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Ethical dilemma: Is homeopathy ethical?

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"Madam,

I am an evidence-based health professional. There is no evidence to suggest that homeopathy is effective at treating anything. As such, I am unable to recommend homeopathic products for the treatment of any condition. May I ask why you have a lack of trust in pharmacy products..."

We would then have a long chat in which I would try to assuage her fears about 'conventional' medicinal products and if that failed to convince her and she still wanted to purchase a homeopathic remedy I would direct her to a major multiple pharmacy chain who have a Professional Standards Director who is on-record as stating that his company stocks these products - without any evidence of their efficacy - because they sell (should such a thing exist *ahem*).
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Ethical dilemma: Is homeopathy ethical?
Answer
22/10/11 15:55as a reply to Joseph Bush.
As a Pharmacist and a qualified Homeopath, with experience in both conventional and natural medicine, I would be happy to recommend homeopathic remedies for hay fever.

As homeopathy works on individual symptoms, I would ask the lady what her specific symptoms were and then recommend a suitable homeopathic remedy.

I have both taken and recommended homeopathic remedies for hay fever in the past, with outstanding results.
RE: Ethical dilemma: Is homeopathy ethical?
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24/10/11 16:26as a reply to Rahul Shah.
Are there any proven homeopathic remedies for life threatening conditions?
Ethical dilemma: Is homeopathy ethical?
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24/10/11 08:22as a reply to Joseph Bush.
I see you are resorting to anecdote at the first opportunity. No further questions your Honour.
Is homeopathy ethical?
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27/10/11 13:35as a reply to Joseph Bush.
It is not too difficult to work out which pharmacist the patient is more likely to take notice of. Unfortunately, we need to realise that it is not what we believe that matters, but in order that patients can have confidence in us, we need to listen to them rather than preach. There are occasions where it might be appropriate to pompously proclaim how clever we are and how important science is, but hayfever is unlikely to be one of them.
Is homeopathy ethical?
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27/10/11 15:37as a reply to Joseph Bush.
Forgive me. Obviously the latter part of my first post was both sarcastic and sardonic.

I must say, I find your reply troubling in a couple of aspects. The first of these is the suggestion that adopting an evidence-based approach to the recommendation of treatment(s) for hayfever is 'preaching'. The second is the assertion that adopting an evidence-based approach would lead a pharmacist to pomposity and condescension.

Patient beliefs and patient choice are obviously important and should be respected but to recommend overly-expensive sugar pills at the expense of effective treatments is in my humble opinion unethical, in certain circumstances dangerous and also damaging to the professional reputation of pharmacists.
Is homeopathy ethical?
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28/10/11 16:55as a reply to Joseph Bush.
Even though they are not recommended, checking that the patient is not on any medication that can interact with the stocked homeopathic remedies. I would give all the information i could to the patient about the products so the patient can make a informed choice.
Is homeopathy ethical?
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29/10/11 08:43as a reply to Joseph Bush.
The question at hand is very good as it can be extended to other medication such as cough medication, Zinc&Vit C supplements in colds... etc that also have a very weak evidence base. I've read some of the above posts and agree with both sides.

Evidence based recomendations are important but we can't forget that everyone is different and occasionally homeopathy might work for some individuals even if remotely impossible on the concept that they are sugar pills and give a placebo effect. Whilst conversing and providing information on their efficacy, it might also be worth asking the customer if they have tried any homeopathic remedies in the past that could have worked for them (hayfever can come and go although symptoms normally peaks between ages 15-25).

We can't completely disregard complementary and alternative medicaines, after all, it's what customers turn to when conventianal medicines have failed.
Is homeopathy ethical?
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29/10/11 10:08as a reply to Joseph Bush.
The idea of a 'conventional' medicine interacting with a homeopathic remedy is scientifically implausible.
Is homeopathy ethical?
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29/10/11 10:19as a reply to Joseph Bush.
The placebo effect is a powerful thing. However, you wouldn't be supplying a homeopathic remedy as a placebo. You would be supplying it as a remedy for hayfever and thus bestowing it with a social mystique that it does not merit.

