Homeopathy sold in Pharmacy. Your thoughts please.

nesf · 08-11-2011 4:13pm

kuro_man wrote: »

I hate this argument. You have breached the customer's trust in your judgment. The white coat gives you authority, you must take responsibility.

People find it very hard to make informed choices. Giving them anecdotal evidence suggesting that is works is hiding behind semantics. No wonder most buy it. Did you at least inform them that they are diluted so much that the so-called "ingredient" doesn't exist?

Pharmacist make money from homeopathic "remedies" despite knowing that they are placebos. Having homeopathic remedies in pharmacies gives them credence. Homeopathic "remedies" administered instead of suitable treatment can be dangerous, especially to children.

Give a woman sootha this time. Next time, she'll give her fever-ridden child a homeopathic "remedy" instead of calpol or ibuprofen, which could be very dangerous. It is reasonable to believe (right or wrongly) that a pharmacy or pharmacist would not sell a "remedy" with no active ingredient.

You must take some responsibility for this: if you don't believe it works, don't sell it.

This kind of comes back to my main issue with this. By just being displayed in a pharmacy these placebos get an air of authority about them. If the remedies were stocked on a Tesco shelf they wouldn't sell half as well.

kuro_man · 09-11-2011 11:34am

Pharmacists are saying "hey, other ill-advised desperate parents in your situation bought this, so perhaps you should too, that's €12 please".

They should say: "go a supermarket and buy some honey and a lemon - much cheaper."

SpiderP · 09-11-2011 5:09pm

kuro_man wrote: »

I hate this argument. You have breached the customer's trust in your judgment. The white coat gives you authority, you must take responsibility.

People find it very hard to make informed choices. Giving them anecdotal evidence suggesting that is works is hiding behind semantics. No wonder most buy it. Did you at least inform them that they are diluted so much that the so-called "ingredient" doesn't exist?

Pharmacist make money from homeopathic "remedies" despite knowing that they are placebos. Having homeopathic remedies in pharmacies gives them credence. Homeopathic "remedies" administered instead of suitable treatment can be dangerous, especially to children.

Give a woman sootha this time. Next time, she'll give her fever-ridden child a homeopathic "remedy" instead of calpol or ibuprofen, which could be very dangerous. It is reasonable to believe (right or wrongly) that a pharmacy or pharmacist would not sell a "remedy" with no active ingredient.

You must take some responsibility for this: if you don't believe it works, don't sell it.

I work as a pharmacist in a community pharmacy where I am not the supervising pharmacist. I have no say in what is stocked by the shop but my superior (the supervising pharmacist) would never question my judgement with respect to recommending or not recommending any product.

I would never recommend a homeopathic "remedy" to a patient on the grounds that I think they offer at most a placebo effect. That being said, we have a lady who has used the pharmacy for years for her prescriptions and is a valued patient/customer to the pharmacy. She uses Bach's rescue remedy to help her when she gets a bit anxious from time to time. I heard her purchasing a bottle recently while I was busy in the dispensary, she was chatting to the OTC assistant explaining to her that she was to give a lecture in front of several hundred people the next day and that she wanted to get a bottle "just to give me peace of mind". What would you have done in my situation:
a) "Excuse me madam, don't you know that that's just a bottle of water and will at most elicit a placebo effect and that if you're suffering from situational anxiety you should find another, better way of dealing with it? Best of luck with your public speaking now!"
b) Leave the woman, who has her own judgement of the value of said product to make a purchase that's not doing her any harm.

It's a much more complex issue than people saying "You should be promoting only evidence based medicine in your establishment there my good pharmacist, and shame on you for doing otherwise!" - hate to tell you, a lot of the coughs and colds formulations etc you can buy over the counter don't have much evidence to support their widespread use, particularly at the doses obtainable over the counter - something that's recently been addressed by the IMB - but you will nonetheless even find doctors prescribing them from time to time.

The same goes for nutritional supplements that are available widely in pharmacies. If I had a penny for every time I've told someone that a person who eats a healthy balanced diet and has no underlying illnesses shouldn't need to take a multivitamin to be told "ah sure it won't do any harm" and have them buy it anyway, I'd have a sh*tload of pennies.

