On January 30, protesters gathered outside outside pharmacies across the United Kingdom and Australia, took massive overdoses of homeopathic remedies … and nothing happened.
The event, designed to draw attention to the Alliance Boots pharmacy chain for selling homeopathic “remedies” in pharmacies, was the brainchild of the Merseyside Skeptics Society. Called the 10:23 campaign (the name is a play on the Avogadro constant), the event is another embarrassment to the pharmacy profession in Britain, which is increasingly being criticized for selling dubious and unproven health products to consumers.
Homeopathy is an elaborate placebo system of “remedies” with no active ingredients. Based on the prescientific notion of “like cures like”, proponents of homeopathy believe that any substance can be an effective remedy if it’s diluted enough: raccoon fur, the sunlight reflecting off Saturn, and even pieces of the Berlin Wall can all be homeopathic remedies. The 30C “potency” is common – it’s a ratio of 10-60. With this remedy, you would have to give two billion homeopathic doses per second, to six billion people, for 4 billion years, to deliver a single molecule of the original material.
However, homeopathy advocates believe that water can retain a memory of a substance even when it is diluted to the point where there are no active ingredients. This diluted water is then typically dried on sugar tablets. Clinical trials on homeopathy demonstrate that its effects are exactly as we would expect for sugar tablets – it is as effective as a placebo, nothing more.
In November, the UK Parliament’s Science and Technology Committee met to evaluate the strength of evidence that supports the Medicines and Healthcare products Regulatory Agency’s (the UK equivalent of Health Canada) decision to license homeopathic products for sale. Pointed questions were directed at Boots, and their decision to sell homeopathic remedies in pharmacies. During those hearings, the Professional Standards Director for Boots made a startling admission:
There is certainly a consumer demand for these products. I have no evidence to suggest they are efficacious. It is about consumer choice for us and a large number of our customers believe they are efficacious.
The media response to this statement was scathing. Boots: We sell homeopathic remedies because they sell, not because they work was one headline. However they sugar it, you’re swallowing a delusion was another. An open letter to Boots from the Merseyside Skeptics followed:
The Boots brand is synonymous with health care in the United Kingdom. Your website speaks proudly about your role as a health care provider and your commitment to deliver exceptional patient care. For many people, you are their first resource for medical advice; and their chosen dispensary for prescription and non-prescription medicines. The British public trusts Boots.
However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious. Despite this, homeopathic products are offered for sale in Boots pharmacies - many of them bearing the trusted Boots brand.
Not only is this two-hundred-year-old pseudo-therapy implausible, it is scientifically absurd. The purported mechanisms of action fly in the face of our understanding of chemistry, physics, pharmacology and physiology. As you are aware, the best and most rigorous scientific research concludes that homeopathy offers no therapeutic effect beyond placebo, but you continue to sell these products regardless because “customers believe they work”. Is this the standard you set for yourselves?
The majority of people do not have the time or inclination to check whether the scientific literature supports the claims of efficacy made by products such as homeopathy. We trust brands such as Boots to check the facts for us, to provide sound medical advice that is in our interest and supply only those products with a demonstrable medical benefit.
We don’t expect to find products on the shelf at our local pharmacy which do not work.
Not only are these products ineffective, they can also be dangerous. Patients may delay seeking proper medical assistance because they believe homeopathy can treat their condition. Until recently, the Boots website even went so far as to tell patients that “after taking a homeopathic medicine your symptoms may become slightly worse,” and that this is “a sign that the body’s natural energies have started to counteract the illness”. Advice such as this directly encourages patients to wait before seeking real medical attention, even when their condition deteriorates.
We call upon Boots to withdraw all homeopathic products from your shelves. You should not be involved in the sale of ineffective products, because your customers trust you to do what is right for their health. Surely you agree that your commitment to excellent patient care is better served by supplying only those products whose claims can be substantiated by rigorous scientific research? Or do you really believe that Boots should be in the business of selling placebos to the sick and the injured?
The support lent by Boots to this quack therapy contributes directly to its acceptance as a valid medical treatment by the British public, acceptance it does not warrant and support it does not deserve. Please do the right thing, and remove this bogus therapy from your shelves.
With no response from Boots, and the continued sale of homeopathy in British pharmacies, the 10:23 campaign was born. Hundreds met outside pharmacies and consumed massive doses of homeopathic remedies. And nothing happened. No illness, no side effects, nothing. Exactly what you’d expect from taking hundreds of sugar tablets. See it for yourself:
The Canadian Context
The situation with homeopathy in Canada is largely similar to the United Kingdom. Health Canada regulates and approves homeopathic remedies through the Natural Health Products Directorate. What this effectively means is Health Canada assigns unique identification numbers to indistinguishable sugar pills. Yet Health Canada states that their approval should give consumers confidence in the efficacy of homeopathy:
The issuance of a product licence means that the product has been assessed by Health Canada and has been found to be safe, effective and of high quality under its recommended conditions of use.
The product Oscillococcinum is a fermented duck’s heart and liver which has been diluted 10^400 times. At that dilution, there are zero active ingredients – they are simply sugar tablets. Wikipedia notes,
Mathematically, in order to have a reasonable chance to obtain one molecule of the original extract the patient would have to consume an amount of the remedy many times larger than the known universe.
Oscillococcinum is popular as an influenza preventative despite an absence of any evidence to demonstrate it has any meaningful clinical effects. Yet Health Canada has approved the sale of the product, assigning it the DIN-Homeopathic Medication number 8001415. And you’ll frequently see Oscillococcinum, along with hundreds of other homeopathic remedies that have Health Canada’s stamp of approval, on pharmacy shelves.
With Boots still standing firm in their decision to sell products which they do not believe to be effective, can we expect the 10:23 protest to have any meaningful effects on pharmacy practice, or on how homeopathic products are regulated and approved? Ultimately, it may be up to individual pharmacists and pharmacy regulators to demand that homeopathic products be removed from pharmacies. A similar battle took place over a decade ago in most of Canada – but the debate was over tobacco, not homeopathy. While the harms are arguably greater with tobacco, the fundamental issues are the same. Tobacco, like homeopathy, has no health benefits, is inconsistent with the goals of pharmacy practice, and and was only sold in pharmacies because of profit and consumer demand. But regulators persisted, and today, tobacco has been removed from most pharmacies across Canada. Time will tell if the pharmacy profession takes a similar approach with homeopathy.