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FEATURE
DR BETTY CHAAR MPS
is Senior Lecturer and MPharm Co-ordinator at the Faculty of Pharmacy, the University of Sydney. Opinions expressed
in this column are not necessarily those of the Pharmaceutical Society, its Board or staff.
NHMRC statement on homeopathy – March 2015
Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective. Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments. The National Health and Medical Research Council expects that the Australian public will be offered treatments and therapies based on the best available evidence.
People who use homeopathy need to understand the potential benefits and risks to enable them to make an informed decision. Health practitioners also need to know what homeopathy is, be aware of the current scientific evidence from research on homeopathy, and understand any possible benefits and risks to patients, particularly when people decide to use homeopathy instead of other evidence-based treatments.
ETHICAL DILEMMAS
Homeopathy and pharmacists
BY DR BETTY CHAAR
Over the years there has been growing concern over the role of homeopathy in healthcare.
The fact that many pharmacies offer homeopathic products amongst their many ranges of over-the- counter products means these concerns are of particular interest to the pharmacy profession. So serious has this issue become to the profession globally, that the International Pharmaceutical Federation (FIP) is currently formalising its position on behalf of the pharmacy profession worldwide – and the message is crystal clear.
Therefore, regardless of whether you personally believe in homeopathy or not, or carry the stock in your pharmacy or not, it is incumbent on each and every pharmacist to be aware of and well versed in the arguments both for and against homeopathy, and where we as pharmacists stand.
Homeopathy is a practice created by Samuel Hahnemann (1755-1843) based on the belief that minute quantities of substances dissolved in water can have powerful healing effects on the human condition.
This is based on two premises:
• that substances that may cause illness or symptoms in a healthy person can, in very small doses, treat those symptoms in a person who is unwell, and
• that highly diluted preparations retain a ‘memory’ of the original substance. Homeopathic medicines are prepared by taking a substance (e.g. plant, animal material, or chemical), diluting it in water or alcohol, then forcefully hitting the container against a hand or a surface.
Of course there are no direct adverse events to report as a direct result of consuming or applying homeopathic substances of such minimal concentrations. The concerns lie in the fact that some people, in choosing such options lose crucial time
in which more effective, evidence-based treatments could have been used. There are literally hundreds
of documented incidents of harm caused by lack
of efficacy that can be found on the internet, with names, places and times of death for some. These reports are increasing the gravity of existing concerns.
In 2015 the National Health and Medical Research Council (NHMRC) released a major report on homeopathy which has resonated around the world. Its message is about lack of efficacy, the danger of time lost, and lack of evidence to support claims of any therapeutic value except that of a placebo.
In terms of pharmacists’ ethical duties in
practice, and the bioethical principles that guide contemporary healthcare practice, we often need to consider the principle of respect for patient autonomy as ‘first amongst equals’, and herein
lies the ethical dilemma. Do we respect patient autonomy, when we suspect the patient is either uninformed or lacks awareness of the crucial importance of the parameters of time and efficacy in the treatment of healthcare conditions? Do we respect patient autonomy in the face of defiance and strong beliefs?
These questions have often plagued healthcare professionals, particularly before the introduction of the NHMRC Report, when everything bandied around was more or less hearsay. However, this report now informs our standards of practice and should be recognised as such. Therefore it is our duty to ensure our own knowledge is up to date, and that of our client/patient. Once we are assured that the individual has made an informed decision, either way – we have thereby met our duties as a healthcare professional. It is also strongly advisable to document any discussion of this nature for any follow up if needed.
uThe PSA Position Statement on Complementary Medicines includes homeopathy (www.psa.org.au/ policies/complementary-medicines)
58 Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd.