Pharmacists, Pharmacies, Homeopathy, and Ethics

Is it ethical for a pharmacist to knowingly sell a mislabeled product – one that contains no active ingredient, and has been demonstrated to be no more effective than a placebo? That’s the question being asked by Dr. Chris MacDonald over at the Business Ethics blog today:

If someone selling something believes that it doesn’t work, should they tell you so? Does it matter if the person doing the selling is a licensed professional, someone with advanced training and a sworn duty to promote the public good?

Dr. MacDonald is referring to the fallout from the UK Parliament’s Science and Technology Committee Evidence Check on Homeopathy, which I’ve blogged about previously. As I pointed out in yesterday’s post, the regulatory body for pharmacists in Northern Ireland is acting on this report, and has proposed that patients be told that homeopathic products do not work, other than having a placebo effect.

Importantly, the Evidence Check made specific recommendations about pharmacies and pharmacists. Recall that Boots, Britain’s leading pharmacies, admitted to selling homeopathy simply because of consumer demand, despite the fact that there’s ample evidence to demonstrate homeopathy is a placebo treatment:

It is about consumer choice for us. A large number of our consumers actually do believe they are efficacious, but they are licensed medicinal products and, therefore, we believe it is right to make them available.

The Royal Pharmaceutical Society, pharmacy’s regulatory body, also acknowledged that there’s no scientific evidence to support homeopathy, but also argued for pharmacy sale:

We would contest it is better for the patient for pharmacists to be present […] because they are able, if appropriate, to offer advice to that patient, and there are two things that are important. It is important that patients should realise there is not any evidence for the particular preparations and, also, it gives the pharmacist an opportunity to ensure that the patient is not actually taking something unnecessary.

The committee rejected this argument, noting that the only advice an ethical pharmacist could give would be that the products are placebos. The Committee went on to make the following recommendations (bolding in original):

Although the availability of homeopathic products in pharmacies could be interpreted by patients as an endorsement of efficacy, in our view it would be pointless to seek to remove homeopathic products from sale in pharmacies. Many pharmacies sell ranges of non-evidence-based products and homeopathic products are easily available over the internet in any case. We consider that the way to deal with the sale of homeopathic products is to remove any medical claim and any implied endorsement of efficacy by the MHRA—other than where its evidential standards used to assess conventional medicines have been met—and for the labelling to make it explicit that there is no scientific evidence that homeopathic products work beyond the placebo effect.

What do you think? Is the sale of homeopathy in pharmacies appropriate and ethical? What does it say about the profession of pharmacy? Did the committee strike the right balance between the right of a pharmacy acting as a commercial enterprise, and the pharmacist’s responsibility to put the patient’s interest first? Is it more acceptable to sell homeopathy if it’s clearly labelled as a placebo?

Your comments are welcome, and I’ll revisit this topic in the future. Head over to Dr. MacDonald’s blog and share your perspective, too.

8 thoughts on “Pharmacists, Pharmacies, Homeopathy, and Ethics

  1. I think that any normal person would assume that anything sold within a pharmacy, labelled as a medicine has some medical benefit. It is not ethical to sell homeopathy, how can it be, it has no active ingredient. By allowing the continued sale, pharmacists are implicit in suggesting that it somehow has some effect. Science should not be promoting or endorsing such products, no matter what.

  2. I am from the US, and hope that what has happened in UK, Ireland and Canada with regards to homeopathy happens here. As one who has studied the purported methodology, as a required part of a training program, and abandoned it, because the deeper one gets into it the more obvious it is (if you are willing to see) that it has no effect beyond placebo effect (which is not to be dismissed), I am in agreement with the bolded recommendation above. It is true that a person goes to a pharmacy with the expectation that they are “getting something.” There is nothing in homeopathics to “get.” Even if the claims of its proponents that it is an advanced form of energy medicine are somehow true (and I don’t believe they are), the sale of homeopathics as they are now done would be unethical, as the means by which a homeopathic is prescribed by a trained practitioner of this method are intense and extensive and involving hours usually of patient interview and assessment before prescription. This is to say, the proponents make the case that there is a simillimum…..ONE perfect remedy for this individual person sitting before one, out of potentially thousands. The claim is made that if one does not get the perfect remedy, then it is perfectly logical to see no effect…and in some cases, to make the patient actually worse. Not because one is using physical forms, but because one is affecting their energetic core badly. So, on the simple fact that a patient can walk into a pharmacy and themselves with no training and no real knowledge beyond a simplistic label on each remedy choose to self -medicate with such a supposedly powerful material would itself be unethical. I’m surprised that the proponents of the methodology are not in agreement with the need to regulate on this basis, if in fact their materials work. It is just not true in their philosophy that the remedies “can’t hurt.”

