Christopher Brookmyre’s short story place b., contained in his anthology, Jaggy Splinters, includes a rather amusing story about how a journalist goes undercover to sting the fictitious NHS Hospital, the Edinburgh and Lothian Homeopathic Hospital.
What would happen if there was a break-in by sceptical activists at a homeopathic pill manufacturers where the pills were swapped for blank sugar pills? How would the homeopaths at the hospital react when newspaper stories revealed they had been using blank pills for months? Of course, the initial horror of the homeopaths is quickly dissipated after patients, having read the reports, start coming forward to say that their pills had not been working as expected.
So, spoiler alert. Skip the next two paragraphs if you want to read the story yourself. The doctors see the opportunity to turn the disaster into a PR coup and so write a paper and hold a press conference to say the unexpected ‘blinded experiment’ has confirmed the effects of homeopathy. As soon as the hospital had been able to source an emergency source of remedies, the patients started reporting the beneficial effects again. But unbeknown to them, the journalist at the heart of the story had faked both the footage of the break-in at the pill factory and had also set up a fake homeopathy clinic, place b. The hospital had been tricked into using place b as the source of emergency remedies believing the story that it had received the hospital’s original supplies in error. So, when the hospital had been claiming ineffective pills, it had indeed been receiving the genuine product, and when it has been claining renewed success, it has in fact been using blank sugar pills as supplied by the journalist.
Brookmyre is playing with the idea that the effects of homeopathic remedies are all expectation and confirmation bias. But the story also highlights the impossibility of providing effective quality control for homeopathic pills. This fictitious story highlights a very real problem in homeopathy? How do homeopaths know that the pills they give to patients really are the pills they wanted to give? Since all homeopathic pills have been diluted to such an extent that all pills are physically and chemically identical, there is no test you can do that would reveal which homeopathic remedy you have should the labels ever be removed.
Uniquely in the medical world, the homeopathy industry can have no complete quality control mechanisms in place. There is no way of telling if the break-in actually occurred, whether computer records were correct and not tampered with, whether shipments made really were what was ordered. In itself, this should be enough of a reason never to use homeopathy.
In the real world, do such problems exist? What sort of quality control is there within homeopathy suppliers?
We saw a few months ago how the UK’s leading homeopathy supplier Nelson’s had received a damning letter from the US FDA. Imports to the US had been suspended while quality control issues were being sorted out.
The report is damning. Nelsons have been completely failing to perform the most basic quality control. In addition, their production methods fail to ensure the products are made correctly and fail to prevent contamination from hazardous substances. The concerns fall into two areas. The first are to do with the sort of controls that Nelsons could and should be doing, such as having a proper paper trail, retaining batch reference samples and taking steps to avoid broken glass entering the finished product. (Glass vial breakages would appear to be common.) Others though arise from the magical nature of the production of homeopathy:
Laboratory controls do not include the establishment of scientifically sound and appropriate test procedures designed to assure that components and drug products conform to appropriate standards of identity, strength, quality and purity.
Remember, homeopathy pills are chemically and physically identical, no matter what is on the label. There can be no scientifically sound technique to ensure the pills are what they say they are. Homeopathy is a form of sympathetic magic. You cannot test for magic and that the rituals have been performed correctly. Bizarrely, Nelsons look like they try to test with infrared spectroscopy. But the FDA quite rightly point out that the test is carried out incompetently.
When this scandal broke, I wrote to retailers of Nelsons products, such as Holland and Barrett and Boots the Chemist. Boots told me this:
I can confirm that the audit undertaken was on a targeted area of their business. I can assure you that this does not affect any of their products supplied to the UK market.
Quite clearly, given the findings of the FDA, Boots have either been misled or were misleading me. Holland and Barrett wrote to me to say that they had passed on the concerns to the UK regulators, the MHRA, who had not expressed any concerns and so they were not taking action.
How can we explain such a complete failure of manufacturing standards and quality control?
The cynic might argue that all involved in the supply chain, the manufacturers, the retailers and the UK regulators all know that homeopathy is a sham that only delivers sugar pills to the gullible public. Why then waste time and money on quality systems that can never work? We know that Boots for example are quite aware of the lack of evidence for the efficacy of homeopathy after they testified to an MPs’ select committee to this effect. But of course this cynic’s view does not explain why they are not concerned about the lax production standards that could lead to routine contamination.
I am happy to accept that Nelsons believe their products work. They are homeopaths. And an axiom of homeopathy is that it is perfectly safe. Why then waste time on QA when you have total self-belief and a delusional mindset that thinks you can do no harm? This still does not explain the shoddiness of the production environment.
Once again, we must look to the regulator, the MHRA. Why did it take the Americans to uncover this string of failures? Why have the MHRA not taken action in the UK to prevent this uncontrolled business shipping supposed medicinal products to consumers when there is absolutely no quality control in place?
Just as the MHRA only takes the most minimal action over homeopaths making life threatening claims with their products, we do not know why they are so appallingly inactive and friendly to the peddlers of homeopathic delusion.