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Keywords:

  • Homeopathy;
  • professionalism;
  • quackery

Abstract

  1. Top of page
  2. Abstract
  3. References

Homeopathy has grown to an alarming extent in the USA in recent decades. There are many compelling reasons for pharmacists to refuse to stock and sell these products. For instance, their safety and efficacy is unproven, patients using them may forego legitimate medical therapy, their sales yield a dishonest profit, selling them may expose the seller to legal consequences, they violate the oath of the pharmacist, they foster the encroachment of quackery in medicine, and they appeal to greed and profit motives. Pharmacists should adhere to a high professional standard that demands proven safety and efficacy in the products they sell.

Although my remarks on this topic carry weight as a result of my scientific background and publications, they are greatly influenced by my work history and past experiences. As a pharmacist and academician based in the USA, this article is of necessity written from that perspective. Nevertheless, my views encompass pharmacy as practised in all geographic locations. I first worked in a pharmacy in 1970, and have been a pharmacist since 1973. I have worked in community and hospital pharmacies on a full-time or part-time basis for decades. I also serve as voluntary director of a free medical pharmacy that dispenses medication to the medically underserved in our area. I have thus had thousands of opportunities to counsel patients on self-care issues and prescription products, and have worked side by side with many excellent practitioners. Since 1976, I have also taught thousands of pharmacy students in my position as Bernhardt Professor at the College of Pharmacy, Southwestern Oklahoma State University, USA.

I believe that pharmacists, by and large, deeply care about the health of their patients. For most pharmacists, this high regard for their patients transcends loyalty to manufacturers, professional organisations, professional publications and personal greed.

I also believe that pharmacists are highly educated professionals who have a full understanding of the scientific method, and respect the discoveries that have arisen from its application.

Unfortunately, I have noticed with deep disappointment and growing alarm, the rapid expansion into pharmacy of certain practices that violate my fundamental beliefs regarding the inherent high ethics and morals of my pharmacist colleagues.

Pharmacists stock, recommend and sell non-prescription products that have not been proved to be safe or effective through application of the scientific method. For many years, the profession at large disparagingly referred to this practice as ‘quackery.’ The US FDA, in its ‘investigations operations manual’, defines quackery (considered synonymous with ‘health fraud’) as:

‘the deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, which are represented as effective to diagnose, prevent, cure, treat or mitigate disease, or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes.’1

‘Quackery’ as a descriptive noun has fallen into disfavour in pharmacy circles. This is partly or wholly due to the fact that certain professional pharmacy organisations now encourage the sale of quack products, and using the term exposes the dishonour they have brought to the profession. These organisations sanitise quackery by using more acceptable terms, such as ‘alternative medicine’, or ‘complementary medicine’. Whichever term is used, recommending products not proved safe and effective by FDA approval is still quackery. Using the FDA definition, the entire body of homeopathic products is quackery.

Once a medical product or practice is submitted to the full weight of the scientific method and found to be safe and effective by the FDA's trained scientists, it no longer meets the definition of quackery and becomes a legitimate therapeutic alternative. No homeopathic product has ever been proved safe and effective. It is expensive to design and conduct the trials needed to prove safety and efficacy, and homeopathic manufacturers find it far more fruitful to throw a portion of their profits to shareholders and to divert another large chunk into publicity aimed at perpetuating those profits.

If pharmacists truly care about the health of their patients, why would they be involved in any way with quackery? Why should they sell quack homeopathic products? I have exhaustively dissected, carefully exposed and fully documented the numerous shortcomings of homeopathy in various articles and non-prescription product textbooks.2–9 It would be redundant to do so yet again. This paper will thus discuss the many reasons that pharmacists should refuse to sell quack homeopathic products. They include the following:

