An antibiotic may kill the bug- the body has yet to dispense with the dead bug and render itself ship shape. How can this be best assisted?

    Whilst the views of the consultant partialists to whom GPs refer patients for an opinion are highly valued, the general medical care of the individual rests in the GP's responsibility- Consultant partialists offloading the carcass once their remit has been completed, and 80% of the cost of our medical care occuring in Primary Care. Less often now we hear the hackneyed expression: "the operation was a success, blasted patient died!" Yet the effect on numerous souls of being read the list of risks (including death) prior to signing their surgical consent form has a serious nocebo effect, partially mitigated by the anaesthetist playing whale music and whispering per-operative encouragement to their charges.

  11. The sad fact of Iatrogenesis proves we still have a lot to learn about illness, disease and healing. Crucifying homeopathy is a bit like not putting any water in the bath lest the baby drown, or not putting the baby in the water lest it be thrown out. The baby will grow dirty and grimy and stinky. The Royal College of General Practice motto reads "Scientia cum Caritas"- Compassion with Science, not "Scientia, Scientia, Scientia".

    There is evidence of effect for homeopathy from RCT's. If there were none I would not be practising and my life would be so much simpler.

    Dr Rawlins could look to his own back yard. The BMJ evidence website states 12% of current medical (including surgical) interventions have an evidence base. NICE could suggest 88% of medical work need no longer be funded by the taxpayer. Stones and glasshouses. But do please ask NICE to recommend the wider awareness and use of Autogenic Training of which Professr Ernst is a patron- it really is rather good!

    Finally the cost effectiveness of homeopathy is without question for those heartsink patients who have graced multiple partialist out patient departments, undergone repeated expensive investigative procedures and therapeutic manoeuvres to no avail and with a 'tried everything else- try homeopathy' have found objective and subjective improvement at the cost of a milk sugar pill impregnated with a fraction of a chemical substance. Don't ask me how- A scientist and chemist found he developed malaria like symptoms when he took Chinchona bark; that these symptoms ceased with a wash out period, recommenced when he restarted the dose; that the effect was initially repeatable with himself, his family and subsequently medical colleagues; extended to other 'toxic ' substances which effected a cure on patients suffering similar effects to those the experimenters experienced and, paradoxically, the healing effect was magnified when the medicines were diluted to reduce side effects ( a bit like digoxin). All this came about from observation rather than intellectual theory. Also known to Paracelsus and Hippocrates. Please do spread the word about the truth of EBM- the truth- as wide as you can!!

  12. There is evidence of effect for homeopathy from RCT's

    Depends on how you define "evidence", surely. If you regard a statistical anomaly or insignificance as evidence then you can say there is evidence for loads of impossible stuff.
    On the basis of such a virtually meaningless definition of evidence, as is required to claim evidence for homeopathy, there is without doubt similar quality evidence for astrological predictions, phrenology, palm reading, exorcism…

  13. Surely indeed Shirley,.. perhaps that's how conventional medical interventions make it under the 'evidence radar'. Are you not aware of the recent media and medical press column inches dedicated to asking questions about the scientific purity of medical research and published/ unpublished results? Similar shenanigans have blown the wheels off the Copenhagen summit on Climate change- to my regret. Were Aspirin discovered now it would not achieve ABPI approval,…why? So many of the wonder drugs we learnt about at medical school no longer figure in the pages of the BNF,…why? Is it post-marketing surveillance, or……? Many cutting edge discoveries have failed the test of time, yet Homeopathy, despite criticism from sceptics, scientists, medics and patients for over 200 years just keeps on truckin'…..YeeeeHa!!!
    Hey Shirl!…You!….Yeah You!….Don't You go takin' that beam outta Ya eye now……YA HEAR!!!!

  14. Dr Andrew Sikorski,

    "This amazing ability of each of our bodies to heal is close to being ignored by being derogatorily coined a placebo effect."

    Since when is the natural history of an illness or disease part fo the placebo effect?

    "60% of GPs in Scotland have had training in Homeopathy and blend it in effortlessly with their daily repertoire for the greater good of their populace."

    As a homoeopath/GP acquiantance once: "When I realised what a load of codswallop homoeopathy was I continued to manage my patients with all the care and attention I did when I used homoeopathy, but I've now dispensed with the bullshit".

    " An antibiotic may kill the bug- the body has yet to dispense with the dead bug and render itself ship shape. How can this be best assisted?"

    What? Are you really an actual medical doctor??

    "Crucifying homeopathy is a bit like not putting any water in the bath lest the baby drown, or not putting the baby in the water lest it be thrown out. The baby will grow dirty and grimy and stinky."

    Christ got crucified, babies get washed, and homoeopathy….um…er..
    (I mean, that's about as intelligent as your statement)

    "There is evidence of effect for homeopathy from RCT's. If there were none I would not be practising and my life would be so much simpler."

    There simply is none, and so it seems you should get a life and stop practising. 😉

    "The BMJ evidence website states 12% of current medical (including surgical) interventions have an evidence base. NICE could suggest 88% of medical work need no longer be funded by the taxpayer."

    That's 12% of interventions, but 58% of what doctors actually do, but for the reast at least there is prior probability, which for homoeopathy is zero. For zero prior probability, homoeopathy requires extraordinary evidence but all it has are marginal effects provided you're not too fussed about protocol.

    "the cost effectiveness of homeopathy is without question for those heartsink patients "

    Untill they travel to third world countries foer their holidays armed with nothing more that their homoeopathetic vaccines.

    "a milk sugar pill impregnated with a fraction of a chemical substance. "

    And now I see you don't understand homoeopathy.