Regarding desperate people - yes, very sad. But why exploit their desperation by selling them a product with no evidence of efficacy?
Is homeopathy ethical?
Answer
29/10/11 17:23as a reply to Joseph Bush.
I think I might have not been too clear earlier. Again, I agree with what your saying and in my conversations with customers in these situations is to present medication with clear cut evidence of efficacy first. If however, after informing and educating customers on these conventional remedies, they insist on alternatives for whatever reason, be it a placebo, then its clearly their own rightful decision. I think no matter how hard you try with evidence-based medicines with some, you will never be able to change their minds.

In such cases, i believe i won't be classed as exploiting customers or making a quick profit although you've steered the conversation towards it so i'll make a last comment:

Regarding desperate customers looking for hope in alternative medicine if for example their prognosis is not very good in terminal cancer patients or they've been diagnosed with ovarian failure..etc, i would never quash any hope they might have by blurting out "evidence-based weaknesses" of such treatments like acupunture, reflexology homeopathy..etc- thats my own personal view!
Is homeopathy ethical?
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07/11/11 21:24as a reply to Joseph Bush.
Hi there. I don't really want to fight with you guys over whether or not homeopathy works. But the evidence (http://www.facultyofhomeopathy.org/research/rcts_in_homeopathy/) is much more positive than most of you are saying. Please look for yourself and make your decision. Or if you take the wikipedia conclusion, good luck to you sir. I personally believe that a pharmacist should apply all the things we normally expect with regards to safety and suitability and take patient choice into consideration - not just our own expectation of efficacy (which would make fools of us all, having recommended cough bottles all my professional life). I realise that often we push what we think the patient should have rather than accept their views. I think dismissing homeopathy etc. out of personal disdain is wrong. Remember that most of our little army of OTC products have less evidence than homeopathy in their use, and they still please patients, make us money and help the odd cold out there to boot. Please don't be one of the holier than thou, I know everything, you'll take what I tell you to pharmacists as there are too many of you out there! Peace, out.
Is homeopathy ethical?
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07/11/11 21:25as a reply to Joseph Bush.
Good man rahul. Don't let the internet commenters drag you down!
RE: Is homeopathy ethical?
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14/11/11 21:09as a reply to James Mcmurray.
Thanks for the support James. No chance of getting dragged down!
Is homeopathy ethical?
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11/11/11 10:57as a reply to Joseph Bush.
Promised myself I was going to engage in this 'debate' any more but I can't resist replying to this one.

Right, if you're attempting to make a case for the efficacy of homeopathy it would probably be advisable to link to credible sources rather than linking to an organisation with the aim of promoting homeopathy. For example, the Cochrane Collaboration is the 'gold standard' organisation for the provision of information about the effectiveness of healthcare. They have published a raft of systematic reviews examining homeopathy none of which have suggested that it is more effective than placebo.

I do not dismiss homeopathy out of "personal disdain". That assertion is laughable. I dismiss it because it's implausible bunkum without a shred of evidence to support its use.

You go on to say "most of our little army of OTC products have less evidence than homeopathy in their use". That statement is demonstrably false. If you genuinely believe that there is 'more' and better evidence to support the use of homeopathy than the use of paracetamol, ibuprofen, aspirin, clotrimazole, hydrocortisone, aciclovir, lactulose, potassium citrate, loperamide, loratadine, cetirizine, omeprazole, ranitidine, mebeverine, hyoscine, malathion, diclofenac, fluconazole and promethazine then maybe you need to modify how you interpret evidence.

PS: You raised the issue of OTC preparations for cough. I agree. The evidence to support their use is absent. Ergo, I think pharmacists should refrain from supplying them also.

PPS: Again, I find the notion that articulating the fact that there is a lack of evidence to support the use of homeopathy means you are preaching or "holier than thou" disingenuous. In fact, seeing as a belief in the efficacy of homeopathy is based on blind faith I would argue that the proclamations of homeopathy supporters are much more akin to 'preaching' sermons.
Is homeopathy ethical?
Answer
27/11/11 19:41as a reply to Joseph Bush.
Dear Joseph,
Why discount the BHA / FOH evidence? If similar studies were published on an anti-homeopathy website would that make them okay?
I would urge anyone interested in this to check the studies referred to themselves.

I think you might be quite a pleasant chap in real life, but on the internet not so much.

In no circumstances do I advise people to select homeopathy over everything else out there, the same way I try not to force people's hands in medicine selection. The inference being that I am incompetent or irresponsible as a practitioner is deeply personally offensive.

