Do pharmacy regulators “get” homeopathy?

It’s on almost every pharmacy’s shelves. I’ve written at length about the problems with homeopathy in pharmacies. In fact, it was the subject of my very first post, over three years ago, where I described how homeopathy is an elaborate placebo system, with “remedies” that contain no active ingredients. Homeopathy was “invented” in the late 18th century, and is effectively a vitalistic belief system that rejects established facts about biochemistry, physics, and pharmacology. If homeopathy works, then real medicine as we know it cannot work. Over several posts, I’ve detailed the problems with the pharmacist provision of homeopathy:

• The “principles” that underlie homeopathy have never been proven. There have been no scientific advances in homeopathy since it was invented. Attempts to explain how homeopathy works are either bizarre or laughable.
• While the sale of homeopathy is permitted by Health Canada, the evidence standard for approval is effectively absent. Despite this, Health Canada grants individual approval numbers to indistinguishable sugar pill packages. It has led to products as ridiculous as homeopathic insect repellent.  Using fake products instead of real products have a real potential for harm.
• Consumers generally have the expectation that products sold in pharmacies and sold as if they were medicine, actually have medicinal effects. That’s not the case with homeopathy. By allowing the sale in pharmacies, these products are given a veneer of legitimacy by virtue of their proximity to pharmacists.
• From an ethical perspective, then, homeopathy serves as a disutility, wasting resources and redirecting patients away from valid treatments.
• For placebos to work, patients must believe something that is untrue – that homeopathy has medicinal effects. From a patient autonomy perspective, patients have the right to make informed decisions about treatments. Withholding information from consumers is unethical and paternalistic.
• Further to the points above, ethicist Dr. Chris MacDonald notes that pharmacists have an ethical obligation to not just be honest with customers about homeopathy, but to be candid about it. Just because consumers don’t ask, doesn’t make it ethically acceptable to sell homeopathy without disclosing information about its lack of effects.
• In the United Kingdom in 2009, the parliamentary science and technology evaluated the evidence supporting the sale of homeopathy. In public hearings, pharmacy chain Boots admitted it sold homeopathy not because it worked, but because consumers wanted it. “However they sugar it, you’re swallowing a delusion” was the headline in the Times. Another was “Distrust me, I’m a pharmacist”. The awareness is rising is Canada, risking the reputation of the profession.
• Some consumers and advocacy groups have had enough with this situation. In Canada, a class-action lawsuit has been launched against homeopathy manufacturer Boiron and Shoppers Drug Mart for selling the homeopathic product Oscillococcinum. The suit alleges that the firms have violated at least twelve consumer protection acts.

Homeopathy has no place in modern pharmacy practice, except perhaps as a case study in history, ethics or perhaps most appropriately, critical thinking. Despite the numerous problems that exist with the sale of these products, I’m unaware of any pharmacy regulator, worldwide, taking any voluntary action to limit or restrict their sale in pharmacies.

With all of this in mind, I was recently informed that I was required by my own pharmacy regulatory college to participate in the “Quality Assurance Program Practice Review”. As a registered pharmacist, I am required to maintain my professional competency to practice. It is my own responsibility to manage my professional development and life-long continuing education. My regulator has developed different tools to help pharmacists evaluate their own competency and to develop their own learning plans. It’s now a fairly elaborate process that must be completed every five years, and sections of analysis include standards of practice, communication, clinical knowledge, practice environment, and finally, an education action plan. In general, the assessment is fair – probing knowledge and understanding in a variety of areas, and helping pharmacists develop their own list for their personal development. Once you’ve completed the assessment, you’re required to document your learning plan for their review. Note one of the learning categories for pharmacists (click the image to enlarge):

Homeopathy? A category for learning? And “Herbals/Naturopathic Products”?  Naturopathy is a belief system with a similarly vitalistic, not scientific, philosophy. It is not a therapeutic category. And naturopathy is not a synonym for herbal. While naturopathy can include herbal products,the practice includes homeopathy.

If pharmacy regulators consider homeopathy to be a legitimate subject for professional development, then it’s probably unrealistic to expect pharmacy profession to ever address the ethical and professional issues I described above. Regulators have a responsibility to put the public interest first. Putting the public interest first should include committing the profession to meet science-based, professional standards.  And homeopathy is incompatible with a science-based practice standard.

Ironically, the Practice Review application shows me the learning goals I set back in 2008, and asks me to evaluated my progress against them. One of the objectives I set for myself, way back then?

How do I challenge the profession to stop the explicit and implicit support of non-evidence-based quackery such as homeopathy?

I’m marking that learning objective as “incomplete”. And I continue to wonder if the profession of pharmacy really “gets” the problems with homeopathy.

Pharmacists and other health professionals, what does your regulator think of homeopathy? Share your observations in the comments.

Photo from flickr user drtchock under a CC licence.