If you walk into a Quebec pharmacy and reach the “cold and flu” section, you may see a sign you’ve never seen before. The green-blue notice will tell you, “dear customer”, that there is “generally” no scientific evidence to support the effectiveness of homeopathic products. In one store (perhaps in an act of quiet vindication), the pharmacy staff slapped the notice over a pull-out display meant to help you figure out which homeopathic product may be right for you. The notice essentially answers, “None.”

How did we get here?

First, a crash course in how we know homeopathy does not work. For anything. Take ipecac, a plant that produces vomiting. Dilute in water, then dilute that dilution, and dilute some more… until there’s no ipecac left. Put that drop of water on a sugar pill. Give to somebody who’s been vomiting… to stop them from vomiting. This absurdity may make you nauseous, but these are the foundational principles of homeopathy, created by a German physician in 1796 because medicine at the time relied too much on leeches and bloodletting.

Despite homeopathy being the pinnacle of preposterousness, a number of scientific studies have been done to see if it works. Some were of dubious quality and are held by homeopaths as irrefutable proof. The best evidence was reviewed by many governments around the world and their conclusions were congruent: homeopathy is not effective for any condition and should not be recommended. So why do pharmacies sell these products?

Presumably for the same reasons that pharmacies also sell sugary beverages, chips and, up until 2000 in Quebec, cigarettes. Pharmacies extend well beyond the prescription counter. They are businesses, one-stop shops for all your bathroom needs and quick fixes in the kitchen. When it comes to homeopathy, there is a tension between a pharmacist’s scientific knowledge and the corporate interests of a store whose defence is usually, “if a consumer wants it, we can sell it… especially if it’s approved by Health Canada.” And there’s the rub. Health Canada gives validation to these nonsensical products by approving them in a way that looks to the average consumer like a proper drug approval process but which is not. No efficacy needs to be scientifically demonstrated. Anecdotes and “historical evidence” suffice. As long as they don’t endanger the population directly, they get approved. The system is so easy to game, CBC’s investigative journalism programme Marketplace got its authorization for a fake homeopathic remedy targeting children after sending in photocopies from an old book as proof that it would work.

And the word “system” is important here. To move us into a more evidence-based consumer landscape, we need to understand the different actors who take part in this system. Pharmacists say they’re at the mercy of the chains. The chains defend themselves by highlighting the fact that Health Canada approves these products. And Health Canada claims it’s up to pharmacists to sell these products or not. But recently, another cog in this machinery refused to give in to inertia.

The ABCPQ is the French initialism for the Quebec Association of Pharmacy Chains. When a little investigation I conducted revealed that two-third of Montreal pharmacies were selling a particularly popular homeopathic product against the flu, French newspaper La Presse followed with an investigation of its own, questioning the various cogs in this system and highlighting the absurdity in pharmacists being told they can sell this type of product but can never endorse it. And the ABCPQ said to La Presse they would create signs for pharmacies to display next to homeopathic products. A few months later, lo and behold, the signs are here (though optional). 6,000 were printed out, intended for the “near totality of Quebec pharmacies”, we recently learned. Moreover, the ABCPQ wrote to Health Canada to demand they revise how they authorize these products in the first place. Health Canada did not answer, but we know they are in the midst of a multi-year deliberation to revise this process. An announcement is scheduled for spring 2020.

As a scientist and a communicator who cares deeply about people making informed decisions about their health, I can say that homeopathic products have no place in pharmacies. Their mere presence represents a tacit endorsement by an evidence-based profession. Getting to the point where they are banished from drugstores is a long way off (if even possible), so I am pleased that we are now seeing a concrete step in the right direction. Consumers who know little about homeopathy and wander down the cold-and-flu aisle will now be faced with a fairly bold notice. It may be enough to nudge them away from wasting their money. And it might just make them wonder why, if pharmacists know these products don’t work, they are still selling them.

“Consult your pharmacist for details,” the sign will tell them.

Take-home message:

- Pharmacies in Quebec recently received signage to put up next to homeopathic products

- The signs tell the consumer that the effectiveness of homeopathic products is generally not supported by scientific evidence

@CrackedScience

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