Did you know that some of our Montreal pharmacies employ naturopaths who give advice to customers, even though this is forbidden? This is one of the many upsetting facts uncovered by Philippe Mercure for his La Presse investigation on the sale of homeopathy in drugstores. He was inspired by an article I wrote a few months ago, revealing that at least two-thirds of big-chain pharmacies in Montreal were selling the now-infamous Oscillococcinum, sugar pills alleged to help with flu-like symptoms.

Mercure visited 20 pharmacies in our city. In the 19 that carried the homeopathic product, he asked to speak to a pharmacist. He explained that a friend of his had been bedridden with muscle aches and a fever for two days. He heard about Oscillococcinum. Should he buy it?

Seven professionals told him not to. Six had more ambiguous messages, warning him of the lack of evidence but concluding that it could potentially work. Six more actually recommended the product (four pharmacists, one pharmacy technician, and one naturopath).

For those who want to delve deeper into “What is homeopathy and how did Oscillococcinum come about“, click here - Homeopathy was conceived at a time when medicine was pretty barbaric, and it was based on ideas borrowed from sympathetic magic (like cures like… so something that provokes a fever will cure one in an ill patient) and bad observations (a remedy that was inadvertently shaken while taxiing on cobblestones seemed to work better). Its proponents will approve of the titanic dilutions used to create the final product (because the more you dilute, the more powerful it becomes, obviously): they will say the water remembers the original molecule (but somehow forgets all the poo it’s had in it, as Tim Minchin reminds us). - Oscillococcinum is particularly egregious in its mind-bending dilution factor. The duck heart and liver, digested in pancreatic juices, get diluted 200 times in a row, leaving nary a quacking molecule behind. Why a duck to help treat the flu? Because a French physician thought he saw an oscillating bacterium in the blood of patients with the Spanish Flu (though no bacteriologist saw it again). Since homeopathy says “like cures like”, and since the physician thought he spotted the bacterium in ducks as well, he decided to give flu patients a taste of their own disease in an attempt to cure them

A representative from the Quebec Order of Pharmacists told Mercure they were surprised and disappointed by his findings. Indeed, article 34 of the pharmacist’s code of ethics in Quebec states that he or she “must practice with competence and in accordance to scientifically acceptable data”. The Order told Mercure that pharmacists who recommend homeopathic products will find themselves in a precarious position from the standpoint of professional ethics. I was happy to read a clear statement from their representative in La Presse: “There is no scientific evidence that demonstrates the efficacy of homeopathy for any indication” (translation mine).

In these situations, many practicing pharmacists are quick to blame the chain for which they work, which decides what gets sold beyond the prescription counter. So Mercure went to the ABCPQ (the Quebec Association of Pharmacy Chains) for comments. Their response beggars belief. They told him that they had only been informed these past few weeks of new publications which they believe are credible and which cast doubt on the efficacy of homeopathic remedies. When asked what these “new” and “credible” publications were, their spokesman pointed to the media coverage of our Oscillococcinum investigation. It should go without saying that we did not provide evidence of homeopathy working or not. The research on homeopathy has been conducted by actual researchers and isn’t new. Entire governments have conducted evidence checks on the body of evidence behind homeopathic claims and have come to the conclusion that, as the Quebec Order of Pharmacists correctly stated, it does not work for any indication.

So what will the ABCPQ do with this “novel” information? They told Mercure they will give signs to pharmacists to put next to homeopathic products. These signs will indicate the absence of scientific data regarding homeopathy and will invite customers to consult their pharmacist for more details. I believe this is a small step in the right direction if consistently implemented, as it will expand on Health Canada’s requirement for cold-and-flu homeopathic remedies targeting children to carry a similar warning. A two-fold problem remains. First, how many signs will go up, since homeopathy is usually distributed all over the pharmacy, mixing the sugar pills with the actual drugs? Second, will the incorrect advice by some pharmacists be corrected in the future?

The final (and most disturbing) revelation from this piece of reporting concerns the presence of naturopaths in some of our pharmacies. When I sought to determine how many pharmacies carried Oscillococcinum last December, I discovered that one of them had a naturopath on staff. I was transferred to her and she recommended the product. I was shocked by her presence in an actual medical pharmacy, but Google Reviews of the establishment provided further proof that she was real. Mercure uncovered a second naturopath working in a Montreal pharmacy. Both pharmacies belong to the Shoppers Drug Mart banner (Pharmaprix on the French side). A representative for the pharmacy chain claimed they were “clerks” who should not be giving advice.

Forgive me if I can’t believe this. Two pharmacies from the same chain happen to have floor clerks with such a universally recognized knowledge of alternative medicine that the pharmacy staff decides to systematically reroute questions on homeopathy to them?

What this looks like instead is a tentative step toward “integrative pharmacies”. Much like creationism was rebranded as “intelligent design” (and later as “teach the controversy”), alternative medicine is in the midst of an academia-friendly reinvention: integrative medicine. The elevator pitch is that “Western medicine” is good but insufficient, and must be integrated to alternative therapies for the patient to receive optimal care. Some pharmacies have fallen under that spell (I visited one in Vancouver last year).

I do have some bad news for their potential infiltration in Quebec: our Order of Pharmacists states that it is forbidden. According to article 9 of their code of ethics, pharmacists are barred from collaborating with non-professionals. Since neither homeopaths nor naturopaths have a professional order in Quebec, they are considered non-professionals. Their employment in pharmacies as alternative health “professionals”, even away from the prescription counter, is prohibited.

Pressure is mounting against homeopathy. All of this media coverage is generating discussions behind closed doors. There is a national class action lawsuit led by a citizen, Adanna Charles, against the makers of Oscillococcinum, the claim being that its publicity is deceiving and misleading. In British Columbia, the Registrar of its College of Pharmacists recently asked people following the media coverage of our investigation to chime in on whether or not homeopathy belongs on drugstore shelves. South of the border, the Center for Inquiry is suing CVS, a major pharmacy chain, for fraud over the sale of homeopathic remedies. And in the UK, the unremitting efforts of the Good Thinking Society and its allies led to the National Health Service stopping its funding of homeopathy through taxpayer money. And I should mention pharmacist Graham MacKenzie of Nova Scotia who publicly removed homeopathy from his shelves.

Homeopathic products, which masquerade as real medication, have no place in our drugstores. By being sold in pharmacies, they receive an implicit endorsement. And it’s the consumer, physically ill and ill-informed, who ends up paying the price.

Take-home message:

• A journalist from newspaper La Presse visited 19 pharmacies in Montreal that sold Oscillococcinum, a homeopathic remedy against the flu that does not work

• The product was recommended to him in 6 pharmacies, but the Quebec Order of Pharmacists says it should not have been endorsed

• Some Shoppers Drug Mart (Pharmaprix) drugstores employ naturopaths who seemingly collaborate with the pharmacists (though a representative said they were clerks), which is forbidden by the pharmacists’ own code of ethics

@CrackedScience

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