The heady days of June produced yet another Twitter discussion on pharmacy’s continuing – and frankly shameful – association with the ridiculous foolishness that is homeopathy. This debate was prompted by a blog post authored by Royal Pharmaceutical Society (RPS) chief scientist Jayne Lawrence, which concluded with the sentence: “Surely it is now the time for pharmacists to cast homeopathy from the shelves and focus on scientifically based treatments backed by clear clinical evidence.”

Ignoring the fact that Professor Lawrence appears to have had a change of heart on this matter since 2010, if you’re not prepared to nail your colours to that particular mast, then you must have no nails. If you do have nails and you’re not prepared to use them, then I think you probably need to reflect on whether you’re suited to play a part in a modern, patient-focused, evidence-led health profession. Even if we inexplicably ignored the patient care concerns around the supply of ineffective interventions, our association with such snake oil is damaging to our professional reputation.

Professor Lawrence’s original stance drew on what has become the magic sugar pill salesman’s response of choice, which runs along the lines of: “There is customer demand for these products. Pharmacies selling homeopathy allows us the opportunity to provide advice and/or intervene, an opportunity that would be lost if we stopped selling it.”

While this position may appear superficially attractive, it is a position supported by a fundamentally illogical stance. There is customer demand for all sorts of commodities. It wasn’t all that long ago that pharmacies sold cigarettes (reportedly, you could still purchase cigarettes from some pharmacies in 2001) and I’m pretty sure you’d struggle to find a pharmacist who would vouch for pharmacy supply of tobacco, even though the opportunity for a brief intervention with a smoker is lost.

I know that homeopathy is not directly harmful in the way that tobacco is, but the potential health gains from successfully engaging a smoker and helping them to quit is likely to be significantly greater than persuading a customer not to buy silly potions.

Is demand really that strong?

Already I’ve had to stumble into the occasionally delicate territory of customer demand whereas I find the ‘patient need’ bubble much more comfortable. That said, while I know that former Boots professional standards director Paul Bennett implied there was some demand for homeopathy within the company’s customer base, I struggle to believe that demand for homeopathy from pharmacies is strong.

Many moons ago, when I used to work regularly in community pharmacy (let’s say I’ve accumulated a grand total of two years’ worth of full-time experience), I was not once asked for advice about homeopathy and nor did I ever sell any of it. While this is anecdotal and is no doubt drawn from a biased sample of pharmacies, I am prepared to stick my neck out and say that less than 0.1% of 99.9% of pharmacies’ turnover is derived from selling unicorn tears – sorry – homeopathic ‘remedies’.

What seems to have evaded a number of commentators’ responses to Professor Lawrence’s position, as defined in her blog, is that her position is a personal one. It is not the stated position of the RPS. While the RPS goes on to state that it “does not support NHS funding of homeopathy”, its position on pharmacies selling homeopathy products remains unclear.

This begs the question as to why the RPS is opposed to the NHS funding of homeopathy. Is it on the grounds that it is:

1. a waste of public money
2. scientifically implausible and ineffective
3. both of the above?

The only logical case for opposing public funding for homeopathy while not opposing the retailing of homeopathy is that the RPS is opposed on the grounds that it is a waste of public money. If the RPS was opposed to the NHS funding of homeopathy on the grounds that it is ineffective then, by extension, it should surely be opposed to the retailing of homeopathy (as per Professor Lawrence)?

The manner of how a patient obtains homeopathy is an irrelevance – paying for it as a customer does not suddenly bestow it with effectiveness. As it stands, although the RPS chief scientist has publicly stated her opposition to the sale of homeopathy through pharmacies, the RPS has not stated its opposition to the retailing of homeopathy. While I am wholly cognisant of the fact that the RPS has much bigger (and, frankly, more important) fish to fry, I would welcome Professor Lawrence’s position becoming the position of pharmacy’s professional leadership body at the earliest possible opportunity.

Homeopathy is scientifically implausible and ineffective. Our involvement with it is anti-evidence-based practice and damages our standing in the eyes of external parties (some of whom may be commissioners of services). The costs of our involvement with it are almost certainly not outweighed by the financial benefits accrued by those contractors who sell it.

I’m afraid to report that writing about this subject yet again has left me somewhat despondent. I think I might need some Berlin Wall 30C.

Joseph Bush is a senior lecturer in pharmacy practice at Aston Pharmacy School

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