    I stand, of course, on the ground that there is nothing there to “hurt” in the first place. And so one is selling to patients tiny amounts of specially handled water, and nothing else, with a promise to cure. All the arguments that the water has memory of positive content from an earlier time in its history are undercut with questions of why then the water does not remember nasty things which were in it, and the rejoinder that it remembers because there is progressively less and less of the material and at each lessening vigorously succussed (violently slammed) to encourage (force) the memory to imprint fly in the face of rationality.

    What is never, never addressed is that it flies in the face, also, of most traditional philosophy of body-mind energetics. That is, the disbelief that physical means can directly effect spiritual energies. The key word being direct. It is a bit out of place here, but in traditional understanding of humanity in the West, out of which homeopathy has come, the body and soul were intimately and *inextricably* joined but not intermingled, with the soul being the form of the body but being of higher capacity, *not* being able to be directly manipulated by physical means. Homeopathy makes a great deal of its ability to shift the spiritual energy of a person. I suppose one can say “like cures like,” in that if the homeopathic is indeed an energetic form, it could shift an energetic form. But then why are we starting with physical matter and using physical means to “force” the matter into spiritual form? That is backwards. To one trained in formal philosophy at least. Though, it is not backwards to an hubristic idea of human ability to influence the Divinity, or to actually be a form of the Divinity, as most old/new-age spiritism believes.

    But I digress! 😉

    An argument I’ve also noted, and agree with, though not seen developed deeply, is this: Because there is nothing in the mixture that is measurable by standard means, then there is no way to ensure that a patient is getting the “real thing,” and not just plain old water. That is, even if this stuff worked and we all believed it, how in pete’s sake is the pharmacist supposed to verify that what he or she is selling in the shop is even there, if there is nothing there to measure? How does he or she sleep at night not knowing whether what is being sold is a big, fat nothing??

    On all these grounds and more I am hoping that the regulation of homeopathic “medicines” continues, and grows. Insofar as the West rightly prides itself on being grounded in rational means, it must apply the same to this aberration in Western medical thought. Don’t let the emotional blackmail (at least as happens here in the States) claiming you are “not compassionate,” or “not evolved enough to understand,” and a host of others trying to divert the argument, prevail.

  3. JAOS said: “trying to divert the argument.”

    With homeopathy, you gotta put the really big boots on.

    Keep in mind that in science “energy” is measurable, it is physically registered inevitably.

    So I’m not sure what you mean by “body-mind energetics” or “spiritual energies.”

    You’ve acceded much to New Agers when you employ their linguistic misappropriations.

    sCAM euphemizes ‘spiritual’ quite incorrectly as ‘energy’ to falsely add a gloss of ‘factual’ / ’empirical’ to the whole thing.

    Whomever can truly do that surely has a Nobel Prize awaiting them.


  4. Hi, daijiyobu!

    Thanks. The “trying to divert the argument” is the typical tactic of the folks who support homeopathy, or, actually, other unproven CAM. (I don’t think it is all necessarily sCAM, though from being within the fold for awhile…..and extremely important and helpful time….. I do think the weight of it is that, or at least totally self deluded and therefore unethical for use on/with others)

    Did you misunderstand this phrase as being about “you,” meaning those of us who challenge homeopathy? That we are trying to divert the argument? I am not sure why you use it, seriously. I thought I was clear that I was pleading with those of us who know homeopathy does not work to refuse to wilt in the face of emotional (or other) attack.

    To speak in the terms of deluded folks does not mean one has acceded to them, it often shows them that you get what their fundamental proposals are. Then you can dismantle them. It is just a tactic. Others are also useful. I’ve brought a few folks over by not mocking them or their thought, but showing them systematically that it just ain’t so. It is a hard pill for them to swallow at first, there is a real, human sense of deflation, because the vast majority of folks using these methods are not manipulative, but instead really wanting to help. I usually start with a form of CAM that is outright sCAM even they see, and work with them from there. “The enemy of my enemy is my friend.” Takes time to do this but the conversions are deep and stick.