I understand the general point of view people are making, and I think for the most part, the vast majority of pharmacists would agree - the plural of anecdote is most certainly not data. Yet many are like myself and unfortunately have no say in what the store stocks and are thus stuck between a rock and a hard place. This will becoming increasingly more the case in the coming years with current developments in the sector.

I would also like to point out that I think the example of giving a homeopathic remedy to a "fever ridden child" is a bad one. No OTC assistant would recommend such a product if a child was feverish - it's literally the first thing that they're taught on their training programmes. If it warranted (at least where I work) I would intervene if I thought a person/child was seriously ill, and was not going to benefit from anything that the OTC assistant could recommend. 9/10 though this is not the case as they generally refer them to a pharmacist in such situations.

kuro_man · 11-11-2011 12:12am

SpiderP wrote: »

It's a much more complex issue than people saying "You should be promoting only evidence based medicine in your establishment there my good pharmacist, and shame on you for doing otherwise!" - hate to tell you, a lot of the coughs and colds formulations etc you can buy over the counter don't have much evidence to support their widespread use, particularly at the doses obtainable over the counter - something that's recently been addressed by the IMB - but you will nonetheless even find doctors prescribing them from time to time.

Given that the principals of homeopathy break the laws of physics it would be easy to single out homeopathy as quackery. Not stocking them would avoid the situation above and any implicit condoning of its usage. Also, a lot of people confuse homeopathy with herbal remedies and the packaging often exploits this. [/quote]

SpiderP wrote: »

The same goes for nutritional supplements that are available widely in pharmacies. If I had a penny for every time I've told someone that a person who eats a healthy balanced diet and has no underlying illnesses shouldn't need to take a multivitamin to be told "ah sure it won't do any harm" and have them buy it anyway, I'd have a sh*tload of pennies.

This is not a fair comparison: vitamin/suppement pills can be useful to certain people (e.g. pregant women) and they have active ingredients. I agree they are over-marketed and are not needed by the majority but they do have a use. You can't say that of homeopathy.

SpiderP wrote: »

I would also like to point out that I think the example of giving a homeopathic remedy to a "fever ridden child" is a bad one. No OTC assistant would recommend such a product if a child was feverish - it's literally the first thing that they're taught on their training programmes. If it warranted (at least where I work) I would intervene if I thought a person/child was seriously ill, and was not going to benefit from anything that the OTC assistant could recommend. 9/10 though this is not the case as they generally refer them to a pharmacist in such situations.

I wasn't suggesting this but a parent may do it by themselves. They could give their children a homeopothy "remedy" for a cough which then gets better, reinforcing the belief that it works. They may then use it for more serious conditions, like a fever. A pharmacist/doctor may not be present to advise otherwise. Pharmacies that stock homeopathy "remedies" are part of the problem, not the solution. Even the Irish Times can't tell fact from fiction - read this irresponsible article and tell me we don't have a problem. http://www.irishtimes.com/newspaper/health/2011/0308/1224291571073.html

nesf · 11-11-2011 12:29am

kuro_man wrote: »

Even the Irish Times can't tell fact from fiction - read this irresponsible article and tell me we don't have a problem. http://www.irishtimes.com/newspaper/health/2011/0308/1224291571073.html

That article just reinforces my belief that we need a Ben Goldacre of our own with a regular column in the Irish Times. (Bad Medicine in the Guardian for those who don't get the reference)

nesf · 11-11-2011 12:31am

Oh and in the spirit of the thread, bypass the middleman!

http://bulkhomeopathy.com/

boardswalker · 12-11-2011 6:55pm

nesf wrote: »

That article just reinforces my belief that we need a Ben Goldacre of our own with a regular column in the Irish Times. (Bad Medicine in the Guardian for those who don't get the reference)

I second the support for Ben Goldacre. While he criticises homeopathy, he doesn’t seem to wear blinkers. Over the years, he has been outspoken about the failings of big pharma.

