Community pharmacy treads a fine line between professionalism and commercialism, and nowhere is this more evident than in the stocking of homeopathic products. While evidence of efficacy is lacking, homeopathic remedies continue to feature on the shelves of pharmacies up and down the country, and the issue was the focus of a debate at this year’s Royal Pharmaceutical Society conference with strongly held views both for and against the practice.
Homeopathy was included under the umbrella of the NHS when it was created in 1948 but NHS support is now most definitely on the wane. At one point there were 14 homeopathic hospitals in the UK, now there are just two (in London and Glasgow). Bristol’s dedicated homeopathy facility, which sits within one of its community hospitals, closes this month, and the city’s clinical commissioning group has announced that it does not intend to continue funding such treatments.
Pharmacy has not held back in supporting this approach. Only last month the RPS said that it believes there is “no evidence from randomised controlled trials for the efficacy of homeopathic products beyond the placebo effect, and no scientific basis for homeopathy… The Royal Pharmaceutical Society does not endorse homeopathy as a form of treatment.”
A House of Commons Science and Technology Committee report was also critical of the MHRA for licensing homeopathic medicines, saying that “deficient labelling” lent “spurious medical legitimacy” to what were “sugar pills with no active ingredient”. At the current time, there are two regulatory schemes in the UK for homeopathic medicines (see Register a homeopathic medicine or remedy):
The RPS has been reviewing its policy and guidance on homeopathy (a consultation closed on October 26). Hopefully the outcome of this work will help pharmacy make a decision one way or the other. Could pharmacists’ previous reluctance to decide be because homeopathy occupies that awkward space between NHS and retail? Or is it because the profession is worried about nannying customers and removing patient choice at a time when it is trying to encourage self-care and health literacy?
One of the main reasons pharmacies should continue to stock homeopathic products is because of the opportunity it provides for someone who isn’t feeling well to have an interaction with a healthcare professional, says Sibby Buckle (pictured), a member of the RPS English Pharmacy Board and community pharmacist. The established and robust supply chain that exists within the pharmacy network also offers a level of reassurance in a way that internet purchases do not, she suggests.
Tony West (fellow EPB member and chief pharmacist and clinical director at London’s Guys and St Thomas’ NHS Foundation Trust) agrees, saying this opportunity to undertake a consultation would be lost if customers could only purchase homeopathic products from health food stores or online. “I’m concerned we will lose our relationship with patients if we don’t listen to their beliefs,” he said.
While the efficacy of homeopathic medicines may be down to the placebo effect, Ms Buckle says this should not be underestimated in terms of improving patient outcomes, and is not dissimilar to many OTC medicines, which also have little proof backing the claims they make. “It is not black and white; the whole OTC category including nutraceuticals is a huge grey area and needs looking at,” she says. “As long as a product causes no harm and the patient feels better having taken it, why should we undermine their convictions?”
“Our role is to stop being paternalistic and to support patients in their own health decisions, even if it is to explain that there is no evidence for homeopathic products and that they can’t replace conventional medicines,” says Ash Soni (RPS president and community pharmacist). “We can’t and shouldn’t tell people what to think, but we can help them to make decisions.” Mr Soni also believes that taking homeopathic remedies out of pharmacies could remove opportunities for all-important health conversations.
Homeopathy has no place in a science-based caring profession, according to Anthony Cox, English Pharmacy Board member and a senior lecturer in clinical pharmacy at the University of Birmingham. “Randomised controlled trials have shown these products don’t work, and to sell them fosters the incorrect beliefs held by many… In some cases, people have died in agony because they have neglected conventional medicines in favour of homeopathy.”
RPS Welsh board member and primary care pharmacist Rob Davies agrees that while some may think that homeopathy is acceptable because it does no harm, that doesn’t necessarily mean it does good. Terry Maguire (pharmacy contractor and honorary senior lecturer at Queen’s University Belfast’s school of pharmacy, pictured) says he is disappointed the issue is still not resolved when, in his opinion, the lack of supporting evidence speaks for itself.
“Selling in pharmacies gives credibility and credence to homeopathic products, which do not work,” he says, arguing that the high prices set by manufacturers of homeopathic remedies only augments the perception that the products are of high quality. Angela Alexander (professor of pharmacy education at Reading University) refutes the principle that pharmacies should continue to stock such products simply because they have done so historically.
“Pharmacies used to sell cigarettes and alcohol until it was realised that this was inappropriate,” she says. Felicity Lee comes at it from a very different angle as a former pharmacist and now an advanced homeopath. During her 30 years of practice she says she has come across many patients who have found homeopathic medicines safe and effective.
“There is no danger of interactions, the remedies are safe in breastfeeding and pregnancy, there are no concerns about hepatic or renal dysfunction, no allergies, no plasma protein displacement and they are safe in the elderly,” she points out. However, Ms Lee is of the opinion that homeopathy has no place in pharmacy because the practice is complex, involving over 3,500 remedies, and prescribing has to be accurate.
Community pharmacists simply do not have the time to undertake the 90-minute consultations she conducts or the necessary training to make appropriate recommendations. This is an area of healthcare they should not be involved in, she says.
The RPS has been reviewing its policy and guidance on homeopathy