Concerning Signals in Pharmacy Students’ Attitudes About Complementary and Alternative Medicine

pharmacy students
While I’m now two full decades out of pharmacy school, I am occasionally invited to return to give a lecture or facilitate a workshop. Pharmacy education has changed a lot since the 1990’s. For me, pharmacy was a Bachelor’s degree program you started right out of high school. Today, students must have a few years of university completed before they can apply (some already have one degree), and the more common degree granted is doctorate-level, the Pharm.D. The clinical training has been bulked up and the practical training is much more rigorous. I see all this as positive change, as the practice of pharmacy has changed along with the education standard. The era of the “count, pour, lick and stick” pharmacist is disappearing as these tasks are automated or delegated to others. Today’s pharmacist has the opportunity to deliver care in different ways, including new roles like vaccine provider, and medication review/drug therapy optimizer. Many find positions that allow them to leverage their drug-related expertise to other areas of the healthcare system.

With pharmacists’ knowledge of drug products it should not be a surprise that they are consulted widely for advice by patients as well as other health professionals. Public surveys on trust show pharmacists lead other health professionals on this measure. It should also not be a surprise that pharmacists can be quite influential in shaping drug use, particularly when it comes to advice about complementary and alternative medicine (CAM), especially when it is used with conventional, science-based drug treatments. After all, drug stores are becoming (to my professional embarrassment) purveyors of all forms of CAM, ranging from homeopathic “treatments” through aisles of herbal remedies, vitamins, and other supplements. One pharmacy I used to work at sold copper bracelets, magnets, salt lamps, ear candles, homeopathic “first aid” kits, and detox packages that were purported to “balance” your pH. If there was a plausibility limit to what this pharmacy would sell, I never saw it reached. I gave the best science-based advice I could, but eventually left due to my concerns about what was on the shelves. But my time in that setting showed me the opportunity to improve care: the pharmacist is well positioned to advise on the evidence for or against any particular treatment, as well as explain the potential risks with combining CAM with evidence-based treatment approaches.

Given the continued popular interest in CAM, and its proximity to pharmacy practice, research on roles and professional/ethical responsibilities are of interest to academics and researchers. Regrettably, from what I’ve seen in the literature, those with an academic interest or focus in CAM tend to lean towards being believers, rather than scrutinize the promotion of these products and their incorporation into medical therapeutics. (Pharmacy education really needs its own Edzard Ernst, a fierce critic of CAM, who has discussed CAM and health professional ethics). Almost exclusively the criticism of pharmacy and its role as a purveyor of CAM tends to come from outside the profession, with rare, but notable, exceptions.

Mark Crislip has mused that surveys on CAM seem to be an easy path to getting published, given the thousands that exist. Given my personal and professional interests in CAM and pharmacy practice I couldn’t resist reviewing a new survey of attitudes among student pharmacists. Just published in the Journal of the American Pharmacists Association, and entitled Student pharmacists’ attitudes toward complementary and alternative medicine, the paper is from Marwa Noureldin, a pharmacist and graduate student at Purdue University. The survey included 62 questions and was distributed to first, second, and third-year pharmacy students at 10 schools of pharmacy across the United States. There were 887 complete and usable responses. The average student was 25 years old, white, and female. Among the products categorized as CAM, respondents had personally used vitamins (64%), supplements (48%) and massage (39%) in the past.

The survey was divided into three parts – the first section queried attitudes towards CAM, using Likert scales (1=strongly disagree, 5=strongly agree). Questions were adapted from the CAM Health Belief Questionnaire and were modeled after the National Center for Complementary and Alternative Medicine (NCCAM) categorization of CAM:

  1. Biologically-based therapies (e.g., supplements, vitamins, etc.)
  2. Manipulative and body-based therapies (e.g., massage, chiropractic & acupuncture)
  3. “Mind-Body” interventions (hypnosis, biofeedback, prayer)
  4. “Energy” therapies (e.g., reiki, qi gong)
  5. Alternative medicine systems (e.g., homeopathy, traditional Chinese medicine, Ayurvedic medicine)

Here’s the results (click to embiggen):
table 2 - JAPhA - CAM

The CAM Health Belief Questionnaire, while it has been “validated” seems to have been designed by CAM proponents as is evident from the common tropes embedded within the survey. Describing health as a consequence of “balance” that is “self-healing” are subtle references to the ideas of vitalism that are common across many alt-med practices. Notably there is no reference anywhere to the fact that CAM therapies are either not proven effective, or are proven to be ineffective. (Any CAM therapy that is therapeutically effective, is by definition not CAM, and should just be called medicine.). The survey paints CAM as a separate set of therapies that represent an equally valid therapeutic choice, rather than more accurately describing it as a collection of therapies and practices that lack evidence of benefit. The surveys also lumps vitamins in as a category of CAM, when some vitamin use can be appropriate and science-based (e.g., folic acid supplementation in pregnancy). It also include interventions like massage, which, depending on the treatment goal, isn’t necessarily CAM at all.

The student responses lean toward the positive, with most ranging from neutral to strongly agree. This is perhaps not surprising, given how the questions are worded. The strongest support was for the statement “A patient’s health beliefs should be integrated into the patient care process” with 91% of students agreeing. This question is one that could be answered affirmatively by someone that takes a strongly science-based perspective, so what this implies about CAM is unclear. There was also strong agreement that CAM knowledge is required in the practice of pharmacy – a question I also strongly agree with, though my vision for CAM education would likely be quite different than what CAM proponents would like to see. As I have argued before, specialized CAM training in academia is designed and delivered to distract from the fact that CAM (often branded as “integrative medicine”) attempts to embed a double standard of evidence for products and procedures that don’t meet the standard of care for medicine. It should not be surprising then, that students who had taken previous CAM courses had much more favorable views towards the statements in the survey than students without any formal CAM coursework (55.89 vs 48.87, respectively).

The second part of the survey asked about views on acceptability of using CAM with “conventional medical therapies” (the authors’ words), again using the same Likert scale:

table 3 - JAPhA - CAM

Few students disagreed with any CAM therapy. There was the greatest support for vitamins and minerals (94%, mean 4.29) which could include the science-based use these products. But there was strong support for demonstrably ineffective treatments like acupuncture, with 64% agreeing it was acceptable. Even homeopathy, which any pharmacy student with basic medicinal chemistry skills ought to know is absurd, was supported by over 40% of students. In fairness, these questions could be interpreted in different ways – I agree there are no medical or therapeutic reasons why homeopathy cannot be taken concurrently with actual medicine. However, I’d say the same about qi gong and reiki, yet students gave somewhat less support to concurrent use of those treatments.

Finally, students were asked for the influences on their own philosophy about CAM:

table 4 - JAPhA - CAM

The biggest influence was personal experience (“It worked for me”?), which exceeded coursework, faculty attitudes, family and professional experience. Surprisingly there was no explicit question about the direct influence of the scientific evidence itself. Perhaps disappointingly for bloggers like myself, media (including the internet) was cited as the least popular influence, with 25% indicating it was “not at all influential”.

The discussion section of the paper raises more questions about the overall intent of the survey. Negative opinions about CAM (such as concerns about safety and efficacy) seem to be viewed as problems that can be addressed with more CAM education, rather than crucial issues that call into question the entire endeavor of CAM as a distinct system of treatment. Completely absent from the discussion is any statement about the double standard created by specialized CAM education – the authors draw conclusions that seem to suggest that mixed or negative opinions on CAM are problematic, and that more CAM education is advantageous for pharmacy practice.

The limitations to surveys like this are substantial, which needs to be considered as we study the findings. Given this was a voluntary survey, with a low response rate (23%), it’s quite likely that non-responder bias is a factor. It is plausible that those that are indifferent to CAM, or have critical perspectives, may not have participated in the survey. A second factor was the exclusion of fourth (final) year students from the survey. It’s conceivable that students in their final year might have more critical perspectives on CAM. A third limitation is the use of NCCAM’s categorization of CAM which incorporates science-based therapies alongside rank quackery. The result is a mix of science and pseudoscience, bundled up as “CAM”, which could increase positive perceptions, giving unscientific and disproven treatments the appearance of being deemed acceptable. Finally, the statements and questions were worded in ways that fail to distinguish between what’s appropriate from a science-based perspective, and what’s acceptable from a patient-focused perspective. I would never recommend homeopathy to a patient and would actively advise against its use. However, to an insistent patient, I would assure them that concurrent homeopathy use poses no medical consequences. The survey fails to distinguish between the two scenarios.