In Feb 27 2008, on the subject of the trials of anti-depressants, he wrote “Alongside these deep-rooted, systematic problems with the pharmaceutical industry, the single issue of SSRI antidepressants, and these new findings, becomes almost trivial. Biased under-reporting of clinical trials happens in all areas of medicine. It wastes money, and it costs lives.”

On 9 May 2009, he wrote “The pharmaceutical industry, and publishers, as we have repeatedly seen, have serious difficulties in living up to the high standards needed in this field, and bad information in the medical literature leads doctors to make irrational prescribing decisions, which ultimately can cost lives, and cause unnecessary suffering, not to mention the expense.”

On 24 Jan 2011, he wrote “We don't talk enough in medicine about the barriers to people taking changes in evidence and practice on board, recognising that we are human and prone to marketing and inflexibility; and while we do make an effort with "continuing professional development" in medicine, our systems for disseminating information when it changes - getting the right information to the right person at the right time, in an avalanche of tens of thousands of papers published every years - those systems are inefficient and slow. “

In the foreword for the book “Testing Treatments” he wrote “But there is a lot of money at stake in some research, and for reasons you will see in this book, 90% of trials are conducted by industry. This can be a problem, when studies funded by industry are four times more likely to have a positive result for the sponsor’s drug than independently funded trials. ……. Where the stakes are so high, sometimes the ideals of a fair test can fail.”

On 4 Nov 2011, he wrote “Pharmaceutical companies can behave dismally. Most important, they still won't publish all the results of all the clinical trials conducted on humans. This is indefensible, and because we tolerate it, we don't know the true effect of the medicines that we give.”

Yes, I would love to see posts like that around here.

nesf · 12-11-2011 10:12pm

boardswalker wrote: »

I second the support for Ben Goldacre. While he criticises homeopathy, he doesn’t seem to wear blinkers. Over the years, he has been outspoken about the failings of big pharma.

In Feb 27 2008, on the subject of the trials of anti-depressants, he wrote “Alongside these deep-rooted, systematic problems with the pharmaceutical industry, the single issue of SSRI antidepressants, and these new findings, becomes almost trivial. Biased under-reporting of clinical trials happens in all areas of medicine. It wastes money, and it costs lives.”

On 9 May 2009, he wrote “The pharmaceutical industry, and publishers, as we have repeatedly seen, have serious difficulties in living up to the high standards needed in this field, and bad information in the medical literature leads doctors to make irrational prescribing decisions, which ultimately can cost lives, and cause unnecessary suffering, not to mention the expense.”

On 24 Jan 2011, he wrote “We don't talk enough in medicine about the barriers to people taking changes in evidence and practice on board, recognising that we are human and prone to marketing and inflexibility; and while we do make an effort with "continuing professional development" in medicine, our systems for disseminating information when it changes - getting the right information to the right person at the right time, in an avalanche of tens of thousands of papers published every years - those systems are inefficient and slow. “

In the foreword for the book “Testing Treatments” he wrote “But there is a lot of money at stake in some research, and for reasons you will see in this book, 90% of trials are conducted by industry. This can be a problem, when studies funded by industry are four times more likely to have a positive result for the sponsor’s drug than independently funded trials. ……. Where the stakes are so high, sometimes the ideals of a fair test can fail.”

On 4 Nov 2011, he wrote “Pharmaceutical companies can behave dismally. Most important, they still won't publish all the results of all the clinical trials conducted on humans. This is indefensible, and because we tolerate it, we don't know the true effect of the medicines that we give.”

Yes, I would love to see posts like that around here.