I did not at any point state that there is more rationale to use homeopathy other than such medicines as NSAIDs etc. but rather meant cough meds, compound flu preps et al. Sorry if I did not make that clearer.

The fact that there is a lot of evidence for use of homeopathy out there is something which we're going to have to disagree on. Of course I would surmise in your case that no amount of credible evidence would change your mind, but that's not important. The important thing is that patients do not lose their choice and access to these products, and that HCPs don't get punished for advising on the same.

Respectfully, James
Is homeopathy ethical?
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28/11/11 16:16as a reply to Joseph Bush.
This article obviously raises some issues as to where we stand as health professionals in regards to an evidence-based approach to treating hayfever.

I do agree that the evidence-base for homeopathic hayfever remedies is almost non-existent and therefore we should make the decision, using our knowledge and skills, to back credible sources of evidence i.e. randomised and placebo-controlled trials such as cochrane reviews which DO provide evidence for the use of OTC hayfever products. It may be an idea to find out why she "doesn't trust" pharmacy products. You might be able to change her mind.

But at the end of the day the decision to buy is with the customer. We can only give our best professional advice on the matter. Having failed to convince her, if she wants a homeopathic remedy to treat hayfever then she can have one.

the customer is always right, right?
Is homeopathy ethical?
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28/11/11 20:42as a reply to Joseph Bush.
Looks like another error on your part James, in response to Joseph:

"Of course I would surmise in your case that no amount of credible evidence would change your mind, but that's not important"

I would say that a certain amount (like the usual scientific amount) of credible evidence would indeed change the mind of Joseph. That's what we should all do - change our minds according to the evidence. But there isn't any credible evidence, simple!
RE: Is homeopathy ethical?
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12/12/11 19:00as a reply to Gavin Fitzgerald.
Ahem:
http://www.telegraph.co.uk/health/alternativemedicine/8913820/Little-pill-big-trouble.html
quote: And yet the sceptics are wrong when they say there’s “no evidence” for homeopathy. There is evidence. But there’s much better evidence that says it doesn’t work.

Looks like you made the mistake here gavin.
Is homeopathy ethical?
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29/11/11 11:47as a reply to Joseph Bush.
What's the mark-up on Snake Oil ?
Is homeopathy ethical?
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29/11/11 12:49as a reply to Joseph Bush.
As far as I am aware - if you have read the systematic reviews and do not believe in the concept of homeopathy, then you are a crook to sell such a product, knowing that it will not work, will prolong the patient's symptoms, and pocket you some profit as well.
Is homeopathy ethical?
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29/11/11 13:42as a reply to Joseph Bush.
Dear James,

I do not discount the BHA/FOH evidence. Quite the contrary. Of course, an evidence-based approach dictates that one considers the entirety of the available evidence. However, the studies you mention tend to lack rigour (small sample sizes, inadequate blinding, author bias etc.). That is the inherent problem with the stance you have adopted - you insist on relying on a small number of poor-quality studies that support your hypothesis at the expense of the totality of the evidence.

I have no desire to respond to your ad hominem.

You surmise, completely incorrectly as it happens, that "no amount of credible evidence would change your mind". As Gavin Fitzgerald points out, as time passes, should the totality of the evidence point to homeopathy being an effective treatment then I would of course change my mind. To not do so would render me as myopic as those who persist in the belief that their particular branch of woo is more effective than both all the other branches of woo and 'conventional' medicine.

Equally respectfully,

Joe.
RE: Is homeopathy ethical?
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12/12/11 18:37as a reply to Joseph Bush.
Thanks Joe honestly no hard feelings at all. James
Is homeopathy ethical?
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08/12/11 14:56as a reply to Joseph Bush.
I am not a Pharmacist, however, even I know Homeopathy is basically placebo effect.

The fact that the active ingredient is diluted so far down that it is scientifically impossible to have a medical effect!

I think some people may confuse Herbal Remedies with Homeopathy, so I would clear that with them first. If they find Homeopathy works for them, then that's fine, but why someone would distrust pharmacy products which has been patented and gone through rigours clinical trials as well as manufactured in an MHRA-Licensed facility is beyond me!

Anyway, I love Ben Goldacre and his book "Bad Science" - an excerpt of which is on The Guardian website regarding Homeopathy... http://www.guardian.co.uk/science/2007/nov/16/sciencenews.g2 Enjoy!!

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