Conclusion

This survey on CAM attitudes paints a concerning portrait of American pharmacy students. However, limitations in the survey process may have created biases that could have exaggerated the overall perspective presented. More concerning than the results themselves are the researchers’ interpretation of this data: Critical and negative perspectives on CAM seem to be viewed as problematic, rather than positive examples of good critical thinking.

One lesson from surveys like these is they illustrate the educational goals of CAM proponents. Just like “integrative” medicine that is making its ways into academic hospital settings, CAM education on campus is another tactic that is being used by proponents to shape health professional attitudes and perspectives early in their careers. The objective is obvious: normalize pseudoscience with students, and watch it become embedded into pharmacy practice.

Is this going to change? Unless there is a deliberate and explicit attempt to call out and push back against the degradation of academic and scientific standards created by existing forms of CAM education and “integrative medicine” programs, we should expect to see a growing normalizing of pseudoscience in health professions like pharmacy.

Update: Edzard Ernst has also commented on the study.

Reference

Noureldin M. Student pharmacists’ attitudes toward complementary and alternative medicine, Journal of the American Pharmacists Association, e205. DOI:

 

Photo from flickr user Haonavy used under a CC licence.

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57 thoughts on “Concerning Signals in Pharmacy Students’ Attitudes About Complementary and Alternative Medicine

  1. This is what the homeopathy skeptics are fighting to maintain:

    http://atlanta.cbslocal.com/2013/06/19/study-70-percent-of-americans-on-prescription-drugs-one-fifth-take-5-or-more/

    This is what homeopaths and their patients are fighting to maintain:

    Much exciting collaborative research on the effectiveness of homeopathy is being done world-wide and now in collaboration with research institutions in the United States.
    “The University of Texas MD Anderson Cancer Center in Houston – The US department of alternative medicine followed the cases presented in Corfu with lab trials using Banerji’s homeopathic medicine on cancer cells at The University of Texas MD Anderson Cancer Center (MDACC) in Houston. Dr. Sen Pathak, Prof. of Cell Biology & Genetics, at the University of Texas MD Anderson Cancer Center, Houston, collaborated in this joint research between the PBHRF and the MDACC. The research work is now complete and published. An in vitro study with the medicines has shown brilliant results in killing brain cancer cells while activating the normal cells. The paper entitled “Ruta 6 selectively induces cell death in brain cancer cells but proliferation in normal peripheral blood lymphocytes: A novel treatment for human brain cancer” was jointly published with Pathak S, Multani AS, of the Department of Molecular Genetics, M.D. Anderson Cancer Center, Houston, USA., in the October 2003 issue of the International Journal of Oncology. (PBHRF and the University of Texas MD Anderson Cancer Center, Houston, USA conducted jointly an in vitro research study on the effectiveness of the medicines Ruta 6 and Calcarea Phosphorica 3X in destroying brain cancer cells while activating the normal cells. The research study was published in the form of a paper in the October 2003 issue of the International Journal of Oncology.)”

    http://www.ayudacancer.com/foro/viewtopic.php?id=7778

    • Art Tricque says:

      Sandra, the first link you give is a page from Mr Banerji’s own “foundation”, and the reasearch you tout is a single article published *10* years ago that is solely an in-vitro study (Pubmed link https://www.ncbi.nlm.nih.gov/pubmed/12963976 ). Mr. Banerji has published no other research on the use of the “Ruta 6″ remedy. Thus, the argument that homeopathy is somehow promising fails.

      • Art, That would be Doctor Banerji. Does not matter how “old” the study is. And, there are many other remedies that have proven successful in the treatment of cancer. Link below to some of them. Still have not studied homeopathy or consulted your own family homeopath? If not, your opinion does not matter. You might want to let M.D. Anderson Cancer Center in Texas know how you feel. They have started collaborative research work with Dr. Banerji. The skeptics have a very steep uphill battle facing them.

        Nitroglycerine was found to be successful in treating cardiac angina, by a homeopath over 100 years ago. It is still being used today under the name “Nitrostat” by Pfizer I believe. Look it up.

        http://www.pbhrfindia.org/index.php/treatment-of-cancer/19-cancer-a-banerji-protocol/37-recent-success-rates

  2. Art, That would be Doctor Banerji. Does not matter how “old” the study is. And, there are many other remedies that have proven successful in the treatment of cancer. Link below to some of them. Still have not studied homeopathy or consulted your own family homeopath? If not, your opinion does not matter. You might want to let M.D. Anderson Cancer Center in Texas know how you feel. They have started collaborative research work with Dr. Banerji. The skeptics have a very steep uphill battle facing them.

    Nitroglycerine was found to be successful in treating cardiac angina, by a homeopath over 100 years ago. It is still being used today under the name “Nitrostat” by Pfizer I believe. Look it up.

    http://www.pbhrfindia.org/index.php/treatment-of-cancer/19-cancer-a-banerji-protocol/37-recent-success-rates

  3. For a blog labelled “science based pharmacy” I don’t see any . . Scott Gavura misses reference to a comprehensive review of the literature on homeopathy performed by pharmacists for pharmacists, so working pharmacists can answer customer’s questions about homeopathy. So either Gavura didn’t read it,or he doesn’t want anyone else to. JOHNSON BOON, Am J Pharm Educ. 2007 February 15; 71(1): 07. “Where Does Homeopathy Fit in Pharmacy Practice? tinyurl com/7htoejq
    The authors state: “Several meta-analyses concluded that homeopathic treatment is significantly better than placebo.” This of course is a bomb in the face of homeopathy bashers like Gavura.
    The Johnson study was done at the Univ. of Toronto Leslie Dan Faculty of Pharmacy and is a good place to begin a study of the controversy for a fair and balanced appraisal by professionals instead of a misinformed blogger. Perhaps the next invitation to lecture before a graduating class should include a debate over homeopathy . . with someone fmailiar with the literature and the facts. Homeopathy btw has worked amazingly well for me, doing things patent chemistry could never hope to do.
    .

    • ChristyRedd says:

      John…..

      It’s done things for me too that con med did not and could not hope to do. That’s why it’s my primary form of medicine. My animals love it and so do my plants thanks to Kaviraj.

      • Ah, the mighty Christy Redd! Thank you for this excellent topic, Christy. During my lectures at Hahnemann College in London and at Prof Josephson’s symposium at the Cavendish Lab at Cambridge, I took Kaviraj with me and introduced him tp my audiences as the Great Prover. Other than the testimonials from ourselves and our patients, what better proof is there for the action of homoeopathics than botanicals? We have countless subjects to experiment on without fear of reprisal. I have increased the growth rate of oat seedlings by 150% using homoeopathic Staphysagria; I have altered the fermentation of yeast using the same; I have caused a house plant that has never flowered to flower. My dear friend and mentor Kaviraj did exponentially more than this. He created botanical vermifuges using ionized pharmacetuicals. In India he treated 100’s of people a day with it for years. Woe unto the pharmacist Pharisees, LOL! “Pharmisees”?

      • ChristyRedd says:

        @John Benneth:

        “Pharmisees”………love it! You do have a way with words not to mention oat seedlings and staphysagria. Blessings to you and Kaviraj both!

  4. Walter jr. says:

    Being a pharmacy student myself at UofM in Montreal, Canada, I am happy to report that a vast majority of students are very sceptical of homeopathy and other alternative medical practices and that evidence based medecine is THE standard of practice being vehiculated by the faculty and used by the students.

    @Sandra Courtney, yes nitroglycerin was tried as a homeopathic medicine but not for angina, it was used as a «like cures like» treatment for headache. «Lauder Brunton, the father of modern pharmacology, used the compound to relieve angina in 1867, noting the pharmacological resistance to repeated doses.»
    -http://www.ncbi.nlm.nih.gov/pubmed/10779131

    Also the article on ruta 6 you are talking about is at most bad science. How can they conclude that «Ruta in combination with Ca3(PO4)2 could be used for effective treatment of brain cancers, particularly glioma.» when their trial is on 15 people, non-randomnised and non-placebo-controlled? Also, the calcium phosphate dose administered is far from homeopathic (~230mg/day)…

    http://digitaljournal.com/article/302769

    • @Walter, jr

      We’re both right…

      “But even during his lifetime, nitroglycerine was already being used to save lives as a medicine. When first discovered, Sobrero had cautioned against tasting nitroglycerine since it invariably caused severe headaches. After hearing this news in 1849, the American homeopath Constantin Hering reasoned, following the homeopathic doctrine of ‘like cures like’, that nitroglycerine might also be able to cure headaches if sufficiently diluted. This eventually brought the explosive to the attention of more serious medics and in 1879 the English physician William Murrell published a report in the medical journal The Lancet, titled ‘Nitro-glycerine as a remedy for angina pectoris”.