The thing is, Ben Goldacre's reasoned and calculated complaints about Big Pharma are a world away from the average conspiracy theory-esque stuff that anti-Pharma people come out with on here and elsewhere online. I'm all for reasoned critique but most people just seem to come out with a "we can't trust them therefore herbal medicine must be brilliant" level of crap.

kuro_man · 13-11-2011 5:01pm

I just watch this interview with Micheal Baum, wonderful intellegent and empathic man who is obviously emotional and dispaired about the use of homeopathy in the NHS and the rise of irrational belief systems. Great stuff, worth watching all of them, it gets better and better.

http://www.youtube.com/watch?v=grWfxsFWOFI

boardswalker · 13-11-2011 5:16pm

nesf wrote: »

The thing is, Ben Goldacre's reasoned and calculated complaints about Big Pharma are a world away from the average conspiracy theory-esque stuff that anti-Pharma people come out with on here and elsewhere online. I'm all for reasoned critique but most people just seem to come out with a "we can't trust them therefore herbal medicine must be brilliant" level of crap.

Don't worry about the "average conspiracy theory-esque stuff" - that's just a red herring for you to divert attention.

What scares me about Big Pharma is the reasoned and caculated analysis of Big Pharma that are made by many, including Ben Goldacre.

Given what I know now about the abuse of evidence as part of the approval process, about off-label prescribing and about serious conflicts of interest in research, all well documented by Ben Goldacre et al, its very clear that patients/consumers are much more at risk from flawed highly potent drugs than they are from "sugarpills/water."

I haven't seen too many threads on here concerned about the risks of medicines where the evidence turned out to be lacking and patients suffered as a result.

nesf · 13-11-2011 5:30pm

boardswalker wrote: »

Don't worry about the "average conspiracy theory-esque stuff" - that's just a red herring for you to divert attention.

What scares me about Big Pharma is the reasoned and caculated analysis of Big Pharma that are made by many, including Ben Goldacre.

Given what I know now about the abuse of evidence as part of the approval process, about off-label prescribing and about serious conflicts of interest in research, all well documented by Ben Goldacre et al, its very clear that patients/consumers are much more at risk from flawed highly potent drugs than they are from "sugarpills/water."

I haven't seen too many threads on here concerned about the risks of medicines where the evidence turned out to be lacking and patients suffered as a result.

I don't know, I suffer from a mental illness that requires long term medication and to be honest the doctors are very well up on what works and what doesn't work, which drug to prescribe for lower side effects and which for maximum effectiveness. I think you're underestimating the wisdom of doctors and their experience here, it doesn't take long for the medical profession to figure out if a medication isn't that effective or if it has some serious drawbacks side effect wise.

boardswalker · 13-11-2011 7:30pm

nesf wrote: »

I don't know, I suffer from a mental illness that requires long term medication and to be honest the doctors are very well up on what works and what doesn't work, which drug to prescribe for lower side effects and which for maximum effectiveness. I think you're underestimating the wisdom of doctors and their experience here, it doesn't take long for the medical profession to figure out if a medication isn't that effective or if it has some serious drawbacks side effect wise.

I am sorry to hear about your illness and I am very glad that your treatment is working well for you.

However, in a Health Sciences forum, you should be aware that you cannot extrapolate from one example to conclude that all must be the same.

If you read Goldacre regularly you would be very familiar with the problems with medical research.

In the General Press, in the last two weeks alone, it was reported that

(i) "GlaxoSmithKline Plc agreed to pay $3 billion to resolve U.S. criminal and civil investigations into whether the U.K. company marketed drugs for unapproved uses and other matters, its biggest legal settlement."

http://www.businessweek.com/news/2011-11-08/glaxo-to-pay-3-billion-to-settle-u-s-sales-avandia-cases.html

(ii) Medtronic sought approval for a product even though they had undisclosed information that the product increased the risks of cancer in patients. A similar product, with similar risks, is widely prescribed off-label in the US, where Doctors have not been made aware of the risks.
http://www.nytimes.com/2011/11/04/health/research/amplify-by-medtronic-may-raise-chance-of-cancer-data-shows.html

(iii) Look at the quotes from Goldacre in my post above.

The information is out there. Its not highlighted in this forum but its easily available.

Compared to the side-effects of some approved products, the risks of homeopathy seem slight.

kuro_man · 13-11-2011 8:44pm

boardswalker wrote: »

Compared to the side-effects of some approved products, the risks of homeopathy seem slight.