    I agree totally with you that the use of ‘spiritual’ incorrectly as ‘energy’ is false but I don’t think (again from being inside for awhile) that most of the folks who use it do it with as much deliberate smarts as you give credit for. Rather, they either believe the two are one (the fully deluded, many themselves sCAMMED over time with wishful thinking played out on them by other “practitioners” — often desperate people with their own troubles who tried one of these dicey techniques and convinced themselves it worked) OR, in some much more savvy and difficult persons, they use the term “spiritual” as a shield, figuring that by naming their work such they protect it against true and scientific critique.

    This is a little different from adding a gloss of factual/empirical, though **many** also use “spiritual” terms for that reason. You are right there.

    But some invoke the “spiritual” quite knowingly as a cloak against which many people will be afraid to challenge in our very relativistic society where any belief at all, especially in so-called “spiritual” matters, is ipso facto considered valid. They are less concerned with proving factuality as having that assumed for other reasons.

    Those who use the term this way use it knowing they can mock and shame and challenge anyone who pushes them to “show me the proof” by hiding under the term “spiritual” or its derivatives……and never need to address proof of any kind at all. They know that “spiritual” in the current New Age distortion (which you know I’m sure is a very old distortion simply arising again) is equivalent in the minds of most people with openness, goodness, enlightenment, kindness, and every other moniker which folks like to think they are. Make no mistake that the folks who use “spiritual” this way are counting on the upending of traditional use to also help upend society, whether for money, or power or narcissistic needs, or One-World political gain. Trust me, this latter is a big part of the game, there is an inherent hatred of the West in many of these folks and this is actually taught in the hones CAM as well as pure sCAM classes, in countless ways. Science and hard sensate knowledge = the hegemony of not only rigid individual people but systems which are against the “true evolution of humanity” in the minds of these people. And there are many of them.

    In some ways I am less concerned with the “only” scientific being finally and definitively vindicated in the minds of the vast majority of folks who’ve had their minds shifted by the tactics of sCAM as I am by what that hugely important victory will mean for the larger society. Remember I’m speaking as one who is considered an insider/semi-insider, and so see a side of this that many from the outside never do. Their guard is down with me. I can be “two-faced” with them in a very helpful way, for us.

    Please don’t take anything I’ve said as indicating what you’ve said is wrong. I’m not into a tit for tat argument. Your points are wholly valid. I’m simply adding in another layer here. It is I promise you a very unpleasant place to be, I do live with a good deal of anxiety because of where I am placed. I must be ruthlessly honest about the truth and yet find a way to speak it so that one does not lose those who themselves are beginning to see through the whole-cloth sCAM of sCAM. Often my best tactic is to appeal to what is in most folks a genuine desire to help and then show them where they are wrong. That is the only reason I use their terminology…….in my original essay, perhaps I erred in not using quotations to indicate I meant ironic usage for our audience.

    Many friendships have been lost in the press to help/make/plead with others to see that much of what they take for granted as good CAM is nothing but dangerous sCAM. Professional losses have and will also continue to occur. Never worry that I’ve acceded to the mess we are challenging. But thanks for the warning, it is indeed easy to slip over, for self-protective reasons.

    There is a saying I am fond of, and offer it here, for all of us: “To accept not to be loved: it is at this cost that one puts one’s mark on things.”

    I’d say carry on to all of us who are trying to re-erect common sense in the thinking of so many, in both science and medicine.

    My best to you.

  5. I’ve previously written on this topic (see link on my name), including the Northern Ireland stance. My own views are at the very least the bottles need to be accurately labelled in conventional units the *contents* (not the original ingredients) and that claims (for treatment, efficacy, etc.) cannot be made unless they can be substantiated.

    Personally I’d go further and have them removed from pharmacies, using pressure from the medical councils to the effect that they can’t both prescribe prescription-only drugs and non-evidenced products as the latter conflicts with the business of selling prescription medicine.

  6. Pharmacies here in Québec sold tobacco products until 1998, when the Québec court ruled that it was unethical. Tobacco products are effective but unsafe; homeopathic products are safe but known to be ineffective. No, they should not be sold in pharmacies.

  7. Dr. Samuel Hahnemann developed and perfected homeopathic practice for over 50 years. As a science it was founded on some very important principles which are both a guide to clinical work and a basis for ethical practice.


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