      It is important to note that William Murrell was both a physician and homeopath.

      Source: http://www.rsc.org/chemistryworld/podcast/CIIEcompounds/transcripts/nitroglycerine.asp

    • ChristyRedd says:

      Walter,

      To begin with, the generations of the Banerji family have been working with homeopathy for 150 years which gives them an incredible volume of first-hand and accumulated knowledge about and experience in using the remedies.

      They have been treating 120 to 200 cancer patients a day at their clinic along with cancer patients in 70 countries for many years. This vast experience has given them the opportunity to work with every type of cancer at every stage over many years. It has allowed them to develop a specific set of protocols for the treatment of each type of cancer. You are referring to the treatment protocol for brain tumors which is Ruta grav. 6c and Calc phos. 3x (not 230 milligrams). Both potencies are homeopathic. The Banerjis use only homeopathy.

      The majority of patients at PBHRF opt to use homeopathy alone. Out of 91 cases using only homeopathy the mean survival time is 92 months. Out of 20 cases also using chemo and radiation the mean survival time is 20 months.

      Pharmacy students would add tremendously to their understanding of the treatment of cancer by reading about the work at PBHRF.

      cdn.intechopen.com/pdfs/26491/InTech-Homeopathy_treatment_of_cancer_with_the_banerji_protocols.pdf

      • Walter jr. says:

        «The dosage of Ruta 6 prescribed for our patients was two
        drops (about 100 µl) in a teaspoonful (about 5 ml) of drinking
        water taken orally twice a day. The usual dose of Ca3(PO4)2
        prescribed was 5 grains (~0.324 g) taken orally twice a day.»

        So that would actually be 648mg of calcium phosphate/day. Sounds like quite a high dose for homeopathy no?

      • ChristyRedd says:

        Walter, please do read the Banerji’s description of their own protocols as they have noted them on their own web site. Once again, the protocol for treating brain tumors is Ruta 6 and Calc phos 3x. Remember that each remedy has already been potentized before administration. Additionally, one drop of a potentized remedy in a teaspoon of water further reduces the number of nano-particles of the substance administered to the patient and is, again, a homeopathic dose.

    • ChristyRedd says:

      To address your comments on the paper “Ruta 6 selectively induces cell death in brain cancer cells but proliferation in normal peripheral blood lymphocytes: A novel treatment for human brain cancer” I’m going to draw material directly from the paper itself rather than depending on your link to an op-ed piece.

      This was a treatment program — not a trial — so randomization and placebos would not be part of the program. The treatment program involved 15 patients diagnosed with intracranial tumors. The paper states “Of these 15 patients, 8 of the 9 glioma patients showed complete regression of tumors, one patient showed partial regression. Two of the three patients with meningiomas showed prolonged arrest of their tumors. The third had complete regression. One patient with craniopharyngioma and one with pituitary tumors showed complete regression. One patient with neurinoma had prolonged arrest of the tumor.”

      Also from the paper “……Ruta inhibits the growth of human glioma brain cancer cells and induces complete regression.” The paper goes on to give more details of the effects of Ruta 6 on cancer cells.

      http://www.labhomeopatico.com/articulo1ing.pdf

  5. What’s amazing to me are the apparent prerequisites for pharmacy students at the U of M requiring hypocrisy, blindness and ignorance of science, and like lemmings any gesture commands them. Apparently they are taught to jump without looking, speak without thinking or, against their own natural instincts, conscience and better judgment, just do what they’re told to do by the criminal drug cartels, keep their mouths shut, fill the prescription and murder another human being, knowing full well that the pills they peddle are toxic. Or do they know? According to the AMA, 100,000 people a year die in hospitals from “properly prescribed” and “properly administered” pharmaceuticals. Good grief, no wonder they think that supramolecular pharmaceuticals as used in homeopathic medicine are not evidence based . . I guess its a cse of misery seeking company: Behind every school yard mass murder is a grinning pharmacist pushing fluorexetine or some patent like it. Any homeopath could predict the results of what would happen with halogen toxicity and iodine depletion induced by pills handed to the victim by a pharmacist. As for supramoleculars, the evidence of action for these “implausible” substances is easily evidenced simple self administration, as prescribed! Why do they think homeopathy has such enthusiastic devotees? Do they think that it comes from reading the many science papers that drive homeopathy haters beserk when these papers show in vitro action demonstrably beyond the reach of the “placebo” effect? And BTW, where IS the scinetific evidence for the placebo effect in homeopathy? No, I use homeopathy because it works for me, my family and my pets. It even works on my plants. I am certainly pleased that some scientists are honest enough to report successful replications of biochemical tests of supramoleculars (Witt,tinyurl com/7n9sedq) but I don’t need them to know that it works. So this repeated bashing of homeopathy in the face of overwhelming pre-clinical and clinical evidence is a solicitation of malice and is actionable. Rejecting two centuries of evidence observed by medical doctors, Nobel laureates and millions of users is not just stupid, it’s genocide. Pharmacists, stop the doping and start the curing, use homeopathy.
    Here are links to peer reviewed studies:
    Am J Pharm Educ tinyurl com/7htoejq
    Int J Onc tinyurl com/7n9939c tinyurl com/6m2dpnd
    Integr Cancer Ther tinyurl com/7r7zajg
    Arch Otolaryngol Head Neck Surg tinyurl com/cb88aym
    UK Parliament tinyurl com/7666q5g
    Nature tinyurl com/6rc3jy tinyurl com/7aelcv9
    Inflam Res. tinyurl com/6fj9jsn
    BMC Public Health tinyurl com/7r7zajg
    Lancet tinyurl com/84xt56k
    NY Acad Sci.tinyurl com/6w7t4bf
    RHINITIS BMJ2000;321:471 tinyurl com/bemiring
    http://johnbenneth.wordpress.com

  6. Walter jr. says:

    «Why do they think homeopathy has such enthusiastic devotees?» Making money with water is the first thing that comes to mind…

    Evidence-based medicine is exactly that: making choices based on solid evidence. Solid evidence does not mean treating people by the «it works for me» method, neither by the «it worked on my cell culture» method or even by the «it helped my 15 patients in this treatment protocol» method. Can you please direct me towards a large, randomized, placebo-controlled, clinical trial for a homeopathic remedy? If solid clinical evidence demonstrates it’s effectiveness then I will be happy change my mind on the subject. That’s what being skeptical is, needing proof and ignoring fear and emotion based arguments.

    • @Walter Jr something for you to consider:

      In the past reports from the Scottish Office Department of Health have recommended further exploration of the integration of some complementary therapies, including homeopathy, more fully into health care. A pilot study of 700 patients was undertaken in Northern Ireland, and evaluated by the Department of Health in 2008.

      Their report (source below in PDF format -146 pages) concluded that the addition of homeopathic treatment not only benefited patients, but it also gave respite to GPs. The patients were able to learn and acquire self-management strategies to manage and further improve their health. The participating GPs indicated that they did not need to provide follow-up care to these patients as often and the patients required less medication.

      Source: http://www.dhsspsni.gov.uk/final_report_from_smr_on_the_cam_pilot_project_-_may_2008.pdf

      Similar comparison studies, based on cost effectiveness, patient survival and treatment outcomes, should be funded. But then the results would not be so favorable to the pharmaceutical industry’s approach to health care would it?

      One other fact you might well consider:

      The health care industry is a for profit driven entity. The health care consumers are more well educated with regard to their health care options. Why? Because conventional medicine has failed them. They are opting to spend their money on what works. Nothing sells better than sex and success. Homeopathy offers success over hype and failure. My advice to you young man would be to include homeopathy in your studies.

