What is it about homeopathy that has enabled it to survive over 200 years of usage in spite of having what some current studies insist is no greater effect than placebo? Is it simply that the placebo, or essentially our own immune system, is that effective when given a little encouragement?
My overall experience in using these medications with clients has been surprisingly positive. I was first introduced to the medication system in the mid-nineties when we had just opened a new pharmacy. My husband, who is also my business partner (and a non-pharmacist), had noticed the rising interest in natural remedies and, in spite of my hesitation, insisted that we should stock homeopathy as well as herbal medicines.
As a pharmacist, I had a hard time getting my head around the way homeopathy was prepared, and the Latin names and different preparations were confusing to me, but I agreed to give it a try. Of course, we didn’t have the “meta-analysis” studies that we have today, which would likely have convinced me to do otherwise.
Initially, my role was simply to provide specific medications that clients came in looking for, or I would consult homeopathy texts to help clients determine which medication would specifically be recommended for them when someone asked. Although I didn’t have an overwhelmingly large number of clients and didn’t specifically track their responses, it seemed that I received far more positive feedback than negative.
Very early on, I had a chat about homeopathy with a pharmacy student who was with me for the summer. “I think it’s a crock,” she said. Then a client came in, looking for more Rhus Toxicodedron to take along with his standard rheumatoid arthritis medications. He felt that he was sleeping better with the homeopathy added.
My pharmacy student decided to take some home for her mom to try for her arthritis. Within a week or two, she marvelled that several spots of eczema that she had had for several years had disappeared! We consulted a text and discovered that Rhus Toxicodendron was also useful for the crusted-over stage of eczema! Our little “N=1” study had produced results, although not what we expected. We certainly couldn’t credit the placebo response in this case, since none of us knew this agent was recommended for eczema. I suppose one could say it was just chance, and it was going to disappear anyway on its own, but it seemed more than that.
One type of situation where I found homeopathy particularly useful was in cases where it was not safe to recommend standard medication. An example of this would be a client with high blood pressure or diabetes who was looking for something for a low-level sinus problem (where my questioning had determined that it was unlikely they had a sinus infection). I would cautiously suggest a combination sinus product with several homeopathic ingredients, since I did not have the time or expertise to do a full homeopathic assessment to determine the single most recommended ingredient. After a few such recommendations, this product quickly became one of my best-selling sinus medications. It was obvious that people were being referred by others who had tried it. “My friend/neighbour/relative told me I should get some of the sinus medication they bought here, called ‘Sinus-something’ (Sinusalia),” they would often say.
Comparing to other accepted products… To be fair to homeopathy, I should mention that there are a large number of other questionable medications being carried in pharmacies. Pharmacists happily recommended children’s DM and decongestant products for years, only to find out that they were ineffective and did more harm than good. I even gave them to my own children, believing that they would help. And perhaps they did, given that the care and attention that I administered them with probably helped to stimulate a good placebo response.
And what about all the vitamins that are stocked in pharmacies? There has been plenty of educated commentary advising that we should be able to get all the nutrients we need from our food, making multivitamins unnecessary for most people.
To be in compliance with Natural and Nonprescription Health Directorate guidelines for obtaining a Natural Product Number (NPN), most herbal products no longer make any claims at all on their labels, presumably leaving other sources (such as websites, and advertising) to promote claims that are not acceptable to Health Canada. This leaves the consumer to search out whatever information they might find, often on the Internet or through word of mouth. That’s not always an ideal situation, depending on the source!
As a pharmacist, I subscribed to reputable sites and bought approved texts on herbal medicines so I could give evidence-based replies to questions about herbal medicines. I tried to do the same with homeopathic medicines, and purchased several standard and newly printed texts on homeopathy.
Knowing how highly diluted homeopathic medications are prepared, I had difficulty understanding how they possibly could work. There is a parallel with vaccines, where the agent that causes the problem is basically destroyed and then made into a solution that then stimulates the immune system to do the action we desire. This seemed to be a plausible explanation for how homeopathy could work, but why would a more dilute solution give a stronger effect rather than a weaker one?
Confounding my understanding was the existence (although rare) of the “exacerbation reaction,” which is reported in the literature and was experienced by one of my clients who tried an allergy product. How could a substance that is diluted beyond Avogadro’s number (leaving it unlikely to contain even a single molecule of the original substance) cause her allergic symptoms to strongly intensify only minutes after taking a homeopathic medicine?
Could it be that standard testing methods cannot be used for homeopathy due to its individualization?
Homeopathic medications are used around the world far more commonly than they are in North America. England even has homeopathic hospitals, described to me by a pharmacy student who had done a rotation in such a hospital. Another student from India told me that homeopathic medicines were routinely used at home.
One of my best clients was a veterinarian who regularly used homeopathic medications with his animal patients—if the action of homeopathy relies only the placebo response, how could they work in an animal?
Are we missing something? Could it be that standard testing methods cannot be used for homeopathy due to its individualization? Do we need to, perhaps, include the ability of the immune system to respond in our attempts to prove or disprove this system? More questions than answers…
The bottom line...
So, while other pharmacists may make a different decision, I found a way to use these medications safely and productively in my pharmacy practice. When someone asks for advice on a homeopathic product, I make sure they are using it for a self-limiting condition or at least as an adjunct to a standard treatment.
And I find homeopathic remedies are useful to have available when a client is determined that they want to take a medication, but it is unsafe for them to take the standard non-prescription medication because of an existing condition or another medication they are taking.
I also make sure that they know what non-drug measures are helpful for their condition. In this way, I can try to ensure that they benefit from having visited the pharmacy and that their treatment doesn’t do more harm than good.
An important part of the decision to use homeopathy, is making sure that the condition is self-limiting. In other words, only use homeopathy for conditions that the immune system can overcome. At the very least, given the power of the placebo, the fact that they are taking something may well mean that they will get better sooner!
Previously published in Pharmacy Practice Plus journal for pharmacists
