Pharmacies are hurting my patients and I’m sick of it

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.)

example of homeopathic products sold directly next to real medications in pharmacies
Real medication side by side with placebo. Both claim to relieve pain. How is a concerned parent supposed to know that one is nothing more than expensive sugar water?

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.

homeopathy disguised as real medication in pharmacies
homeopathic medication sold on the shelf next to real medications in pharmacies

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.

unethical homeopathic medication placement in pharmacies

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.

Cite this article as: Justin Morgenstern, "Pharmacies are hurting my patients and I’m sick of it", First10EM blog, June 17, 2019. Available at: https://first10em.com/pharmacies-are-hurting-my-patients/.

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