    • You can cry and complain about my beliefs and make yourself look stupid all you want. You can construe what you think is evidence and pretend to be an authority on it, but the most it amounts to is obstructing people of their rights to choose what they feel is the best medicine for them by their own experience. But you say you want to see large, randomized placebo controlled trials, and the first response to it is that I don’t think you do. When provided, I don’t think it will make any difference to you, you’ll simply look for other things to harass me and other homeopaths about. My second reaction is a question: If I provide this information to you, then, if you are so “scientific,” why did you have to ask someone else, who you have construed to be unscientific, for your answer, when you could have found it yourself? The reason I think is because you have assumed large clinical studies for homeopathy don’t exist and think you have a gotcha. In other words, you are being beaten in this argument everywhere you turn but you insist on continuing to get pasted. My third reaction to your antagonism, is to this false pride in what you think is skepticism. If you had a truly skeptical, thinking approach to this you’d see your prejudices for what they are and you wouldn’t be harassing us. You imply a standard of proof, you imply there are “scientific criteria” but where are those criteria in the crap you‘re peddling? Take Risperdal, for example. The makers are now getting sued because Risperdal has caused gynecomastia, the growth of feminoid breasts in males. Where were all your gold standard, large cohort medical RCTs for Risperdal? Why didn’t YOUR people discover gynecomastia before subjecting their victims to it? It would have been disovered if a proper RCT had been conducted. Or did they and don’t care?
      Now here’s what you’re asking for . . But let me tell you first, there’s no better way to learn about homeopathy than to try it. Go to a good pharmacy and buy a tube of Boiron’s Lycopodium, 6C or 30C, and start taking it, two or three pellets under the tongue, once a day and notice what happens, see if it has an effect on you after a week.
      Here’s a large study done by the Germans, commissioned by the insurance industry. As a result of this Belgium has just required that all homeopathic prescriptions be administered by homeopathically trained medical doctors . .
      BMC Public Health.
      WITT: Homeopathic medical practice: long-term results of a cohort study with 3981 patients.
      Witt CM, Lüdtke R, Baur R, Willich SN.
      Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, D-10098 Berlin, Germany
      http://www.ncbi.nlm.nih.gov/pubmed/16266440
      BACKGROUND: On the range of diagnoses, course of treatment, and long-term outcome in patients who chose to receive homeopathic medical treatment very little is known. We investigated homeopathic practice in an industrialized country under everyday conditions. METHODS: In a prospective, multicentre cohort study with 103 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data from all patients (age > 1 year) consulting the physician for the first time were observed. The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10) and quality of life at baseline, and after 3, 12, and 24 months. RESULTS: A total of 3,981 patients were studied including 2,851 adults (29% men, mean age 42.5 +/- 13.1 years; 71% women, 39.9 +/- 12.4 years) and 1,130 children (52% boys, 6.5 +/- 3.9 years; 48% girls, 7.0 +/- 4.3 years). Ninety-seven percent of all diagnoses were chronic with an average duration of 8.8 +/- 8 years. The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children. Disease severity decreased significantly (p 1 year) consulting the physician for the first time were observed. The main outcome measures were: The patients’ perceived change in complaint severity (numeric rating scales from 0 = no complaint to 10 = maximal severity) and quality of life as measured by the SF-36 at baseline, and after 2 and 8 years. RESULTS: A total of 3,709 patients were studied, 73% (2,722 adults, 72.8% female, age at baseline 41.0 +/- 12.3; 819 children, 48.4% female, age 6.5 +/- 4.0) contributed data to the 8-year follow-up. The most frequent diagnoses were allergic rhinitis and headache in adults, and atopic dermatitis and multiple recurrent infections in children. Disease severity decreased significantly (p < 0.001) between baseline, 2 and 8 years (adults from 6.2 +/- 1.7 to 2.9 +/- 2.2 and 2.7 +/- 2.1; children from 6.1 +/- 1.8 to 2.1 +/- 2.0 and 1.7 +/- 1.9). Physical and mental quality of life sores also increased considerably. Younger age, female gender and more severe disease at baseline were factors predictive of better therapeutic success. CONCLUSION: Patients who seek homeopathic treatment are likely to improve considerably. These effects persist for as long as 8 years.
      http://www.biomedcentral.com/1471-2458/8/413/abstract

      Now, since you’ll be crying about placebos and double blinds, take a look at the Witt study of biochemical testing, the best way to determine if homeopathics are placebos. But once again, as outlandish and unproven is the palcebo hypothesis, which you can’t prvode any proof for (your criteria) what does it matter in the end result if it is? The best way to prove homeopathy is to try it yourself. There’s nothing more dishonest than to say it doesn’t work without putting it to the test yourself.
      2007 The in vitro evidence for an effect of high homeopathic potencies–a systematic review of the literature. http://www.nationalcenterforhomeopathy.org/files/in-vitro-evidence-high-potency.pdf

      johnbenneth.wordpress.com

    • ChristyRedd says:

      “Evidence-based medicine is exactly that: making choices based on solid evidence. Solid evidence does not mean treating people by the…….”. Good of you to bring up the subject of “evidence based” medicine. I have to guess that you’re attempting to imply that con med is evidence-based medicine (in the positive sense of the term), which, BTW, it is most emphatically not.

      The most recent analysis conducted by the BMJ involved 3,000 common treatments offered on the NHS. It concluded that only 11% — yes, 11% — are actually evidence based, that is, proven to be beneficial. The BMJ added a notation to that analysis which reads: “However, the figures above (those shown in the pie chart at the link below) suggest that the research community has a large task ahead and that MOST DECISIONS ABOUT TREATMENTS STILL REST ON THE INDIVIDUAL JUDGEMENTS OF CLINICIANS AND PATIENTS.” Walter, make especial note of the words “clinicians” and “patients”.

      http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

      So even the BMJ disputes your claim that clinical experience is worthless.

      If you were genuinely interested in homeopathic research, you would have–on your own–looked at the over 300 studies published in 119 respected, peer-reviewed journals showing homeopathy produces significant to substantial health benefits. You would know that there are studies showing homeopathy is superior to con med, studies like these one:

      http://www.ncbi.nlm.nih.gov/pubmed/14960096

      and this one:

      http://www.ncbi.nlm.nih.gov/pubmed/

      I will have to respond to your request for studies in the same way I have responded to other skeptics using that approach: Do your own research.

    • Avicenna says:

      @Sandra Courtney and @ChristyRedd

      Both of you still haven’t answered Walter’s question to provide an example of at least one large rigorous trial supporting homeopathy. The references you provide are only surveys, not trials. They don’t even seem to have any experimental data at all. It proves nothing about homeopathy being clinically beneficial.

      And the comment about BMJ (Clinical Evidence) website is also misleading:

      “AND WHAT DO OUR CATEGORISATIONS MEAN IN RELATION TO CLINICAL PRACTICE?
      We would like to emphasise that our categorisation of the effectiveness of treatments does not identify how often evidence-based and non-evidence-based treatments are used in practise. We only highlight how evidence based treatments are for certain indications, based on randomised controlled trials. As such, these data reflect how different treatments stand up evidence-based medicine and are not an audit of the extent to which treatments are used in practice or for other indications not assessed in Clinical Evidence.”

      So, to say that only 11% of the 3000 treatments on the NHS are evidence based is false primarily because this figure does not account for the rate of which those treatments are used in unproven conditions. For example, the antidepressant paroxetine is evidently effective in major depressive disorders for which the large majority of prescriptions are written for in everyday practice. But on the less frequent occasions where it is prescribed for a short period of time for off-label indications such as diabetic neuropathy or fibromyalgia, for example, the evidence is less clear. The BMJ article does not account for this.

      • I gave you a whole list of links in one post, which you haven’t had anything to sasy about, and then tried posting an extensive answer with two large cohort trials and a review of biochemical tests, but now it says it’s “awaiting moderation.” Apparently the author of this blog doesn’t want such overwhelming evidence to be part of this “discussion.”

    • Yes, and none of them test the placebo response for the action of placebo, All the tests for homeopathy are tests for verum. Placebo is universally a stochastic measure, applicable to any kind of treatment, allopathic as well. Under comparative tests results, homoeopathic trials fare almost exactly the same as allopathic:
      MILGROM: … “It is disappointing you [Rod Liddle, although this could be directed to Scott Gavura and other ignorant critics as well] accept so uncritically the claims of sceptics that there is no scientific basis for homeopathy. Have you ever bothered to investigate this for yourself? Thus, by end of 2010, 156 Randomised Controlled Trials (RCTs) of homeopathy (on 75 different medical conditions) had been published in peer-reviewed journals of which 41% had a balance of positive evidence, 7% had a balance of negative evidence, and 52% were not conclusively positive or negative [24].