  • 1
    The efficacy of homeopathic products is unproved; an essential element and virtual identifier for quackery, as defined by the FDA. There is no legitimate science behind them, and they lack FDA approval. They appeal to magical thinking, instead of scientific reason. They return us to the patent medicine days before 1906. Selling products of unknown efficacy violates the fundamental underlying principles of pharmaceutical care.
  • 2
    The safety of homeopathic products is unknown; another component of quackery. Since homeopathic medicines are diluted to virtually nothing but water or milk sugar, they are often viewed as nothing more than expensive, harmless placebos. However, this is patently untrue. I have provided examples in my textbooks and papers of when reactions (e.g. allergies) have occurred in patients using homeopathic products.2–9
  • 3
    When pharmacists misuse their professional reputation to recommend products that are not known to be effective, patients may feel that they can forego legitimate therapy. Should these patients rely on homeopathic products in lieu of taking medically appropriate action, serious medical conditions may go undiagnosed and untreated. The conditions may progress until the consequences are irreversible and death ensues. The pharmacist becomes directly responsible for giving the patient false hope rather than a recommendation to seek physician care. This exposes the pharmacist to legal liability.
  • 4
    The labelled ingredients of most homeopathic products are in Latin, which obscures their sources and forestalls legitimate questions on the part of the medical professional and the purchaser. For instance, if consumers were to see that a homeopathic product being considered for purchase contained honeybees, tarantulas, bushmaster snake venom and similar unproved ingredients, they might ask legitimate questions about their power to cure any medical condition. Instead, manufacturers call these ingredients Apis mellifica, Tarentula hispanica and Lachesis mutus. Homeopathic manufacturers should recognise that the average consumer will not know that Apis is honeybees and that the consumer lacks the medical background to ask compelling questions about the lack of efficacy and safety of honeybees as a therapeutic modality for any medical condition.
  • 5
    The American Pharmacists Association (APhA) clearly endorses homeopathic products through several of its actions.8,9 First, it allows homeopaths to rent booth space at its conventions, thereby tacitly endorsing these unproved products. Second, APhA gives homeopathic backers the means and time to share their unproved theories with its members by providing a national forum. APhA also publishes book chapters and articles that provide little credible criticism of homeopathy, some even written by homeopaths. This organisation, one that attempts to be the all-inclusive, all-encompassing club for pharmacists, has a history of endorsing homeopathy. For this reason, it has compromised its professionalism. Pharmacists must refuse to sell homeopathic products because doing so legitimises the non-professional stance taken by the APhA and other organisations, and further degrades the status of pharmacy.
  • 6
    Selling homeopathic products dishonours the professional relationship with the patient and yields a dishonest profit. This practice reduces pharmacists to the level of hucksters and predators who prey on their unsuspecting patients. Patients respect pharmacists, but predatory pharmacists engaging in quackery turn these unsuspecting patients into victims. Homeopathic products are dishonest and fraudulent, as defined by the FDA. Through an abuse of US senatorial privilege, which was a clear conflict of interest, Senator Royal Copeland ensured that homeopathic products could continue to be marketed. Their cursory mention in the 1938 Food, Drug, and Cosmetic Act did not legitimise them, it merely exempted them from serious scientific scrutiny.5
  • 7
    Selling homeopathic products is, at best, legally questionable. Any product stocked by a pharmacy is subject to an ‘implied warranty’. This is to ensure that products sold are fit for a particular purpose. Not being proved fit for any purpose through FDA approval, homeopathic products would seem to be in violation of the principle of implied warranty, making the pharmacist legally liable for their sale. If the pharmacist also makes specific claims about an ineffective homeopathic product while selling it to a patient, the liability may rise to meet the criteria for violation of ‘express warranty’. While I am not a lawyer, it would seem axiomatic that the pharmacist would wish to avoid any potential for liability arising from selling or recommending quack products.
  • 8
    Selling homeopathic products violates the ‘oath of a pharmacist,’ in which US graduates vow to ‘. . . apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.’ Selling unproved products clearly and unequivocally violates this vow as optimal outcomes cannot be achieved with expensive placebos. Selling quack products also violates the Pharmacist's Code of Ethics established by the APhA.8,9
  • 9
    Pseudo-medical practitioners wish to displace legitimate medicine. By only selling products proved safe and effective, pharmacists hold the line against the encroachment of quackery on conventional medicine. Conversely, selling homeopathic products hastens the erosion of conventional medicine and lowers that pharmacist to quackery. Those pharmacists are essentially no better than some scientifically illiterate health food store clerks. Selling homeopathic products thus lowers esteem for the pharmacist, the pharmacy and the profession at large.
  • 10
    Homeopathic products appeal to the greed and profit motive. I have spoken to pharmacists who justify selling homeopathic medicines by stating, ‘I know they're junk, but patients are going to buy them somewhere, so I might as well make a profit like the health food store down the street.’ The argument that profit justifies the sale of homeopathic medicines is the identical justification used by heroin vendors, illicit drug dealers, pimps, illegal arms dealers and others who represent the worst of civilised society. Profitable quackery is still quackery.
  • 11
    Selling homeopathic products betrays a lack of intellectual honesty and rigour in thinking. To know the scientific method, but to ignore its power and utility is perhaps even worse than to be scientifically illiterate. Selling quack products lowers respect for the pharmacy in the eyes of physicians and others who adhere to the principles of legitimate medicine.

