Is it ethical for pharmacists to sell homeopathic remedies?

[Pharmavixen]

Given that homeopathy violates the basic physical laws of the universe and is manifestly fraudulent, and we as pharmacists are supposed to follow the tenets of evidence-based practice, is it ethical for us to sell homeopathic remedies?

http://www.sciencebasedmedicine.org/reference/?p=38

Benefits and risks of homeopathy

What is homeopathy?

Homeopathy: the ultimate fake.

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[hereticmnk]

I hate it with every inch of my being. It is quack science. It is so stupid. It is likely that with the dilutions you do, you are not even getting one molecule of the active ingredient. It had its merits back in the day (circa 18th century) when main stream medicine was causing more harm than good vs. say homeopathy which was comparability docile. Some argue, this led to the rise of homeopathy. I would never ever ever ever ever recommend homeopathic medications to anyone.

 

[rxlea]

If a patient comes in on something and says it works, I'm not going to burst their bubble. Placebo effect is very powerful...ask anyone on an SSRI

If a patient wants a recommendation or hasn't taken it, I'll tell them the truth.

 

[Pharmavixen]

If a patient comes in on something and says it works, I'm not going to burst their bubble. Placebo effect is very powerful...ask anyone on an SSRI

If a patient wants a recommendation or hasn't taken it, I'll tell them the truth.

That's kinda what my approach has always been. But now, here in Canada there's this class action lawsuit against Shoppers Drug Mart and Boiron, a homeopathic manufacturer:

he suit has been filed by leading class-action law firm Roy, Elliott, O’Connor (REO), in partnership with Centre for Inquiry Canada. It follows an open letter sent by CFI’s Committee for the Advancement of Scientific Skepticism (CASS) to Shoppers Drug Mart, demanding that it cease selling worthless homeopathic products such as Oscillococcinum, Boiron Inc.’s popular homeopathic flu remedy....

The heart of the case is the claim that Oscillococcinum (“Oscillo”) does not in fact contain the active ingredient Boiron lists on its packaging. The packaging for Oscillo lists the active ingredient as “Anas Barbariae Hepatis et Cordis extractum 200C”. Put into plain English, this describes a dilution of an initial extract of the heart and liver of the Barbary (or Muscovy) duck. Set aside for the moment the fact that there is no evidence whatsoever that Barbary duck organs have any effect on influenza, and focus on the dilution. Even by homeopathic standards, the level of dilution in Oscillo is extreme: “200C” indicates a serial dilution of one part in 100, repeated 200 times. That is, the final product represents a theoretical dilution level of one part in 10400. Given that the entire observable universe only contains an estimated 1080 atoms, it is clear that almost all of these dilutions involve simply diluting water with water – there is no trace of duck heart or liver left after the first dozen or so dilutions. So the claimed active ingredient in Oscillo is neither “active” nor an “ingredient”. Rather, since each 1g pill contains 0.85g sucrose and 0.15g lactose, Oscillo is in fact 100% sugar. By misrepresenting their sugar pills as containing an active ingredient, Boiron violates numerous consumer protection laws.

If this lawsuit sticks, maybe pharmacists could be liable for selling or recommending products they know to be worthless (other than placebo effect).

 

[rxlea]

That's kinda what my approach has always been. But now, here in Canada there's this class action lawsuit against Shoppers Drug Mart and Boiron, a homeopathic manufacturer:



If this lawsuit sticks, maybe pharmacists could be liable for selling or recommending products they know to be worthless (other than placebo effect).

I'm not sure that would stand in court since, in general, we don't know if they work (scientifically, pitting one product against another). There aren't a plethora of studies out there on homeopathic products. Fact is, they work for some people. Interesting topic, though.

Unless the product causes harm, I'm not sure what a pharmacist would be liable for. We don't choose for the customer what and what not to buy.

I wouldn't recommend homeopathic remedies unless there was some sort of cultural need. I don't even recommend mucinex and some other FDA approved products that have questionable efficacy.

 

[WVUPharm2007]

I tell everyone that they are a waste of money. And its definitely unethical to imply otherwise.

 

[rxlea]

I tell everyone that they are a waste of money. And its definitely unethical to imply otherwise.

I try to ease it in there if there seems to be any shred of doubt the patient may have about it's efficacy. I'll jump at any chance to tell them patient they are wasting money. But if they come in raving about how great something is for their RLS, I'm not going to feel bad about it. Most of that stuff is cheap. Now, if the patient struggles with money, that's another issue. I just try to "feel out" the needs of the patient and do my best.

When I was at a clinic on rotation, I talked a lady out of buying the pills for restless legs because she was already spending too much money on other meds. I guess the most important thing is trying to figure out if there is some other issue going on we should know about. TBH, I think it's a perfect opportunity to be "clinical" in a community/ambulatory setting and really listen to the patient to see if maybe there is some medication issue leading to side effects or whatever.

I caught an ACE I cough that way before.

 

[Ackj]

I caught an ACE I cough that way before.