      “A cursory glance at these statistics might cause one to think the ratio of positive to negative trials was clearly in homeopathy’s favour … except when one takes into account the number of trials for which no conclusions either way can be drawn, i.e., >50%. But when one then looks at similar statistics for RCTs of conventional medicine, something odd appears. So data, obtained from an analysis of 1016 systematic reviews of RCTs of conventional medicine, indicate that 44% of the reviews concluded that the interventions studied were likely to be beneficial (positive), 7% concluded that the interventions were likely to be harmful (negative), and 49% reported
      that the evidence did not support either benefit or harm (non-conclusive) [25].

      “Note this, Rod [Scott], because obtaining such a similar spread of statistics regardless of the therapeutic modality would suggest:
      a) Homeopathy fairs no better or worse in RCTs than conventional
      medicine. Therefore, rejecting homeopathy on RCT data is false and biased as many conventional drugs/procedures should on that basis be similarly rejected but aren’t.
      b) There is something fundamentally wrong with the RCT (and those who claim it to be a ‘gold standard’), when around 50% of all RCTs fail to deliver a clear result.

      “So the evidence suggests that at the very least, there is disagreement
      over the effects of homeopathic medicines and how high dilutions work. Thus, a more rational Rod Liddle [Scott Gavura] would have concluded that as with many conventional medical procedures, homeopathy is of uncertain efficacy. And even if it were just a placebo, homeopathy would still be far cheaper than Prozac, currently favoured by the NHS and recently shown to be no better than placebo [26]! Together with the by-now, well-known systemic and systematic, long-term abuse of science in medical and pharmacological research [27–29], you could have eviscerated so-called sceptics who ‘protesteth too much’ over homeopathy. Instead, how disappointing you’ve now joined their ranks.”…

      From Forsch Komplementmed 2012;19:120–122, Lionel Milgrom, “Homeopathy UK: ‘The Sick Man of Europe’?”
      Used by permnission for scholarly review,

      Lionel Milgrom is a British chemist, homoeopath and leading authority on homoeopathy research, author of “Conflict: Homeopathy and Science on Trial.” now available through Amazon.

  7. Walter jr. says:

    I respectfully think we will have to disagree on this one though. In turn, what helps the patient get better is the way to go. The important thing to remember is to know when to refer patients to other resources when we hit our limits as clinicians and put the patient’s interest first, not our own.

  8. Avicenna says:

    @johnbenneth

    “Scott Gavura misses reference to a comprehensive review of the literature on homeopathy performed by pharmacists for pharmacists…(Johnson and Boon, Am J Pharm Educ. 2007: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847554/)”

    That review is about a poor exercise in critical thinking as you can get. The authors state that multiple meta-analysis show beneficial effects of homeopathy but fail to acknowledge that all of those analysis are mostly made up of poor quality randomized trials. This is the most important issue in meta-analysis: if you analyze poorly done trials, the results will be inconclusive. This is because poorly designed trial will almost always show false positive results (type-1 error). Just look at figure 1: ALL of the meta-analysis relied on weak trials and those who separated the better ones show homeopathy to be about as effective as placebo (see Shang et al.). This is an obvious interpretation of the evidence that is somehow lost on the reviewers.

    “According to the AMA, 100,000 people a year die in hospitals from “properly prescribed” and “properly administered” pharmaceuticals…”

    Misleading: this number comes not from the AMA but the Institute of Medicine’s 2000 report “To err is Human” (http://www.nap.edu/catalog.php?record_id=9728). The report estimated that somewhere from 44 000 to 98 000 preventable deaths are due to medical errors – stuff like missed diagnosis, hospital-bourne infections, surgeries – where medication-related deaths are estimated to be around 7 000 annually, only a small fraction. Moreover, anyone can appreciate that this number pales in comparison to the deaths prevented from modern medicine. You can’t reasonably state that medications can have adverse events without stating the benefits they’re associated with. Its disingenuous to do so.

    The issue Scott is raising in this post is what are pharmacists are supposed to be trained in school. It would be a complete shame and disgrace to the profession if we are taught implausible, unproven and ineffective “therapies” like homeopathy. What students need to be taught are pharmacological treatments that are supported by fair tests (e.g.: rigorous randomized controlled trials) which form the basis of standards of practice. Also, I would argue that all pharmacy schools must have critical appraisal courses or evidence based practice incorporated in the curriculum so that students have the critical thinking tools to see most of alternative medicine, such as homeopathy, for what it truly is: placebos.

    • Does not matter what the skeptics think any longer. The health care industry is a market, for profit, driven entity. The skeptics have been fighting homeopathy for the past 250 years and they are still not making a dent in the use of homeopathy.

      “The skeptics are losing ground…., an article by John Benneth:

      http://johnbenneth.wordpress.com/2013/10/19/how-the-homeopath-became-king-british-medical-journal-tumbles-to-homeopathy/

      and this

      “Homeopathy, the skeptics: How effective are they really?”

      http://fighting-for-homeopathy.blogspot.com/p/editorial-comments.html

    • “Avicenna” writes: “That review [Johnson Boone] is about a poor exercise in critical thinking as you can get. The authors state that multiple meta-analysis show beneficial effects of homeopathy but fail to acknowledge that all of those analysis are mostly made up of poor quality randomized trials.”

      Alright, let’s talk about critical thinking for a momement. This kind of rebuttal to anything that shows homoeopathy having a positive effect is so common among self annointed “logical thinkers” like “Avicenna” that it is like a long march down memory lane to hear it once again.

      Attacks on homoeopathy are always motivated by a desire to project guilt onto a medical doctrine that threatens the pharmaceutical industry and the whores that work for them.

      They never hold the products they peddle to the same critieria as they do for homeopathics. Pre-clincial tests? Why is it they never mention in vitro pre-clinical tests? Because pre-clicnal in vitro tests prove ionized pharmaceuticals, as used in homoeopathy, are not placebos! And proper testing of non ionized pharracetuicals would prohibit their sale.

      So they say, “homeopathy is ineffective.” At what? Killing people? Homoeopathy is the most effective medicine there is in the world for CURING people.

      If the health scare industry was honest about medicine, they wouldn’t be able to sell their product!

      Subconciously the health scare industry “professional” is saying to himself, “Homoeopathy must be stopped! If it keeps growing at the current rate, I’ll be out of a job!”

      According to the CDC, “in 2007 approximately 27,000 unintentional drug overdose deaths occurred in the United States, one death every 19 minutes. Prescription drug abuse is the fastest growing drug problem in the United States. The increase in unintentional drug overdose death rates in recent years has been driven by increased use of a class of prescription drugs called “opioid analgesics.” Since 2003, more overdose deaths have involved “opioid analgesics” than heroin and cocaine combined. In addition, for every unintentional overdose death related to an “opioid analgesic,” nine persons are admitted for substance abuse treatment (2), 35 visit emergency departments, 161 report drug abuse or dependence, and 461 report nonmedical use of painkillers.

      Three of the most dangerous antibiotics that have been prescribed have been levofloxacin, vancomycin hydrochloride, trimethoprim and sulfamethoxazole. Antibiotics like ciprofloxacin, moxifloxacin HCL and ofloxacin have caused severe and permanent disability whereas HPUS ionized pharmaceuticals have long been used by homoeopathically trained physicians to treat any number of epidemic and clinical diseases currently being treated allopathically with antibiotics.

      The deadliest modern non-ionized drugs are those in the antipsychotic class. These drugs are now being implicated more and more in the rash of sudden bizarrre mass murders that are occuring almost daily now. Antipsychotics increase blood sugar, lipid and cholesterol levels, and weight gain, but, more disturbingly, these commonly prescribed drugs are driving people clinically insane, whereas homoeopathy has an extensive repertory of known symtpoms indicating an empirically known materia medica for emotional probelms and neural diseases.

      The list of harmful non ionized drugs and the corporations that make them under criminal indictment goes on and on. If real health professionals were doing their jobs, they would be moving over to a class of curative medicine and the use of safe, effective, ionized pharmaceuticals.