    "A scientist and chemist found he developed malaria like symptoms when he took Chinchona bark"

    The irony is that he had an idiosyncratic reaction to quinine

    "All this came about from observation "

    Yes, it came about from observation. It was the realisation that observation was prone to error that the scientific method was developed. PObservation, my dear friend, is the start not the end of the investigation.

  15. Sikorski is simply regurgitating all the old chestnuts that have been debunked countless times over the last 200 years.
    The point he misses completely is that as regards evidence you can't beat real live cases – especially those with non-self-limiting ailments. As I've written many times now, there isn't a single incontrovertible case of a non-self-limiting disease being cured by homeopathy. Not one properly recorded, documented and referenced case in 200 years of supposedly meticulous research and record keeping.
    The same goes for self-limiting conditions, which by definition tend to resolve themselves without intervention.
    Any parent would be able to testify as to the efficacy of a drop of sugar water and a hug for the childhood problems homeopathy claims to treat. The same sugar water would have the same effect as any homeopathic treatment for adults.

    If there is anything positive to be said about homeopathy, I thing it is this. What demonstrates is the pointlessness of many of the other over-the-counter "remedies" for self-limiting or psychosomatic conditions. But what makes homeopathy worse that the other pointless remedies is that it is a completely bogus system of medicine with no active medicinal content and no plausible mechanism by which it could work. Practitioners simply take advantage of patients' ability to fool themselves – which is why they are so keen on self-reporting and anecdote as substitutes for evidence.
    The biggest crime though, in my estimation, remains the legality of what in any other sphere of business would be demed taking money under false pretences. Homeopathy is plainly and simply fraud.

  16. Must say something about "This amazing ability of each of our bodies to heal…" bollox regularly trotted out by quacks.
    One wonders why life expectancy was so low 2000 years ago. 25 years on average. People died of all sorts of thing that we now routinely prevent or cure.
    Even 200 years ago life expectancy in the civilised world was nothing like what it is today. Its increase can be put down to two things – hygene and medical advances like the discovery of antibiotics and vaccination, and medical technologies like non-invasive ways of seeing inside a human body. Mustn't forget diet too.
    But beyond the definition of "self-limiting" conditions "This amazing ability of each of our bodies to heal…" is simply a deceitful piece of ignorance to the extent it is recited by homeopaths and the like. Non-self-limiting conditions tend by definition not to be "healed" by the body, while self-limiting conditions obviously have no need of homeopathic or other magical assistance.

  17. Thank you Andrew,

    I am happy to recommend Autogenic Training as a good method to help stress. As is Yoga. And a stiff drink. And a nice holiday in the sun. And as John Wesley recommended – a good woman.

    But I'm not happy to expect the NHS to pay for any of these, even though they are the sort of thing that people who like them will like.

    NICE looks at the cost effectiveness of treatments within the context of the NHS – not within the context of "lifestyle".

    What diseases does Autogenic Training purport to treat?

    Now as for EBM – EBM means what it says. Evidence Based Medicine. BASED. On evidence. The best evidence that can be found. Which sometimes means, not very good evidence. But still, evidence all the same. And let us keep on trying to find some more. Then make our minds up. And abandon the treatment if there is no good evidence that it works beyond the placebo. (Which of course does work to some extent).

    There is hardly a registered medical pratitioner in the land who would not use homeopathey if there was credible evidence of efficaciousness.

    What a shame there is no such evidence available. Not even the Boots executive has any – and he sells the stuff!

    So there we are. Homeopaths will simply have to move forward, onward, upward. John Wesley prescribed turnips for treating scurvey in 1647, but we now have vitamin C. Methodists don't spend their valuable time on web sites bleating that more research needs to be done into the scorbutic action of turnips. They have moved on. In terms of healthcare at least.

    Please, homeopaths – join us. I promise you'll feel better. And if not, I'll cast a spell for you. Free!

  18. if we need to be honest with our patients as a Pharmacist,how come we never say our patients that I’m giving you a dose of poison( instead of medicine)in no-lethal doses??!!!
    Most of skeptics of Homeopathy do not have a proper Homeopathic education, otherwise they wouldn’t consider it as a placebo!

    • Are you really a pharmacist? A “conventional” one? The pharmacists I know don’t call their customers their patients as they’re not treating them.
      I would really hope that you do tell your customers that taking too many of their pills (or whatever other dosage form their medicine comes in) can be bad for their health and – depending on the (active) ingredient – may even kill them. That’s, after all, part of your job, isn’t it?
      As for the “medicine is poison in non-lethal dose” thing – I think most of your customers had chemistry in school where they learned about Paracelsus.

      • This is with a belief that we have seen an end to all possible discoveries in chemistry. It is good to read a doctor’s version:

        “Medical interventions should be regularly audited, lest it should damage human health instead of promoting it. Audits in many areas did show us in poor light lately! Rather, they have thrown up the possibility that we may even be harming human health in certain areas. Modern medicine, in its present form, was accepted as a science in the European Universities in the twelfth century. Ever since that time medicine has been riding piggyback on natural sciences. The latter depend on linear mathematics. All that science does is to make mathematical models of the happenings of this universe to explain them and then hope the formulae, thus derived, would work in real life situations. This happens very rarely in reality. Mathematical formulae are accurate in themselves, but when applied to the dynamic universe they go wrong. This is the bane of modern medical science and research.

        We presume that blood pressure is a product of cardiac output and peripheral resistance, based on the Ohm’s law of fluid flow. This law applies only to flow in straight tubes. There are no such tubes in the human body. Many drugs that we devised to control raised blood pressure based on this definition eventually failed to deliver the goods in the long run. Alpha-beta blockers should have been the best panacea for raised blood pressure; but, alas, they failed. On the contrary, beta-blockers, which raise the peripheral resistance, work well to lower raised pressures!”

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