Didn't think it was contagious


I pretty much agree with your sentiments. If they think the product is great, I won't talk them out of it, since it's already rooted in their head anyway. If they ask "what's a good product for XYZ condition?" there is zero chance that I'll suggest it. For direct questions like "is this a good product for XYZ?" I'll suggest a different product and explain the difference.

 

[owlegrad]

I agree with most of the above comments. I ain't gonna argue with anyone about how effective homeopathy is just because I see them buying it, but if they ask me I will gladly educate them.

We all agree that homeopathy is the future of medicine, right?

 

[habeansha]

a pharmacist had me call and recommend a homeopathic cream for neuropathic pain to a patient. whenever i have a patient ask about it, i ask them if they understand the concept of homeopathy. Its regulated as a dietary supplement and should be harmless due to the diluteness of it so I see no problem in selling it. i think the main problem is seeing if something actually qualifies as a homeopathic product. i believe one of the zinc cold/flu products was sold at a strength that wouldnt even qualify as a homeopathic drug

but that there homeopathic flu vaccine....

 

[genesis09]

I have explained homeopathy to people before. After I explain it, most of the time they pick something else. There is no active ingredient in those products. I hate selling it to people because they are wasting their money.

 

[BenJammin]

Where's Steve Pray when you need him? He's the only pharmacist that has a very vocal voice against homeopathy. Honestly, if you recommend that garbage you should forfeit your license.

 

[rph3664]

I recently saw a homeopathic remedy advertised on TV for - hang onto your seats, folks - SKIN TAGS.

I'm pretty sure Enzyte's homeopathic too.

 

[xiphoid2010]

I tell people what I think, cough**placebo**cough.

But I was once taught, a placebo effect is still an effect.

 

[hereticmnk]

I tell people what I think, cough**placebo**cough.

But I was once taught, a placebo effect is still an effect.

It can be an expensive placebo. Expensiveness of the med also increases the placebo effect. This raises some ethical questions.

 

[xiphoid2010]

It can be an expensive placebo. Expensiveness of the med also increases the placebo effect. This raises some ethical questions.

It's a waste of money, no argument there. But if you look at the magnitude of placebo effect in studies, it's often bigger than the active med itself.

Wish I can trick myself that easily... Give myself a sugar pill and feel 20% better... maybe I can get my wife to trick me, give me some candy and tell me it's Tamiflu.

 

[bp2313]

It's a waste of money, no argument there. But if you look at the magnitude of placebo effect in studies, it's often bigger than the active med itself.

Wish I can trick myself that easily... Give myself a sugar pill and feel 20% better... maybe I can get my wife to trick me, give me some candy and tell me it's Tamiflu.

I was expecting Viagra.

 

[xiphoid2010]

I was expecting Viagra.

I'm afraid even viagra won't get me into the mood right now.

 

[BidingMyTime]

I really go back and forth on this. There is no logical reason to think that homeopathy works. On the other hand, the placebo effect is very strong. When people tell me that a homeopathic medicine is "the only thing that works" for them, I just tell them I'm glad to hear its working for them. If people ask me what I think, I tell them there is no evidence that the product works. Depending on the person and what they are looking to treat, I might go more into depth about homeopathy and why it can't work, or I might tell them there is no harm in trying it if they want to. If there is a real product to treat their problem, I will recommend that, but when their isn't an OTC treatment for their problem, then I don't work to hard to disuade them.

 

[Lubeckd]

I question that too, since the place I work sells one homeopathic med

 

[Pharmavixen]

In the past I've taken a softer line on homeopathy, believing it has a role in placating the worried well suffering from minor self-limiting illnesses (colds, minor seasonal allergies etc).

But the use of homeopathy legitimizes its effectiveness, implying that there's more to it than the placebo effect. News item a friend sent me:

... it was found that around 700 children suffered from undernourishment and needed special attention.

These children were administered homeopathy drugs and were asked to report back to doctors after a month.
...
Deputy municipal commissioner (health) I K Patel argued that homeopathy was an effective system to treat undernourishment but was to quick to add it was not his idea to give homeopathic drugs to treat children with malnourishment.

 

[zelman]

necrobump: FDA & FTC mull homeopathy's future

 

[deleted158872]

https://au.news.yahoo.com/thewest/wa/a/28496934/pharmacist-bins-crap-homeopathic-products/

because: https://www.sciencebasedmedicine.or...nd-its-acolytes-make-poor-showing-before-fda/

 

[Digsbe]

Being a snake oil salesman isn't ethical. If you know you are going against evidence based practice or pushing something for which no good evidence exists for profit that's unethical. This world doesn't need any ore Dr. Oz's.

 

[SClENCE]

I'v seen people misread the label and buy a homeopathic for a use that even the manufacture doesn't market it for and they STILL swear it works after spewing a few lines about "big pharma" and "processed chemicals".

I'v also seen a guy buy homeopathic eye drops at a "health" store for an infant and it caused serious issues. It's then that they decide to actually see a doctor (after first coming to the pharmacy for free advise on a product that we didn't sell of course).

If someone simply asks where the item is located I just tell them, but if they actually ask anything about the product I make my recommendation.