      John Benneth
      scienceofhomeopathy.com
      johnbenneth.wordpress.com

      • …you do know that a large proportion of pharmaceuticals are formulated as salts for increased solubility, right? They ionize when dissolved in water.

        Or are you just using the word “ionization” to represent something completely different?

  9. Hi, I’m a third year student at the University of Manitoba. Quick question for Scott.

    Scenario: A patient walks into a community pharmacy asking for a homeopathic product for a minor condition. I inform that patient that 1) this particular product has no evidence of efficacy, 2) homeopathy in general has little evidence of efficacy, and 3) that there are over-the-counter or prescription drugs which could fulfill their need better. The patient tells me that they are using a prescription drug for the same condition already, but they would feel more comfortable if they were also concurrently using a homeopathic product.

    Question: If that patient already knows that there is little evidence of efficacy and agrees to continue with their prescribed treatment, but they still want the homeopathic product because it “makes them feel better,” should I deny that customer a homeopathic product?

    I’m not asking because I support the use of “alternative systems” for the treatment of disease. If a patient just wants to use a homeopathic product or an herbal product (and there are no interactions, contraindications, etc.) for what basically amounts to recreational and comfort reasons (not as a treatment), and they are receiving the appropriate scientifically-based treatment and agree to continue with that treatment, is it still unethical to sell that product?

    • Ryan R. Persaud on November 6, 2013 writes: “…you do know that a large proportion of pharmaceuticals are formulated as salts for increased solubility, right? They ionize when dissolved in water. Or are you just using the word “ionization” to represent something completely different?”

      No, we’re on the same page, aqueous solutions are self ionizing. It has been said that the genius of Hahnemann was in discovering the method by which to make the insoluble soluble, but it could be more distinct in saying that he found out how to convert it to plasma.

      The stumbling block for pharmaceutical pseudoscience so abundantly represented here by people like David Colquhoun, “Avicenna” and Scott Gavura is ignorance of phase changes. Avogadro’s limit is taken by them to represent what they think the limit of of biological efficacy of a solution should be when in fact 10^23 is the threshold between the gas and the plasma phase of matter. When this point is understood they will fall back to insisting that specificity is gradually lost in a linear phase change. Not only does the evidence not support their hypotheses but it does not logically follow that phase changes will not retain biological influences from one phase to another. Specificity may change but it is not lost in the other three phase changes of aqueous solutions, why should it be lost in the fourth? And the phase change of the solution in water is not linear. Dielectric tests show that the oscillation of the supercurrent begins at 10^7.

    • I wrote about that exact issue in my post Placebos as Medicine: The Ethics of Homeopathy. In short I am not supportive of the sale of homeopathy in the pharmacy setting because it gives these products a undeserved veneer of scientific legitimacy. We not only have a ethical responsibility to disclose that homeopathy is not a real treatment option, we have an ethic responsibility to not be selling products without active ingredients.

      • I would agree that it would be ideal to remove homeopathic products and natural products that lack evidence of efficacy.

        Just to play devil’s advocate:

        If we did remove those products completely, wouldn’t we run the risk of patients spending more time with alternative/integrative health practitioners and less time being supervised by proper healthcare professionals (such as pharmacists)?

        For instance, a patient reads an article online which claims that tea tree oil is an all-natural cure for lice. If we sell it in the pharmacy, we can at least intervene. If we don’t, the patient ends up going to a natural product store without the opportunity for us to educate them about the lack of efficacy or the opportunity for us to suggest a product backed by actual evidence.

        At the very least, we’d be able to identify the patients who are purchasing ineffective products and make sure that they are getting the most effective science-based treatment (in addition to, if not instead of, an ineffective product).

        This isn’t a problem that can be sold by just yanking the products out of pharmacies. We need Health Canada to start regulating these products properly. Without restrictions on the distribution of these products, patients can always get them from someone else.

        Looking at practice today, could the selling of homeopathic and natural products in pharmacies be the lesser of two awful situations?

      • That’s one of the arguments that pharmacists used to justify selling cigarettes. “We can help them quit,” some argued.

        Ask yourself how confident you’d be if your physician’s office offered homeopathy for self selection. You’d draw one of two conclusions: either they’re ignorant of the scientific evidence, or they’re ignoring it and selling sugar pills to make a profit off their patients’ ignorance. Neither would generate much confidence in their ethics or judgement. As a health professional you have an ethical responsibility to act in the best interests of your patient, and that includes what you decide to draw profit from in your store.

      • Haha, I’m guessing you’re not a huge fan of pharmacies selling potato chips and soda. I agree with you, Scott. Hopefully we’ll either get the corporations on board or see a change in the regulations.

        On a side note, I really enjoy your blog. It’s definitely given me a lot to think about regarding my future practice as a pharmacist. :)

      • I don’t have as much as a problem with chips and soda, because unlike homeopathy, no-one is purporting magical health benefits.

      • Avicenna says:

        @Ryan,

        The only thing I would add is this particular scenario rarely plays out like that if you state explicitly something like: 1) basic test tube science tells us homeopathy is impossible (implausibility) and 2) the better human studies consistently show its no better than taking a sugar pill.

        The reason I think most of those patients don’t end up with that purchase after is that this explanation leave them fully professionally informed of the cognitive dissonance behind homeopathy, yet leaves the ethical decision fully into the hands of the consenting patient that what they’re considering purchasing is a placebo.

  10. @Ryan Persaud

    “If we did remove those products completely, wouldn’t we run the risk of patients spending more time with alternative/integrative health practitioners.

    Yes.

    “and less time being supervised by proper healthcare professionals (such as pharmacists)? ”

    Are pharmacists in Canada able to examine and prescribe medications for patients? Otherwise, that would not be a proper role for a pharmacist to assume.

    “At the very least, we’d be able to identify the patients who are purchasing ineffective products and make sure that they are getting the most effective science-based treatment (in addition to, if not instead of, an ineffective product). ”

    Obviously you believe the pabulum you have been fed by your professors and have never consulted a homeopath, studied homeopathy or taken a remedy such as Arnica yourself. Therefore, your opinion that homeopathic remedies are ineffective is grossly flawed.

    “Without restrictions on the distribution of these products, patients can always get them from someone else. ”

    Yes, patients already do get them from someone or somewhere else. Cutting off your nose to spite your face is nonsense. The health care industry is a market driven entity. Without “supervision” the health care consumers have and will continue to spend their money where it does the most good.

    • Right on, helps4hardtimes!

      These pharmacidal maniacs have got to believe the crap they push over counters is the only thing that can save humanity, or their famous high suicide rate would be exponential of what it is now.

      Everyone of them would go into a funk, blow their brains out or become homoeopaths if they took Arnica 10M pellets dissolved in a teaspoon of water, aggravated and turned beet red . . and it wouldn’t be from shame. If people like Scott Gavura had to admit homoeopathy is real medicine they’d curl up into the fetal position and start sucking their thumbs.

      Like they say about democracy, it may be a lousy form of government, but it’s the best one there is, until “is” becomes “was,” then what? It’s lemming time. And so the same is true about modern pharmacide when a better, more humane, more effective form of medicine threatens to replace it. And so now they want to talk about ethics. LOL! Lethal injections, $100-a-pop poisoned pills, toxic synthesized chemicals pushed over a drug store counter as “medicine” along with disposable diapers, candy and soda pop as the only answer to health scare, is a crime against humanity. The more the public learns about homoeopathy, curative real medicine, the more lawsuits, indictments and prison time there will be for these pharmacidal killers.

      This is why they kill themselves. If they weren’t killing so many people I’d say let their mouths run without rebuttal, let the dogs bark, criticism from anyone so stupid can only make people want to try it . . “if he hates it, it must be good.”

      Keep the faith and stand your ground against pharmapunks like Scott Gavura and the crap he peddles, and the failure rate for U of M grads will be what it should be . . astronomical.

  11. Lisa Lynn says:

    UBC Pharmacy Student chiming in here, mostly just trying to clarify some misunderstanding about what students are learning in Canada, although it’s nice to see that my counterparts in Manitoba and Montreal are already participating. I would just like to note than in our current curriculum, we are given numerous lectures and workshops on critical appraisal of literature and evidence-based medicine. We also do take a course on natural health products in our third year. Granted, there are so many NHPs out there that one course cannot simply sift through the evidence for them all, but my point is that we are receiving some form of guidance on what NHPs are commonly used by patients to treat certain conditions and what type of evidence exists regarding their safety and efficacy. Generally, it is left up to us to decide, at the end of the day, what we would be willing and not willing to recommend to a patient based on what has been presented to us or what evidence we have found for ourselves. We have also had guest lectures from a TCM practitioner as well as a Naturopathic Doctor, so we also have had the opportunity to try and understand the practices of alternative practitioners. There are definitely some ethical issues that come up in our discussions and it at the end of the day it is difficult to find the balance between imposing your own viewpoints on a particular product on a patient and allowing them to make the final decision, especially when some products are definitely more contentious than others.