Homeopathy and other belief systems attack the very same scientific method that doubled out life span in the last 100 years.

Nobody denies there are problems with the pharm industry, but we should not let them throw the baby out with the bathwater.

boardswalker · 13-11-2011 9:33pm

kuro_man wrote: »

Homeopathy and other belief systems attack the very same scientific method that doubled out life span in the last 100 years.

Are you really equating Big Pharma with the Scientific Method? That's quite a leap.

If you read Goldacre et al, you'd know that he accuses them of often abusing the scientific method.

kuro_man wrote: »

Nobody denies there are problems with the pharm industry, but we should not let them throw the baby out with the bathwater.

Right now, the problem is that nobody's throwing anything out. And, as I wrote earlier, the risk from water and sugar pills is significantly less than the risk from big pharma products that have undisclosed side-effects eg Avandia, Vioxx, SSRIs (for teens) etc etc etc.

The information is all in the public domain.

kuro_man · 13-11-2011 9:58pm

I never mentioned big pharma. Medicine is a science that believes in evidence based research, which has served us extremely well.
Homeopathy undermines the scientic method, and that is very dangerous.

I really don't understand your point: we should ignore quackery because of the problems with big pharma? Hardly. The topic of the thread is homeopathy, not big pharma.

We have increases in malaria infections due to the use of homeopathic "remedies", homeopaths telling clients not to immunise their childrens etc. Its all very worrying and certainly not harmless.

nesf · 13-11-2011 10:06pm

boardswalker wrote: »

Compared to the side-effects of some approved products, the risks of homeopathy seem slight.

See this I have a problem with. Just because there are issues with Big Pharma doesn't mean you can substitute any kind of voodoo you want instead of it! It's a bit like saying there are issues with Capitalism so therefore Communism can't be that bad.

boardswalker · 14-11-2011 10:47am

kuro_man wrote: »

I never mentioned big pharma.

The phrase you used was the "pharm industry". Same thing.

kuro_man wrote: »

Medicine is a science that believes in evidence based research, which has served us extremely well.

Evidence-based medicine is becoming more and more discredited for all the reasons that I mentioned earlier - poor design of trials, research bias, suppression of results that don't give the desired answers etc. It's well documented.

Secondly, off-label prescribing cannot be evidence-based. Off label prescribing is not approved usually because there is no/insufficient evidence to support off-label prescribing - that's why its off label.

Evidence Based Medicine is nothing of the sort. That's why the Cochrane Collaboration recently (5 Oct 11) posted the following on their website. "Selective reporting of trial results occurs frequently, leading to exaggerated findings of the beneficial effects of healthcare interventions and underestimates of their harms. As a consequence, many patients are unknowingly treated with interventions that have little or no effect, and may be harmed unnecessarily. This is unethical 1 and has been said to violate the implicit contract between healthcare researchers and patients, where the aim of research is to improve treatment of future patients." http://www.cochrane.org/about-us/our-policies/support-free-access-to-all-data-from-all-clinical-trials

Homeopathy Selective reporting of Trial Results undermines the scientic method, and that is very dangerous.

kuro_man wrote: »

I really don't understand your point: we should ignore quackery because of the problems with big pharma? Hardly. The topic of the thread is homeopathy, not big pharma.

But the real risk lies with Products that claim to be evidence based. Homeopaths or Homeopathic manufacturers did not recently pay out € 3.5bn in fines. As is often pointed out here, homeopathy is just sugared water. You have to address the real risks. Homeopathy is a red herring.

kuro_man wrote: »

We have increases in malaria infections due to the use of homeopathic "remedies", homeopaths telling clients not to immunise their childrens etc. Its all very worrying and certainly not harmless.

But is that a greater risk than patients being harmed unncessarily by being treated with conventional medicine, as Cochrane acknowledges? Why do conventional doctors pay so much more in PI than homeopaths. Because the risk is significantly lower.

boardswalker · 14-11-2011 10:52am

nesf wrote: »

See this I have a problem with. Just because there are issues with Big Pharma doesn't mean you can substitute any kind of voodoo you want instead of it! It's a bit like saying there are issues with Capitalism so therefore Communism can't be that bad.

