Our book ‘Trick or treatment? Alternative medicine on trial’, provides careful assessment of the pros and cons of homoeopathy remedies, which are ubiquitously for sale in UK pharmacies. It concludes that they are biologically implausible and that approximately 200 clinical trials have failed to demonstrate effectiveness.
The Royal Pharmaceutical Society’s code of ethics state that if pharmacists sell homoeopathic or herbal medicines, or other complementary therapies, they must assist patients in making informed decisions by providing them with necessary and relevant information.
Pharmacists should, therefore, inform their customers that a homoeopathy remedy is devoid of any biologically active material and it has not been shown to have relevant health effects beyond placebo.
This is currently not happening. On the contrary, customers are frequently misinformed with information, such as promotional material in the pharmacy or verbal advice given by pharmacists, and so pharmacists are breaching their code of ethics on a daily basis.
We call on the Society to take urgent action so that its ethical standards are adhered to.
Edzard Ernst
Peninsula Medical School
Exeter



Alternative Medicine
Homeopathy and Professor Ernst
From Mr D. Pruce, MRPharmS
The Society’s code of ethics and professional standards state that pharmacists should assist patients in making an informed decision, and provide them with the necessary and relevant information that is available. The code does not attempt to define exactly what information should be provided. Until such time when homoeopathic treatments are regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA), the selling of such products is a matter of professional judgement for the individual pharmacist.
Through undergraduate and postgraduate training, pharmacists are taught to apply scientific evidence, which in the case of homoeopathy can be lacking, inconclusive or ambiguous. Pharmacists are also taught clinical judgement based upon the clinical need, choice and belief systems of the individual patient.
Pharmacists endeavour to provide optimal clinical treatment with the minimal adverse effects to their patients and, at the same time, respect the role individual patients plays in deciding upon their own treatment. Rather than argue around any ethical dilemma of the pharmacist we believe it is now time for all homoeopathic medicines to be regulated by the MHRA and the Society welcomes Professor Ernst’s comments in raising this important and unresolved debate.
The Society believes this should now be done on a much wider scale than pharmacy alone, because it is a matter that affects all healthcare practitioners.
David Pruce
Director of Policy and Communications
Royal Pharmaceutical Society
From Mr P. H. Dawson, MRPharmS
If over-the-counter products were subjected to a similar demand for evidence of effectiveness in the form and strengths available, pharmacy shelves would be far less crowded, starting with the cough and cold section.
As a community pharmacist, I find it is not always possible to adhere to the code of ethics requiring that I ensure safe and effective use of medicinal products.
Primum non nocere, or “first do no harm”, may be a fine principle for physicians, but for community pharmacists the absence of harm is a tenuous basis on which to promote and sell OTC products.
Peter Dawson
Ilkley, West Yorkshire
From Mr. D. B. Needleman, MRPharmS
If it is unethical to supply medicines that have not been scientifically proven, should I refuse to dispense selective serotonin reuptake inhibitors as they have recently been shown to be of no greater value than placebo for mild depression (PJ, 1 March 2008, p235)? And how about aspirin or amoxicillin or other effective drugs that have not been clinically trialled?
D. Needleman
Stanmore, Middlesex
From Mr M. E. Q. James, FRPharmS
However, on pA8 and pA12 you carried two colour advertisements for books on, respectively, homoeopathic prescribing and homoeopathic practice, both of which are stated to be published by the Pharmaceutical Press.
If pharmacists should consider the ethics of supplying homoeopathic products, surely that extends to the Pharmaceutical Press.
Miall E. James
Colchester, Essex
From Mrs Jyotika Singh, infectious diseases pharmacist
Giving a homoeopathic prescription is something that should not be taken lightly and it is not like giving paracetamol for a headache. There are hundreds if not thousands for prescriptions that could be indicated and therefore a prescription should be chosen carefully.
As to the evidence, well evidence based medicine has only come about recently, whereas homoeopathy has been around for hundreds of years. Even today we do not know how all our drugs work, e.g. the full mechanism of paracetamol is not known, but we know it works.
The two systems of medicine are totally different, like you can't drive a car in water or sail a boat on the road, the two systems will always be different.
I just believe that it is not ethical to sell, as a professional, something that you have no knowledge or understanding about. These medicines should only be sold from outlets where people know about the medicine, and are using it in conjunction with conventional medicines for your well being.
Alternative medicines (sic)
Leadership required
"There are thousands of