I walk into the room and see a 3 year old screaming in pain. It’s 3 am and her ear hurts. She couldn’t sleep. I ask her father what he has been using at home for pain. He pulls out a box and my heart sinks. Another parent duped by Shopper’s Drug Mart. Another child harmed. They had no way to know, but the pharmacy they trusted sold them sugar water.
Every week I meet patients in the emergency department who wonder why their medications are not working. Children crying in pain, despite using the “medicines” found in the pharmacy. Time and time again, I have to explain to parents, after reviewing the package, that they bought a product that contains no medical ingredients. I have to describe what is meant by homeopathy. I struggle to explain why their trusted pharmacy is selling them sugar pills and expensive placebos (and is for some reason allowed to do so.)
The homeopathy scam
Homeopathy was invented by a man named Samuel Hahnemann around 1800, based on the strange (and completely unfounded) theory that “like cures like”. In other words, any substance that causes illness in healthy people would cure that same illness in the sick. (If you are thinking that that sounds ridiculous, you are correct). Because these substances actually made sick people even sicker, Hahnemann came up with a system of dilution, such that the original substance was mixed in a series of large quantities of water or alcohol, often with some elaborate procedures (tapping the vials against leather) to ensure that the water “maintained the essence” of the material.
Understanding this dilution is the key to understanding why this particular form of “alternative medicine” cannot possibly have any effect. The standard homeopathic preparation goes by the “centesimal” or C scale. For every 1C, a preparation is diluted by a factor of 100. A 2C preparation would take 1 part of the substance and place it in, for example, 100 litres of water. Then, one litre of that mixture would be placed in 99 litres of pure water to make the second dilution. In other words “2C” is a 1/10,000 dilution.
Because the process is logarithmic, the dilution factor quickly escalates. A 6C dilution leaves 1 part of the original substance for every 1,000,000,000,000 parts water. A 13C dilution would be the equivalent of placing a single drop of the substance in all the world’s oceans. Common homeopathic preparations are often 30C, but 200C preparations are not unheard of. There are only about 10^80 molecules in the entire universe. A 40C dilution would equate to a single molecule in a solution the size of the universe.
In other words, homeopathic products are pure water (or whatever diluent they decide to use). It is mathematically impossible for there to be even a single molecule of the supposed healing agent in most available homeopathic products.
Scientifically speaking, it is impossible for homeopathy to have any biologic effect. I do not have to review clinical evidence, because it can’t possibly work. Hower, there has been a large amount of research done, and the studies confirm what we already knew: they do not work because they cannot possibly work.
So why are pharmacies selling these products to patients?
It has long been considered unethical for doctors to prescribe placebo. Even without any financial conflict of interest, the dishonesty of providing sugar pills in the guise of real medications undermines the integrity of the medical profession and sows distrust. Is this not also true of pharmacies? Is it not unethical to sell placebos side by side with real medications, with little to no distinction? Even more so, as the pharmacy is making a profit off the sale?
Note: There is an important distinction between pharmacies and pharmacists. Pharmacists are essential in health care. The pharmacists I have worked with are all wonderful people. My concern is primarily with larger corporate pharmacies taking advantage of sick patients. However, if you are a pharmacist working in one of those pharmacies, it is probably worth reflecting on the ethics of selling placebos.
Push me hard enough and I would probably argue that homeopathic products should be banned outright. There is no real reason for these products to be available. However, I am not overly concerned with homeopathic “remedies” being sold in specialised alternative stores, where the shelves are only stocked with vitamins, herbs, and other ineffective placebos. In those settings, consumers know exactly what they are getting.
Pharmacies are supposed to be different. I know that large corporate pharmacies are often indistinguishable from Walmart, selling everything from vacuums to toilet bowl cleaner. Clearly, they are commercial entities. However, when sick people go to a pharmacy, they still expect to find products that will make them better. Instead, they are consistently misled.
I have walked the aisles of countless pharmacies, in many different countries, and it almost seems as if they intend to confuse customers. Real medical products are placed side by side with placebos, with almost no markings to distinguish the two. Labels are confusing. Even as a trained professional, I can have a hard time determining what is actually in each of the boxes.
The placement of these products alongside true pharmaceuticals is misleading and clearly harmful. You just have to ask the hundreds of children I have seen screaming in pain because, instead of pain medicines, their parents have been unknowingly treating them with sugar water.
What about patient’s right to choose? Although I think it is pretty clear that these products have no role anywhere, I am not arguing that they should be unavailable. If you want to buy expensive placebos, and you are making a well informed decision, I fell no need to stop you. However, I think our pharmacies must be held to a higher standard than a 7-11 or a GNC.
This is not a pipe dream. Pharmacies have not always put profits ahead of their customers’ health. Across North America, pharmacies have stopped selling cigarettes because the products are clearly at odds with customer health. Pharmacies have shown they are willing to put health ahead of profit, so I am hopefully they will choose to do so again.
Pharmacists are well trained. They know that homeopathy doesn’t work. They shouldn’t sell it. Unfortunately, pharmacies are not part of the healthcare system. They are stores. They sell chocolates and coca-cola right next to the diabetes supplies.
However, if pharmacies are going to sell products that have no healthcare value, they must do so honestly. No one buys a Pepsi from the pharmacy thinking it is good for their health. Unfortunately, patients are frequently duped into buying ineffective alternative medicine products. It is misleading to sell homeopathic products side by side with real medications (normally for a few dollars less, so the unsuspecting consumer walks home with sugar pills.)
If you are going to continue to rip off the unsuspecting public with valueless products, at a minimum, you must move them to a different section of your store. They cannot ethically be sold on the same shelf as real medicines.
I have seen the harm you are causing and it is shameful.
Other FOAMed
Science Based Medicine: Placebos as Medicine: The Ethics of Homeopathy
Don’t want to fall for homeopathy and other scams? Try learning a little bit about evidence based medicine.
Click here for more medical rants.
References
Ernst E. A systematic review of systematic reviews of homeopathy. British journal of clinical pharmacology. 2002; 54(6):577-82. [pubmed]
Ernst E. Homeopathy: what does the “best” evidence tell us? The Medical journal of Australia. 2010; 192(8):458-60. [pubmed]
McCarney RW, Linde K, Lasserson TJ. Homeopathy for chronic asthma. Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No.: CD000353. DOI: 10.1002/14651858.CD000353.pub2
Smith K. Against homeopathy–a utilitarian perspective. Bioethics. 2012; 26(8):398-409. [pubmed]
The Australian National Health and Medical Research Council’s report on homeopathy
The UK House of Commons Science and Technology Committee’s review of homeopathy.
Morgenstern, J. Pharmacies are hurting my patients and I’m sick of it, First10EM, June 17, 2019. Available at:
https://doi.org/10.51684/FIRS.8766
15 thoughts on “Pharmacies are hurting my patients and I’m sick of it”
Justin,
Being on the other side of this (having worked for a box store for a few years), we as pharmacists are often faced with the parent who doesn’t want to treat their child with medications (that would work) and also doesn’t want to go to their doctor/urgent care/ER/etc…they bring these boxes to the counter and despite our best efforts to tell them that they are not regulated, not studied and probably ineffective they are determined to avoid real solutions that exist right next to the homeopathic products. This goes for many adult patients as well. People are stubborn and inherently distrustful of science and look for magic solutions in products that claim to be natural. Should pharmacies sell these products? Probably not…but most pharmacists I know also wouldn’t recommend them which I’m happy to see you noted in your blog. However…I think we place a lot of the onus on the pharmacy here and leave no responsibility to the patient/parent of the patient to trust the advice of their pharmacist or doctor or even go so far as to do their own research. You mentioned soda and cigarettes…an internet search would tell you that they aren’t good for you. Funny thing is, an internet search of “do homeopathic products work” also tells you that they are a bunch of crap. When are we going to ask people to take responsibility for their health and the health of their children?? We can’t shut down all the McDonald’s and Burger Kings in the world and while pharmacies should certainly advocate for the health of their patients, we should also expect some buy in from the other side. Just my thoughts…always appreciative of the thought provoking material you provide here…thank you for that!
I think the distinction is that nobody believes McDonalds is healthy. They make a choice to eat it anyway. I agree that many people would probably buy these products elsewhere anyway, but when they are sold on the same shelf as real medicines, people are misled. Unlike McDonalds, many very intelligent people actually believe the homeopathic products are healthy- maybe even better. And those views are bolstered by the products being sold by reputable pharmacies.
(And unfortunately, not every pharmacist is as science based or ethical as you – because I have spend a lot of time in pharmacies, and the conversations I overhear are almost always patients looking for symptomatic relief and being directed by the pharmacist to homeopathic or herbal products).
In the ideal world, this would be regulated at a higher level, but that isn’t happening. Thus, in the short term I think it is essential that pharmacies consider the ethics of their actions. (Or maybe just spend a few night shifts with me in the ED to see all the patients harmed).
I think the key passage here is not expecting pharmacies to do anything other than maximize profits – that is their charge. It is the charge of regulatory agencies to protect consumers from ineffective medications, and the proliferation of fake treatments is a failure of these agencies. There is some attention paid to this, but not enough.
https://www.theatlantic.com/health/archive/2016/06/supplements-make-tobacco-look-easy/488798/
Totally agree that regulation is needed, but I don’t think it excuses the ethics. I don’t practice ethically just because I am forced to by law. Pharmacists are also health care professionals, and I think as such have an ethical responsibility here when our governments fail us.
About 10 years or so ago I had a mother call me late one night asking for a dose recommendation on a homeopathic cough prep for her two year old. When advised that I couldn’t recommend use of the product at all much less recommend a dose, I was met with accusations of harm against her child and deliberate unprofessionalism. Her argument being the company had been in business for 25 years at the time and that if any problems existed surrounding their products, they would have been identified long ago. This in addition to the “natural is better” battle cry. Being met with a counter of aspirin’s natural derivation from willow bark and its known contraindication in children, her anger only grew resulting in a phone slamming in my ear and a formal complaint placed against me the following morning. This led to a visit from my district manager and a verbal warning threatening my job.
The next time I saw my DM, he was present again to give me a final written warning for refusing to dispense high-dose (60-90mg/cap) compounded single-ingredient immediate-release hydrocodone capsules and topical morphine cream prescribed by a local IM/pain management physician who recently had his license returned after a five year suspension for a litany of infractions. This is after I discussed my concerns with the local DEA office and was advised not to dispense due to equal culpability with the prescriber.
This is a chain community reality that many pharmacists exist in. Corporate doesn’t have your back no matter how evidence-based and ethical the pharmacist. Independent practice is drying up due to the PBM system and chain pharmacy mammoths. I’m sure you’ve seen the acquisition sprees that CVS has gone on. Walgreens, Walmart, etc. are no different. Many pharmacists have to sacrifice some modicum of their ethics in order to maintain employment. If given the choice between selling a homeopathic placebo knowing full well that at least it won’t hurt versus potentially losing your ability to provide for your family, particularly in the job market the over-saturation of pharmacy schools has created, what would you do? My inability to sacrifice my ethics and the soul-sucking nature of retail, were the reasons I found a way out.
So please, I know you explicitly stated this in your post, separate the pharmacist from the pharmacy. Pharmacists just try their best to make a horribly broken, corrupt system a little better. That said, those outright recommending homeopathic products can go to hell.
Excellent post, Justin; this is getting out of control. Also, pharmacies have also been pushing a lot of nutrition nonsense, selling packaged, processed crap and having staff crowned as “coaches”‘ when all they are is sales reps to sell the crap. These coaches do not understand the first thing about food. People are vulnerable to the false authority of a pharmacy environment and are being taken-in by these charlatan approaches to profit. I’d like to see pharmacist community in Canada take a stand against these eroding forces to protect both the health of patients and the integrity of the profession.
Try living in Germany, where it all comes from, where 56% of well-educated citizens have a favorable view on homeopathy, where public insurance companies even pay for the hoax, and where pharmacy companies take legal action against whoever points out the scam. There’s plenty of good here, but this ain’t it.
Hey Justin,
Just to start off with – I don’t leave comments but as a pharmacist this did prompt a word. I work primarily in a clinical role inpatient, but do fill in shifts in the community as a pharmacist when needed. If there is one thing I can say for sure – by and large pharmacists despise these shame products being offered to patients.
I can not stress how often myself and my peers try to turn away a patient from buying a homeopathic flu “medication” only to see them purchase it along with a “pediatric” strength along with it. I would venture to say that 90% of us who have experience on the retail side would mirror my example. There needs to be a significant response from the medical community as a whole to get rid of these products and limit the snake oil that can do no good and only harm.
Love the blog, keep it up
People have a choice to buy whatever they want you can’t blame a pharmacy for keeping up with demand. Manufacturers wouldn’t make a product that doesn’t sell.
Supply and demand have very little to do with ethics. The problem here is that consumers are being misled. There is a demand because consumers believe (falsely) that these products work, and that faulty belief is reinforced when these products are sold by pharmacies. Although an objective view clearly demonstrates that pharmacies are not part of the healthcare team, but actually just stores intent on maximizing the bottom line, that is not how they are viewed by many customers. People go to pharmacies when they are sick with the assumption that they will be provided with medicines that are safe and effective. By supplying homeopathic products (and other such snake oils) the pharmacies mislead their customers and betray their trust. Most importantly, pharmacists are incredibly well trained and know better. That is what makes the practice unethical. You will note, if you read the article, that I said it is fine for these products to be sold in a 7-11. That accounts for your supply and demand issue. It is selling them in a pharmacy, right next to actual medical products, often in indistinguishable packaging, that is unethical. Again, supply and demand is an economic concept that has little to do with ethics. Go to any high school and there will be a demand for drugs. That doesn’t mean supplying teenagers with MDMA is ethical. I know there is a demand for snake oil. That doesn’t mean that well trained health care professionals should misleading and ripping of customers by selling them.
You’re blaming pharmacists for a customer’s own choice lol. Do you know how many times I’ve seen patients completely disregard counseling and advice? Look at the diabetes rate in this country. Common sense would say hey I’ve received this diagnosis let me change my ways. I legit had a patient who had his A1C double because he felt like baking more. You’re looking for someone to blame- it’s the consumer and not Pharmacists. We all are responsible for our own choices as adults made at the end of the day. And if you’re going to group a whole practice together and say they are being “unethical” based on one person’s action you really to reevaluate your thinking and maybe look into the FDA who is responsible for allowing these things to be sold and should be held accountable- not pharmacists.
As an analogy, a consumer loses all their money in a pyramid scheme. Does the consumer bear some of the responsibility for being duped? Sure. But that doesn’t excuse the scammer. They are still acting unethically. Similarly, you could blame the regulators for allowing such a scheme to occur, but that still doesn’t excuse the unethical behaviour of the scammer.
When it comes to homeopathy and other such medical scams, there is no doubt that the regulators are failing at their job, and there is no doubt that consumers could be better informed. However, the failings of others doesn’t excuse the unethical behaviour of pharmacies.
very important information about pharmacies .its very true that pharmacies are hurting my patients you are very aza
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Hi, I live in Australia. Does anyone want to organise a class action lawsuit to ban misleading placebos from pharmacies? My hotmail address is draliano