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.
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.
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.