In the fight against pseudoscience, the idea that simply providing more information works every time has been questioned these last decades. The thinking used to be simplistic: when non-experts disagree with scientists, it must be because they lack the correct information. But as we have seen in the growing struggle against the anti-vaccination movement, feelings don’t care about facts. When your identity is shaped by pseudoscientific beliefs, you have made your brain more or less impervious to facts. But there is at least one pseudoscience where better information is still a powerful remedy: homeopathy.
FIGURE 1. Typical display of homeopathic products in the vitamins and supplements section of a Montreal pharmacy
Homeopathy is a chameleon in pharmacies. It has taken the look and shape of genuine medication and will easily fool the casual shopper. Multiple episodes of the consumer advocacy show CBC Marketplace have provided evidence that the average person cannot distinguish homeopathic cold and flu products from medicated ones when presented with a table spread. Even when asked point-blank to define homeopathy, the near-totality of polled Canadians can’t do it. In 2016, Health Canada conducted an online survey on consumer health products in 2,502 Canadians. Nearly half confused homeopathy with herbal products. Only 5% of respondents showed at least a partial understanding of homeopathy. Information can play a crucial role in changing people’s minds here.
When you go to the zoo, there is a sign announcing that the glass-fronted case in front of you contains chameleons. You can be on the lookout for them. Two years ago, the Province of Quebec got its own signs in pharmacy, warning people about the presence of these homeopathic chameleons. I had to wonder: were the signs still there?
FIGURE 2. Close-up of the optional sign by the ABCPQ, informing pharmacy consumers that homeopathy is not based on scientific evidence
Air guitars on aisle six
The running gag about homeopathy is that it is the air guitar of alternative medicine. At its core, it’s a retread of the Danish folktale, “The Emperor’s New Clothes,” in which a monarch, various officials and soon an entire town play along with a couple of swindlers’ claim that they are making the most sumptuous of imperial clothes which just so happen to be invisible.
In a nutshell, homeopathy was born out of dissatisfaction and coincidences. Two hundred years ago, when actual medicine was more likely to kill than heal you, a German doctor and translator by the name of Samuel Hahnemann predated infomercials by thinking that there had to be a better way. When he ingested a natural antimalarial agent and randomly developed a fever—one of the symptoms of malaria—he made an ill-judged inference that is still with us today: that if an ingredient causes the symptoms of a disease in a healthy person, they must be the cure to the disease itself. This is how coffee entered homeopathy’s hallowed halls as a potent treatment for insomnia.
Of course, Hahnemann was not completely off his rocker. He understood that the negative effects of these natural ingredients—the agitation, the vomiting, the intoxication—were not desirable: they had to be diluted down. So he added water or alcohol to them to dissolve and dilute them, repeatedly, over and over again, until the ingredient itself had often, unbeknownst to him, completely disappeared. For homeopaths, this dilution makes the solution more powerful because the solvent somehow (and defying everything we know about physical chemistry) retains the vitalistic essence of this ingredient. The final dilution can now be dropped onto a sugar pill and voilà! A harmless, noneffective homeopathic remedy is created that can be dressed up in the garbs of actual pharmaceutical products and sold to the masses. (“Harmless,” I should point out, only when the dilution is properly done. When it isn’t, you could be giving a dangerous product to your infant.)
And getting these homeopathic sugar pills and water syrups approved for sale is incredibly easy. Marketplace did it by sending Health Canada photocopies of an old book trumpeting how brilliant certain ingredients were to reduce fever in children. No clinical trial, no safety studies: just assurance by long-dead homeopaths that these natural ingredients, diluted out of existence, really did work. Health Canada got egg on its face and introduced a new labeling rule. To sell a child’s cough, cold and flu homeopathic product, the packaging must clearly state that “this claim is based on traditional homeopathic references and not modern scientific evidence.” But a Marketplace segment released last week shows parents inspecting homeopathic cough syrups for children and failing to see the notice until it is pointed out to them. Would a sign next to the homeopathic products on a pharmacy’s store shelf help?
In Quebec, this became reality two years ago.
Homeopathic chameleons with legs
To make a long story short, I called 150 pharmacies in Montreal in early 2019 to find out that at least two thirds of them carried a particularly egregious homeopathic flu remedy called Oscillococcinum (consisting of duck heart and liver diluted one part in one hundred… two hundred times in a row). A local journalist, Philippe Mercure, writing for La Presse, then visited 20 pharmacies in our city, and in the 19 that carried Oscillococcinum, asked the pharmacist if his bedridden friend with muscle aches and fever should take this homeopathic product. Seven said no, six were ambiguous, and six more recommended it. The Quebec Order of Pharmacists reminded its members that they could not endorse a pseudoscientific product like this without putting themselves in a precarious position regarding their professional ethics. Meanwhile, our association of pharmacy chains (ABCPQ) made signs explaining that “the effectiveness of homeopathic products is generally not supported by scientific evidence based data” and to “consult your pharmacist for details.” They were shipped to pharmacies across the province, who had the option to post them next to the sugar pills. (The whole story can be read here: parts one, two, and three.)
