A recent proposed change to the New Zealand code of conduct for pharmacists provides yet more evidence for my primary criticism of the alternative medicine phenomenon (CAM), that it is explicitly about creating a double standard, while convincing the public that it isn’t. What was considered health fraud 50 years ago has been transformed through deception and clever marketing (facilitated by a willful media and naive regulators and professionals) into an “alternative” that should be “integrated” into science-based health care.

Broadly speaking, there are systems in place to ensure a reasonable standard of safety and effectiveness for medical products and practices. These standards are based upon evidence, as they should be. There have always been operating in the fringes, however, those who are somewhere on the spectrum from true believers to con-artists who want to sell their treatments despite a lack of evidence.

Despite having an NIH office dedicated to finding evidence to support such treatments, and despite raking in literally billions of dollars which could be used to fund research, for the most part the evidence never materialized. Homeopathy, acupuncture, and energy healing continue to lack evidence of efficacy.

This doesn’t really matter to proponents of these treatments, however. They were never about the evidence. Evidence was only just a means to an end – selling their wares and services. It was never about quality control or finding out what works. Therefore, knowing that they lack real scientific evidence to meet the standard of care, they attacked that standard.

Purveyors of dubious health care have consistent made a number of arguments that all loosely fall under the umbrella of “health care freedom.” They have lobbied for changes to the regulations to carve out a double standard, so that their products and services do not require the same standards of evidence as regular medicine. They have largely been successful, at the direct expense of consumer protection. They either did this below the radar, or by selling it to consumers as if they were protecting the consumer’s freedom of choice, when they were really just protecting their own freedom to sell snake oil.

Specific manifestations of this include DSHEA, a 1994 act sponsored by Hatch and Harkin that was a gift to the supplement industry, creating a double standard for “dietary supplements,” the definition of which was expanded to include herbal drugs. Health Care Freedom laws also started to be passed state by state, specifically exempting practitioners of “alternative medicine” from the standard of care – literally erasing any standard for practices labeled “alternative.”

Now from New Zealand we have another smoking gun of a double standard. Pharmacists have a Safe Effective Pharmacy Practice Code of Ethics which includes the following:

6.9 Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.

That seems reasonable, and the public generally assumes that such standards are in place. When they purchase a product from a pharmacist, they expect that the product has met certain standards of safety and that the claims on the package cannot be outright lies.

The problem with that code of ethics (for pharmacists) is that the majority of supplements and “complementary” products lack credible evidence for efficacy, and yet pharmacists stand to make a lot of money from selling them. This applies to the entirety of homeopathy, for example. So, in effect, most pharmacists have simply ignored that part of the code.

In August the Pharmacy Council published their proposed changes to the code of ethics. Paragraph 6.9 was changed to the following:

6.9a Only supply or promote any medicine or herbal remedy where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy. 6.9b Only supply any complementary therapy or other healthcare product where there is no reason to doubt its quality or safety and when sufficient information about the product can be provided in order for the purchaser to make an informed choice with regard to the risks and benefits of all the available treatment options.

Yet again, here is a literal double-standard; regular medicine requires evidence for efficacy, while complementary therapy does not. Instead, just give the consumer information so that they can make an “informed choice.” That is total BS, however, as consumers are never given enough information to make an actual informed choice. Instead they are given propaganda, or weak false-balance statements. If consumers were really informed about what homeopathy is, for example, the industry would collapse.

The Society for Science Based Healthcare, a NZ group that promotes science in medicine much like the SfSBM does, offered this proposed change:

6.9a Only supply any medicine or herbal remedy where there is credible evidence of efficacy.

6.9b Only promote any complementary therapy or other healthcare product where there is credible evidence of efficacy.

6.9c Only supply or promote any medicine, herbal remedy, complementary therapy or other healthcare product where there is no reason to doubt its quality or safety, when there is not credible evidence to suggest that the product lacks efficacy.

6.9d Provide sufficient information about any medicine, herbal remedy, complementary therapy or other healthcare product product in order for the purchaser to make an informed choice with regard to the risks and benefits of all the available treatment options.

My only quibble is that the wording perpetuates the false category of “complementary therapy.” They could combine 6.9a and 6.9b to apply to “any medicine, remedy, therapy, or other health care product.”

The scientific and medical community, and consumer protection organizations, need to be united in demanding one seamless evidence-based standard. No product should be able to make specific health claims that are not backed by adequate evidence. No product should be able to bypass reasonable standards of safety, and basic product standards like purity and accuracy in labeling.

Most consumers already think this is happening, and are universally scandalized whenever I inform them what is actually happening.

Conclusion

In every country, we need to abolish the double standard for so-called alternative treatments. Such regulations and practices are anti-consumer. They are granting businesses a free pass at the expense of consumer protection and real consumer freedom, in the critical market of health care.