    That being said (full disclosure, this is my own personal experience and one hundred percent biased because of that): I have also worked alongside NDs, bowen therapy practitioners, and herbalists in the past and tried to be as open-minded as possible during that time, but have to say that I found no benefit in the herbal, bodywork, or homeopathic remedies that they provided to me. As such, it seems reasonable to me that the skepticism I gained from that is highly supported by the academic training I received on evidence-based medicine a few years later when I entered pharmacy school.

    Someone also asked if pharmacists are allowed to assess and prescribe medications for patients? Well, it depends where you are. In Alberta, where I am from and intend to return to practice, pharmacists can order lab tests and acquire prescribing authority within a certain scope of practice (and this goes beyond adapting prescriptions and making recommendations to doctors, among other things that pharmacists currently already do when appropriate). The scope of practice of pharmacists is evolving and my curriculum is already starting to to introduce further physical assessment skills (such as respiratory assessment) beyond just taking someone’s blood pressure. Pharmacists that are certified diabetes educators absolutely spend time assessing their patients. No, we are not trying to take away the role of physicians as diagnosticians, but yes, we are striving to utilize our full host of knowledge and training to contribute to and improve health care provided in the community, hospital, and other settings.

    • @Lisa Lynn,

      With all due respect, text book learning and listening to a few lectures is far from a credible education in homeopathy. The podium you speak from is setting on quicksand.

      I would like to challenge any one of the pharmacy students reading this article to sit in the waiting room of one homeopath for a few days. The following comment by Gill Hayes of the UK (quoted below, with source) typifies why homeopaths are so excited about what they can offer their patients. To see their patients improve is dramatic and addictive. One can understand why they continue to practice and why patients are seeking homeopathic health care, despite the skeptics’ opinions.

      “I have an Oxford degree in Zoology and qualified in Medicine at Southampton University in 1984. I have twenty-two years of uninterrupted, full-time Homeopathic experience.

      Homeopathy works. Brilliantly. The majority of illness is curable with Homeopathy. There is plenty of statistical proof. If critics sat in my clinic for as little as two days they would be convinced. The clinical results I see every day are fantastic.I have treated seventy patients a week for the last fifteen years. Patients are relieved from all manner of chronic, very long-standing diseases and considerable suffering. That is a fact. If conventional science cannot explain how, then the failing is in the science, not in the facts. Homeopathy works.”

      Source: http://spiked-online.com/index.php/wellcome/responses/5194

      • Sandra, thanks for posting this powerful testimonial and other great posts. I have also seen dramatic cures of chronic and fomrerly incurable problems using homoeopathy, some with OTC potencies, leaving patients and onlookers stunned and disbelieving that it could be accomplished so quickly using such inocuous looking materials.

        I also love how Gill Hayes says “if conventional science cannot explain how it works, then the failing is in the science . .” He’s right, although it is explanable in conventional scientific terms, the bashers just won’t hear it and the homoeopaths don’t need it to udnerstand how to cure. So the problem some people are having with homeopathy is not that it doesn’t work, the problem is that it does. Thanks for your great contribution to homoeopathy in sticking up for it with convincing evidence. Keep the faith and don’t back down from these clowns who say it doesn’t work. You’re on the winning side.
        John Benneth
        http://johnbenneth.wordpress.com

    • Hey Lisa, in Manitoba we’re also getting almost all of the same privileges as the pharmacists in Alberta (the regulations are still coming down the pipeline). It’ll be nice to have the authority to use my education to its fullest.

      At UM we’re also exposed to the broad spectrum of alternative/integrative health fields. We had a number of alternative/integrative practitioners give us guest lectures, including a homeopathic doctor, a naturopathic doctor, a chiropractor, and a MD who practices traditional Chinese medicine.

      We also learn about the products those practitioners would use, any potential interactions or contraindications, and how to evaluate the evidence surrounding those products.

      Just thought I’d throw that in there, haha.

    • ChristyRedd says:

      @Lisa Lynn:

      It’s interesting that skeptics of homeopathy refuse to consider clinical results as evidence for homeopathic efficacy and yet you’ve presented your own anecdotal story as evidence that homeopathy doesn’t work. You’ve even stated that your anecdote is supported by what you were taught about allopathic medicine. Homeopathy and conventional medicine are two very different systems of medicine. It is not at all scientific to claim that homeopathy doesn’t work because it does not work the way allopathic medicines work.

  12. ChristyRedd says:

    @Lisa Lynn:

    My own experience of homeopathy over the past 15 years is that it has been so successful, so safe and so inexpensive in my treatment of chronic problems, acute conditions and injuries that it is now my primary form of medicine.

    Con med could only offer addictive pills or pills with serious side effects to treat my chronic insomnia. Homeopathy safely, gently, permanently and inexpensively resolved this debilitating and frustrating problem. I’m so glad that I used it instead of a drug like Ambien. I would not want to be one of those people who woke up one morning to discover that they had driven a car and hit and killed a pedestrian or cooked an entire meal while they were sleeping.

    You state “I have also worked alongside ND’s, bowen therapy practitioners and herbalists….but have to say I found no benefit in the herbal, bodywork or homeopathic remedies they provided to me.”

    You are surely one of the very few people who have not benefited from those modalities, and considering the facts about them it is doubly amazing that you got no benefit from any of them.

    According to the WHO 70% to 90% of people world-wide use some form of alternative medicine. TCM is the most-used system of medicine in the world today and was chosen by the WHO for world-wide propagation to meet the heath care needs of the 21st century. Almost one-third of American medical schools (including Harvard, Johns Hopkins and Georgetown) offer course work in alternative medicine.

    http://library.thinkquest.org/24206/facts-stats.html
    http://www.who.int/mediacentre/factsheets/fs134/en/
    http://apps.who.int/medicinedocs/en/d/Js7916e

    Considering the vast numbers of people who benefit from bodywork and use it regularly because it does help them, it is odd that you did not find it helpful in any way.

    As far as homeopathy goes, it is puzzling that you are, again, one of the very few people who has not benefited from it. The WHO noted in its 2003-4 report “Homeopathy: Review and analysis on controlled clinical trials” that the majority of peer-reviewed scientific papers over the past 40 years “….have demonstrated that homeopathy is superior to placebo in placebo-controlled trials and is equivalent to conventional medicine in the treatment of illnesses in both humans and animals.”

    Today homeopathy is used over and over again — not just once, twice or even three times and then dropped — by 500 million people and is the second most-used system of medicine in the world because it is effective and safe as well as being inexpensive. For those very reasons it is recognized as a medical specialty or system of medicine and/or is supported on national health care programs by the governments of 19 countries.

    A special referendum held by the Swiss government showed that 87% of Swiss people wanted CAM including homeopathy to be covered by their national health care program and that 31% of the population had seen a CAM practitioner in the previous year.

    A health care revolution is taking place beneath your eyes. Ride with the tide or be left behind.

    • When someone comments that they “tried” a homeopathic remedy and “it didn’t work”, consider the following as the possible reason(s) there was no response:

      1. Wrong remedy.
      2. Wrong potency.
      3. Inexperienced homeopath.
      4. If you purchased an o.t.c. remedy that you did not properly research beforehand in one of the Materia Medicas, you failed, not the remedy.
      5. You antidoted a properly prescribed one by taking an allopathic pain killer, drinking coffee, using a camphor product, smoking cigarettes or by using recreational drugs such as marijuana.
      6. There are other precautions to take as well. See this article:
      http://www.classichomeopath.com/patient-resources/antidotes-to-avoid/
      7. Another all to common mistake inexperienced users of homeopathic remedies is that they expect a remedy to work quickly to suppress symptoms. This is the allopathic, not homeopathic approach to acute and chronic illness and disease. Homeopathic remdies, such as Sulphur can take from several months to years to cure disease using different potencies along the way, based on the “symptom picture” from month to month.