Last week’s Marketplace segment conducted a similar investigation to Mercure’s, visiting a total of ten pharmacists practicing in four major chains in Ontario. Six out of those ten recommended the homeopathic product the journalist questioned them about. The Ontario College of Pharmacists told Marketplace that they could not determine if rules were broken without their own investigation. Ontario could certainly use our signs, with maybe a few propped up behind the pharmacy counter to help the people in the white coats remember their science-based training.
But are the signs still there in Quebec? Pessimism got the better of me when the sign at the pharmacy I regularly go to disappeared during the pandemic. So in late October of this year, I visited 14 pharmacies that sell homeopathic products in four different parts of the island of Montreal (for the natives, I focused on the areas near Jean-Talon, Berri-UQAM, Guy-Concordia and Papineau metro stations). The pharmacies belonged to the chains Jean-Coutu, Proxim, and Pharmaprix (known as Shoppers Drug Mart outside of Quebec). And I was pleasantly surprised to see many of the little signs that could.
FIGURE 3. Signs seen at two different Montreal pharmacies in October 2021
In total, six of the 14 pharmacies I visited (43%) had at least one of these signs. I say “at least” because those little chameleons pretending to be medication have legs. Homeopathy can generally be found in up to three different sections of a pharmacy. There’s the section filled with vitamins and supplements. There’s the adult cold and flu aisle. And sometimes, there is a separate section for children’s cold and flu remedies. Some pharmacies posted the sign in one or two of these sections, but none had signs next to every homeopathic section. Occasionally, the sign was in the wrong section, presumably because homeopathy used to be stocked there and when they moved it, they forgot to move the sign.
FIGURE 4. Can you spot the homeopathic children’s products hiding next to actual medication? We highlighted the homeopathy with bright yellow marker.
To show what a real hodgepodge the situation is in Montreal, one pharmacy stocked homeopathic products in two sections: one had no sign in sight while the other was adorned with a stunning five signs!
FIGURE 5. Inconsistent signage at the same pharmacy. A) No sign next to the homeopathic products in the supplements section. B) Five signs in a separate homeopathic section of the same store.]
The future of homeopathy in pharmacies
The situations in Quebec described by our office and by La Presse and in Ontario revealed by CBC Marketplace make a few recommendations abundantly clear.
We need better education in pharmacy schools. Pharmacists need to understand the foundational principles of homeopathy: that like is claimed to cure like, that dilutions are claimed to make ingredients more powerful, and that most homeopathic products do not contain a single atom of the original substance. It may feel like teaching chemists about alchemy, but homeopathy is being sold in pharmacies and pharmacists should know what it is so they can properly inform shoppers. If pharmacy students were aware that there is such a thing as homeopathic X-rays meant to treat “distressing pain,” they would better understand both the lunacy and potential danger of using homeopathy to treat anything.
[FIGURE 6. Homeopathic X-ray granules for distressing pain.
Health Canada needs to do its part too. When their homeopathy approval process was shown to be laughable and they were embarrassed on national television, they took the smallest possible corrective step: a notice would need to be visible on the packaging, but only for children’s cough, cold and flu remedies. Are homeopathic claims on adult products based on modern scientific evidence? Why did they escape from the change in labeling? As Health Canada has been deliberating on further changes for years now, I can only hope they come to the correct decision very soon. All homeopathic products should clearly mention that they are not based on scientific evidence. Another suggestion: if the Latin names for the once-present ingredients were forced to be printed in English, it might clarify a few things. If you picked up pills for insomnia and noticed that the ingredient was “coffee,” you might walk over to the pharmacy counter for a few explanations.
We could also use more signs in pharmacies and a more consistent posting of these signs. Other provinces may want to take notice of what our association of pharmacy chains did, and skeptical organizations and science communication bodies in other countries may want to try and reproduce the chain of events that led to these signs existing in the first place.
What reassures me is that the information deficit model, which states that the gulf between scientists and other citizens on certain issues can be paved over by good information, can really work for homeopathy. Parents don’t want their children to suffer, so it makes sense that they would gravitate towards cough syrups and granules that are 100% natural and that promise a complete absence of side effects. But likewise, parents don’t want to be deceived by sugar granules with medical aspirations. Clearly and calmly explaining homeopathy to them can make a big difference.
As cold and flu season begins, be prepared to spot the chameleons hiding on pharmacy shelves. They look just like regular pharmaceutical products but if you squint, you’ll see the word “homeopathy” somewhere on the packaging.
And remember this: if the label says homeopathy, it’s not trustworthy.
-Homeopathy is a fake medicine based on the principles that something that gives a symptom in a healthy person will cure it in someone who is ill; that the more you dilute something, the stronger it becomes; and that the solvent used for the dilution somehow remembers the original ingredient”
-In 2019, the Quebec association of pharmacy chains (ABCPQ) printed optional signs for pharmacies to post next to homeopathic products, informing consumers that homeopathy was not based on scientific evidence
-In late 2021, visits to 14 pharmacies in Montreal that sell homeopathy revealed that signs are posted in some pharmacies, but the signage is highly inconsistent, and no pharmacy visited had the sign next to every homeopathy display in their store