See the last section of my reply to Kuro Man.

I am not asking you to substitute voodoo. I am asking you to focus on the real risks - those pharmaceutical products that have been approved on the basis of flawed evidence.

locum-motion · 14-11-2011 11:19am

boardswalker wrote: »

See the last section of my reply to Kuro Man.

I am not asking you to substitute voodoo. I am asking you to focus on the real risks - those pharmaceutical products that have been approved on the basis of flawed evidence.

This thread is about Homoeopathy. Not about the pharm industry/big pharma.

Dr Galen · 14-11-2011 11:25am

boardswalker wrote: »

See the last section of my reply to Kuro Man.

I am not asking you to substitute voodoo. I am asking you to focus on the real risks - those pharmaceutical products that have been approved on the basis of flawed evidence.

Can we keep this thread OT. By all means start a new thread about this topic though.

Cheers

DrG

boardswalker · 14-11-2011 2:14pm

Dr Galen wrote: »

Can we keep this thread OT.

Actually, despite the thread title, the two questions posed in the original post were

Mordy wrote: »

So my questions are;

Do you think that this is a breach of trust of the pharmacist to be recommending and/or selling non clinically proven remedies?

And

Should this practice be stopped?

As far as I can see, we are still on topic when discussing the recommending or selling of non-clinically proven remedies, other than homeopathy.

While the thread title may have misled slightly, the actual questions were not restricted to homeopathy.

And as you may have gathered, I am against the selling or use of unproven remedies including highly potent pharmaceutical remedies, especially when they are held out to be proven.

Dr Galen · 14-11-2011 2:25pm

No

We're on your topic. So far this thread has discussed homeopathy as per the thread title.

I'm not saying that some the points you make arent valid ones, I'm saying that this is not the thread to discuss them in.

That's as far as this discussion goes on thread. Start a new thread if you wish.

Cheers

DrG

nesf · 14-11-2011 6:22pm

Dr Galen wrote: »

Can we keep this thread OT. By all means start a new thread about this topic though.

Cheers

DrG

*contemplates whether getting one more reply in would be worth a ban*

Dr Galen · 14-11-2011 8:31pm

just try it............

:P

kuro_man · 15-11-2011 4:54pm

Image text: I just noticed CVS has started stocking homeopathic pills on the same shelves with--and labeled similarly to--their actual medicine. Telling someone who trusts you that you're giving them medicine, when you know you’re not, because you want their money, isn’t just lying--it’s like an example you’d make up if you had to illustrate for a child why lying is wrong.

http://xkcd.com/971/

15-11-2011 5:06pm

kuro_man wrote: »

Image text: I just noticed CVS has started stocking homeopathic pills on the same shelves with--and labeled similarly to--their actual medicine. Telling someone who trusts you that you're giving them medicine, when you know you’re not, because you want their money, isn’t just lying--it’s like an example you’d make up if you had to illustrate for a child why lying is wrong.

http://xkcd.com/971/

Thanked purely for including the mouseover text, because no-one ever does that when they're posting XKCD

kuro_man · 15-11-2011 8:06pm

28064212 wrote: »

Thanked purely for including the mouseover text, because no-one ever does that when they're posting XKCD

www.explainxkcd.com

ClocksForward · 17-11-2011 4:00pm

Homeopathy is serious bull. It is a shame people buy into this quackery. I say stock this junk on the shelves. If people are thick enough to actually buy this stuff, I say let them.

kuro_man · 17-11-2011 8:24pm

ClocksForward wrote: »

Homeopathy is serious bull. It is a shame people buy into this quackery. I say stock this junk on the shelves. If people are thick enough to actually buy this stuff, I say let them.

Perhaps proper labels would help consumer make more informed choices, like "no active ingredients", "not medicine", "no evidence of efficiacy", "not effective in the treatment of any known conditions". Also, the so called ingredient should be qualified e.g. Arnica 30C (contains no arnica)

Homeopathy sold in Pharmacy. Your thoughts please.

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