      • Anna says:

        Another reason it might not have worked was because you took a sugar pill with no active ingredients. But it’s also cool to keep moving goalposts so that you can blame the patient for being wrong, and not homeopathy.

        But really, if I want my infection cured, and not just the symptoms treated, I’ll make sure to take a homeopathic sugar pill, and not an antibiotic, even though an antibiotic actually treats the root causes of the disease rather than mask symptoms. Weird!

      • ChristyRedd says:

        @Anna:

        It is only skeptics of homeopathy who claim it doesn’t work, and I use the word “claim” for a reason — firstly, because homeopathy does work, and, secondly, because In actuality skeptics KNOW homeopathy works. That’s what frightens them. Homeopathy frightens and threatens all those individuals who have invested their careers in conventional medicine. It threatens the foundation of their beliefs and ideology, their reputations, their influence and their pocketbooks.

        That’s easy to see and understand when you consider the numbers of people who have been harmed (but never cured) by conventional treatments, the numbers of people who are seeing that the treatments they’ve been using are making them sicker and costing them a lot of money in the process and sometimes even ending in their unnecessary deaths.

        Governments are seeing that the way they’ve been approaching health care isn’t going to be sustainable because:

        Entire classifications of medicines are failing — the antibiotics you mention being one of them.

        Severe stress is being placed on their hospital systems which is made worse by having to hospitalize and treat patients for adverse drug reactions (this cost the UK government 2 BILLION pounds in 2010 alone)

        An aging population with chronic conditions which must be treated and currently at great expense

        The tide is turning — ride with it or be left behind.

      • ChristyRedd says:

        @Anna,

        To enlarge on what Sandra Courtney has posted, a CDC report confirms a link between the routine prophylactic use of antibiotics in farm animals and the growing bacterial resistance that is making human illnesses more and more difficult to treat. Bacteria have evolved and become resistant to conventional drugs as quickly as they can be developed.

        Organic farmers all over the world have a solution to this problem — homeopathy. It’s also being used in some conventional feed lots in Europe.

        A study was done by Albrecht and Schulte showing that homeopathy is far superior to antibiotics in preventing respiratory diseases. Using antibiotics made the condition less likely to occur by 11%. Using homeopathics made it 40% less likely to occur.

        http://www.ncbi.nlm.nih.gov/pubmed/10484832

  13. @Anna

    Because of the over prescribing of antibiotics for self-limiting conditions, super bugs have developed that are resistant to antibiotics. See: “Antibiotics Can’t Keep Up With ‘Nightmare’ Superbugs”

    http://www.npr.org/2013/10/22/239247134/antibiotics-cant-keep-up-with-nightmare-superbugs

    and then there is this:

    “Antibiotics can be lifesavers, but misuse has increased the number of drug-resistant germs. ”

    http://www.mayoclinic.com/health/antibiotics/FL00075

    The record is no better for the other chemical concoctions that pass randomized, double-blind, placebo controlled research (done by the very companies that produce them) before approval by the FDA and subsequent marketing. Let’s see, there are the steroids, anti-depressive and anti-anxiety drugs, mind controlling ones (Ritalin comes to mind – pun intended), blood pressure and cholesterol lowering medications and on, and on and on. Read the newspapers about the million dollar settlements by drug companies for permanent adverse side effects and/or death as a direct result of the pharmaceutical “wonder drugs” lately? Spare the readers here your old, tired talking points that are now DOA.

    • David says:

      You have provided nothing that shows homeopathy works or can work. Please provide evidence, no – not from homeopathy or altmed journals or anecdote, that shows homeopath is effective. (Oh, wait, you can’t.) Until you are able to overturn physics, chemistry, biology, and lastly scientific consensus if I want a sugar pill I will just buy some candy.

  14. nic says:

    @johnbenneth

    “I gave you a whole list of links in one post, which you haven’t had anything to sasy about…”

    -Even though we’ve given too much merit already, given your vile and ultra-non-diluted inflammatory statements, I’ll give you one more considerate look at your links on the odd chance they contain actual clinical trials or convincing evidence…

    1) Am J Pharm Educ tinyurl com/7htoejq

    -Already discussed

    2) Int J Onc tinyurl com/7n9939c

    – Not a clinical trial.

    3)tinyurl com/6m2dpnd

    -Also not a clinical trial. Only an in vitro trial with small case series mostly looking at patients with gliomas and meningioma ( 12 out of total 15 patients). Case series cannot establish causality since we can’t really say how likely those patient’s condition would have resolved on their own. Critically, theres no subtype of cancer or stage severity information, (e.g.: 8 out of 10 patients with meningiomas live for at least 5 years, see: http://www.cancerresearchuk.org/cancer-help/type/brain-tumour/treatment/statistics-and-outlook-for-brain-tumours#glioma)

    4)Integr Cancer Ther tinyurl com/7r7zajg

    -Not a clinical trial.This is a questionnaire-based survey of primary care physicians who had homeopathic “training”.The result isn’t even valid because most homeopaths are not physicians as is the case in this survey.

    5)Arch Otolaryngol Head Neck Surg tinyurl com/cb88aym

    – Finally, a clinical trial! However, its an equivalence trial which remains unconvincing primarily because it is not placebo controlled. They used an active comparator (betahistine), but without a true placebo comparison, the methodology used may have resulted in homeopathy AND betahistine no better than placebo anyways. The authors wrongly assumed of betahistine’s effectiveness in Meniere disease. There has been calls to retract this particular study because of this critical point. See: http://www.ncbi.nlm.nih.gov/pubmed/12707185

    6)UK Parliament tinyurl com/7666q5g

    -Not a clinical trial.

    7)Nature tinyurl com/6rc3jy

    -Link broken…

    8) tinyurl com/7aelcv9

    -Not a clinical trial.

    9)Inflam Res. tinyurl com/6fj9jsn

    -Not a clinical trial.

    10)BMC Public Health tinyurl com/7r7zajg

    -This is the same link as 4).

    11)Lancet tinyurl com/84xt56k

    -This links to an 1997 Lancet Meta-analysis that was included in 1). As I discussed, this meta-analysis included mostly poor quality trials. Further: the Lancet meta-analysis’s own authors state in the conclusion (Implications section): “Our study has no major implications for clinical practice because we found little evidence of effectiveness of any single homeopathic approach on any single clinical condition”. So, you just provided evidence that directly contradicts what you allege.

    12)NY Acad Sci.tinyurl com/6w7t4bf

    -Another broken link.

    13)RHINITIS BMJ2000;321:471 tinyurl com/bemiring

    -Assuming you meant this: http://www.bmj.com/content/321/7259/471 … This is a very small clinical trial which looks interesting but looks like it has many issues due to the extensive reader comments, see: http://www.bmj.com/content/321/7259/471?tab=responses. Critically, these results are strongly contradicted by a meta-analysis by Passalacqua et al. (see: http://www.ncbi.nlm.nih.gov/pubmed/16675332 ), where the authors state: ” Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed”.

  15. I don’t think there’s much of an argument about delusions being involved in homoeopathy. One of the pharmacy students here, Avicenna, seems to think there aren’t any in vitro tests that show the action ionized pharmaceuticals on biochemical products, when in fact there are six different types of tests, all of which have been replicated, one more than two dozen times! Another student, “Rics,” dimissed the link to a review of them as irrelevant. The reason for this cognitive dissonance, obviously, as the record will show, is that the biochemical tests demolish the placebo hypothesis for homoeopathics. But once again, to rehumanize the situation, there is a demand for these products because they work, not just in petri dishes for scientists, but in people, for people. So if you have expressed doubts about homoeopathy, I challenge you to put your prejudices aside and investigate further. No thinking, intelligent, compassionate person can do so without having respect for this doctrine.
    The Boiron blue tube display, or something like it, is the most powerful section of a pharmacy. Granted, it’s difficult to find the right remedy, but this is the one place where a person can find curative medicine in a ppharmacy that really works. A pharmacy isn’t complete without a good selection of classical single remedy homoeopathics, and there is no reason why a pharmacist, educated in homoeopathy, can’t help people select the right one for their overall condition, chronic or acute, and know when to recommend a person to a more competent homoeopath.
    If the modern pharmacist is dedicated to healing and serving his customers, he will include homoeopathy in his practice. And he will support testing of these materials.

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