The other day a parent asked me if she could give her 2-year-old Tylenol liquid along with some cough syrup she had purchased at the pharmacy. I was a bit surprised, as cough and cold products for young children have been pulled from pharmacy shelves for a few years given their lack of efficacy and spotty safety record. “What product did you give?” I asked. “Stodal” she replied. I paused, then replied. “Well the good news is that you can give Tylenol and Stodal together. But you should know that Stodal is a homeopathic product – it contains no medicinal ingredients, so what you’re effectively giving is a sugar syrup.” I explained how homeopathy is permitted for sale in Canada, and sold in pharmacies, despite the fact it is an elaborate placebo system of sugar pills and liquids. The mother was furious – at the pharmacy for selling it, at the store staff for recommending it, and especially at the regulator, Health Canada. “How can they possibly permit this to be sold?” she asked me. I had no explanation – but encouraged her to return the product to the pharmacy and demand a refund.

As a pharmacist I’ve counseled hundreds of people about homeopathic “remedies”. I’ve observed that the biggest threat to the practice for a large part of the population is education. Simply explaining that homeopathy is a pseudoscientific ritual, and its products have no active ingredients, is often enough to convince them that using homeopathy is no “treatment” at all: They’re akin to doing nothing, albeit you pay for the privilege of watching yourself get better.

Homeopathy “manufacturers” are well aware of the stigma that accompanies selling products as medicine when they’re actually inert. That’s why some are rebranding their products as “supplements”: “Rebranding products from homeopathic remedies to dietary supplements has helped one California entrepreneur boost sales by more than 80%“. says the article in Nutra-Ingredients, which profiles Stuart Garber, a chiropractor with a Ph.D. in homeopathy:

Using the formulas in his private practice and trying to sell them on the open market were two very different things, Garber discovered. Patients who came to him were already open to the benefits of homeopathy. But in the open marketplace there was resistance, and even hostility, Garber said. “The controversy out there is vehement. People who are anti homeopathy are not just anti. They are vehemently against it,” he said. When he started thinking about freshening the look of the line, he contacted a consultant, and it was then he discovered the option to rebrand as dietary supplements.“I was shocked by the choice. It depends on what you say about them and how you label it,” Garber said. When in doubt, deceive. Changing your claims to meet regulatory requirements – such a bother! Garber was using these products in his practice to treat conditions and diseases. And even if he might believe they still can have those effects, he can no longer say so on the packaging or in his other messaging. “I have to make structure-function claims. As an example, I have a product for depression. So I had to say it was for relief of temporary depression or occasional feelings (of despondency). Not that it treats depression. My joint formula, I couldn’t say it treats arthritics anymore, rather that it promotes healthy joints,” he said. In a couple of other cases, the products themselves had to be renamed, Garber said. Garber’s legal consultant advised him that products with “allergy” and “diarrhea” on the label implied a disease treatment claim. This kind of deception from homeopathy manufacturers should not be surprising. After all, there is no credible evidence to suggest these products have any medicinal effects beyond placebo effects. But what’s more frustrating is that regulators like Health Canada willingly label homeopathy as “safe and effective” and permit their sale. What’s worse, the pharmacy profession, which should know better, doesn’t seem to care about the practice. Where’s the protection for the consumer? Sadly, both Competition Bureau and Advertising Standards Canada also seem reluctant to act against bogus health products. I was at a conference this past week and had the opportunity to hear Steven Lewis speak about the possibility of a pharmacare program for Canadians. He singled out pharmacists in his talk, describing them as a group of health professionals that essentially needed to make a choice – are they contributors to the health care system, or barriers? In one of his older essays on the topic, he expands on the issue: A profession that willingly tethered its income to my consumption of drugs gives me little confidence that it will uniformly forsake a sale for my well-being. Some pharmacists will; some won’t – and I won’t know the difference. That’s not good enough. Hence, the profession has some soul-searching to do. It needs to decide what it is – part of the healthcare-is-a-commodity-and-caveat-emptor oligopoly, or professionals who seek to work in an environment and under incentives that reward them to do the right things well, uncompromised by excessive commercial influence. Pharmacy is by no means alone in this dilemma, but its importance is magnified by being part of the fastest-growing health sector with a well-documented history of ethical missteps. Thinking back to my patient encounter I described above, the patient bought the homeopathic product in an Ontario pharmacy, where it was shelved alongside products that actually contain medication. Someone, likely a pharmacist, recommended it. If willingly selling sugar syrup, packaged to look like medicine, to a worried mother doesn’t illustrate the ethical problems with homeopathy and pharmacy practice, I’m not sure what does.