Balancing out the numerous reasons not to sell homeopathic products are possible reasons to sell them. Although the wording varies, all of the justifications for pharmacists' selling homeopathic products can be usefully distilled into one of three categories:

  • 1
    ‘I don't believe homeopathic products are quackery when I sell them.’
  • 2
    ‘I know homeopathic products are quackery, but I don't care one way or the other about my patients' welfare when I sell them.’
  • 3
    ‘I know homeopathic products are quackery, and I care about my patients' welfare, but I need to make a profit, so I sell them.’

These three justifications can be more simply stated as wilful ignorance, blatant dishonesty, or overwhelming greed. With regard to my fellow professionals, I do not know which devastating personality flaw saddens me more.

Conflict of interest  The author has no conflict of interest regarding homeopathic products and has no relationship with any company manufacturing, advertising or marketing homeopathic products.

References

  1. Top of page
  2. Abstract
  3. References
  • 1
    Food and Drug Administration, USA. Inspections, Compliance, Enforcement, and Criminal Investigations. [website] <http://www.fda.gov/ICECI/Inspections/IOM/ucm122555.htm>, accessed July 2010.
  • 2
    Pray WS. A challenge to the credibility of homeopathy. Am J Pain Management 1992; 2: 63.
  • 3
    Pray WS. The challenge to professionalism presented by homeopathy. Am J Pharm Educ 1996; 60: 198.
  • 4
    Pray WS. Homeopathy. In: PrayWS (Ed). Nonprescription Product Therapeutics. Baltimore, Maryland: Lippincott Williams & Wilkins, 1999. pp. 7506.
  • 5
    Pray WS. Homeopathy. In: PrayWS (Ed). A History of Nonprescription Product Regulation. New York: The Haworth Press, 2003. pp. 189204.
  • 6
    Finkel R, Pray WS. Pocket Guide for Nonprescription Product Therapeutics. Baltimore, MD: Lippincott Williams & Wilkins, 2005. pp. 30, 237, 300, 330, 364.
  • 7
    Pray WS. Homeopathy. In: PrayWS (Ed). Nonprescription Product Therapeutics, 2nd edn. Baltimore, MD: Lippincott Williams & Wilkins, 2006. pp. 81724.
  • 8
    Pray WS. Ethical, scientific, and educational concerns with unproven medications. Am J Pharm Educ 2006; 70: 141.
  • 9
    Pray WS. Health fraud and the resurgence of quackery in the United States: a warning to the European union. Pharm Policy Law (Amsterdam) 2009; 11: 11352.

W Steven Pray, PhD, DPh, Bernhardt Professor, Nonprescription Products and Devices, College of Pharmacy, Southwestern Oklahoma State University, 100 Campus Drive, Weatherford, OK 73096, USA. E-mail: steve.pray@swosu.edu