I was giving a talk to a local stroke group this week when someone asked the question about aspirin. You know, the “should I take a low-dose aspirin?” question, to which patients expect a simple yes or no. I waffled a bit about it “reducing the risk of stroke, but not very effectively, so that’s why you’re on clopidogrel or a NOAC”, until someone stumped me by saying: “Well, if it’s not strong enough to stop me having a stroke or a heart attack, does it actually do anything?”
Now that’s a good question, and we could ask that of a lot of treatments, including our bread-and-butter cough and cold remedies. We’ve been told repeatedly that cough mixtures don’t do anything, or at least that they don’t stop a cough which, considering all the hype, encouragement and expectation, is a bit sad. And although this inefficacy has been reported regularly in the press, it doesn’t seem to be a message that patients have taken on board – which is just as well considering the cough and cold market is worth over £430 million a year. All that money for a bit of flavoured syrup and sachets of powder to make a hot lemon and vitamin C drink.
So then I read on C+D that the British Homeopathic Association (BHA) failed to overturn NHS England’s decision to scrap homeopathy from prescriptions. Considering the UK homeopathic market is estimated to be worth over £200 million a year, I can understand their concern, but it struck me as strange that on the one hand we chemists castigate the sellers of ineffective water drops and sugar pills, while being happy to peddle syrup to patients presenting with an upper respiratory tract infection.
Homeopathy used to be something that divided pharmacists the way you could divide a room into those who did or didn’t believe in ghosts, or an afterlife, or Brexit. But over the years, there seems to have been dwindling support for this most inexplicable of treatments.
Maybe it’s the very inexplicable nature that means we denounce Arnica 6C as witchcraft, while we're happy to sell demulcents containing sub-therapeutic levels of expectorants and antitussives. And even if the public did wise up to our over-optimistic peddling of placebo linctus, they’d still come back for the diphenhydramine cough syrup, that’s a lot easier to buy than those horribly addictive sleeping tablets. So I’m afraid I have no sympathy with the BHA, because there’s absolutely no place in the NHS for homeopathy, or cough mixtures for that matter, and homeopaths should stick to private practice.
There are some pharmacists who say we shouldn’t sell homeopathic treatments, because it’s a professional endorsement. But if we’re OK selling lipstick and aftershave that doesn’t make anyone more attractive but leaves the purchaser feeling better, then I’m happy to take your money for homeopathy and cough mixtures. Meanwhile, the NHS is happy to continue prescribing low-dose aspirin – at least for now.