Posts Tagged new zealand

Calls to remove homeopathic remedies from pharmacies Grant Jacobs Mar 17


Or: Homeopathic remedies in NZ pharmacies redux

A little over five years ago I wrote suggesting New Zealand pharmacies should not be selling homeopathic remedies.

Over the past few days there have been renewed calls for pharmacies to stop carrying these junk remedies following an Australian survey of the evidence. One call has come from fellow sciblogger, Mark Hanna—see Ethical Pharmacy Practice 3: Running Out of Excuses. However it’s not so much that pharmacies are running out of excuses as that they never had any: it’s not realistic that a soundly-trained pharmacists do not know that these remedies are worthless. Furthermore, their regulations oblige them not to sell worthless remedies.

Another call has come from the NZ Pharmacy Today magazine blog,[1] who write -

Ethically, pharmacists should only be selling health products for which there is credible evidence of efficacy, and they are moving towards being more like primary health centres, so there’s a strong argument for pharmacies not selling homeopathic remedies.

In the past, when Pharmacy Today reporters have phoned around on the issue, many pharmacists have said they stock homeopathic products because patients want them and will buy them elsewhere if they don’t sell them.

We know GPs will prescribe placebo treatments because patients want to take something and there’s credible evidence for the effectiveness of placebos.

However, I feel pharmacies need to reconsider their stance in the light of this report, which is comprehensive and reliable, and consider not selling homeopathic products – as part of their move towards becoming health centres, plus towards being respected members of the primary healthcare team.

It’s excellent to see this coming from within the industry, but having followed this topic over several years now I’m left with some thoughts.

Firstly, as Mark points out, it’s not a case that “pharmacists ‘should’ only be selling health products for which there is credible evidence of efficacy” (alterations mine, emboldened) but that they are obliged[2]  to—but choose not to. Their ethical guidelines state -

[PHARMACISTS] MUST:… Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.

Darcy Cowan wrote more on the regulatory issues in 2010 and earlier articles from Mark no doubt cover similar ground.

Secondly, the argument that ‘other businesses sell junk remedies therefore we shall’ is unsound. One of the key points about the ethical regulations for pharmacies is that customers should be able to walk into a store and have an expectation that the remedies within the store are basically sound. If other businesses elect to be unsound, that’s poor health practice, but no justification to do likewise. On the face of it, it would seem that the profit motive is ruling over sound and ethical practice.[3]

Thirdly, that some GPs subscribe placebos should have no standing in this. There is some arguments for GPs to prescribe placebo remedies in some cases; others would argue that education is a better response in most cases. Either way—and just my opinion—it seems to me that GPs prescribing homeopathic remedies encourages people to think these have real remedial effects. I don’t work within the industry, but I am sure are ways of offering placebos that avoid using off-the-shelf commercial products. One might be that patients only get placebo ‘treatments’ via prescription.[4]

There is no valid, ethical, reason for customers to buy a placebo themselves: they’d be aiming to buy a remedy, but in fact buy something that does nothing. It’s the sort of thing that consumer protection is intended for. Bear in mind here that pharmacists are obliged[2] to tell someone the nature of the remedy if they ask. Imagine responding ‘well, that stuff, it does nothing, we just sell it’.

(I tried asking about homeopathic remedies as a small, anecdotal, experiment a few years ago. Some salespeople sung praises of how the remedy treated whatever it was—clearly unaware that the remedy was worthless, something I believe they’re obliged[2] to know. Some pharmacists mumbled vague things: it seemed clear to me that they knew the remedies were, at best, ‘controversial’, but felt too awkward to say so plainly.)

Fourthly, Pharmacy Today encourages that “pharmacies need to reconsider their stance in the light of this report”. While this is an excellent idea, and one I thoroughly support, I suspect the underlying driver isn’t the report, but media presence on the topic. There is a long trail of evidence over many years showing that homeopathic remedies are not effective for anything.

You’d wish a professional body would track evidence reports on things they sell and respond on their own initiative, rather only responding under pressure. Reports showing that homeopathy has no effect beyond a placebo effect have been published for years. So why now? I’m skeptical that it’s the physical proximity of this report being from ‘just over the ditch’. One difference would be local media coverage showing up the embarrassing state of affairs in our pharmacies. The word ‘local’ being key.

There were similar calls to drop homeopathy in Australia April last year. Mark Hanna has listed some earlier studies. I’ve covered some of these previously, in particular the House of Commons Science and Technology Evidence Check 2: Homeopathy report. There are more surveys still. As just one example there’s a meta-study published in 2007 in the highly-regarded medical journal, Lancet. The author, Ben Goldacre, has also presented this work on-line. It opens,

Five large meta-analyses of homoeopathy trials have been done. All have had the same result: after excluding methodologically inadequate trials and accounting for publication bias, homoeopathy produced no statistically significant benefit over placebo.

The studies “large meta-analyses” referred to range from the 1990s to the mid 2000s. There have been reports and letters in the New Zealand Medical Journal. Looking wider, the Australian survey drew from 176 primary studies and 58 systemic studies. It’s not credible that these were ‘missed’.

The Australian study that prompted the latest round of interest drew this statement,

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.

Why were the relevant professional bodies not onto this evidence sooner?

(Currently this is striking me as a bit of a theme with those claiming to have the interest of the public on a topic in mind. I find the similar lack of response House of Common Science and Technology report on GMO legislation[5] disconcerting, too. You’d think those with genuine interests in these topics would take up the advice these reports, but we’re not seeing responses despite the clear relevance of both reports to New Zealand and the strong advice they offer.)

In fact, you don’t even really need these studies: a simple understanding of basic chemistry and how these remedies are claimed to work is enough to realise homeopathy is essentially water with a nice story. (Remember while you’re reading this that pharmacists are supposed to be trained in basic chemistry.[6])

There’s the incorrect idea that like-cures-like concept, that idea a small part of the thing that causes the illness, or causes symptoms shared with the illness, will cure it.

There’s the nonsensical dilutions. Homeopathic remedies are made by taking an ingredient, which is ‘potentiated’ by diluting it; the higher the dilution, the stronger ‘potential’ the mixture is claimed to have. This is contrary to the basic idea of dosage: usually a greatly reduced dosage means the ‘remedy’ will have little effect. Each dilution step is followed by succussion - shaking. The ingredients are most often quite exotic – things we might expect to see in an ancient remedy from before the time of sound medicine.

Take some substance, dilute it 100, so it’s 1% of the solution. Now take that and dilute it 100-fold again. Then take that and dilute it 100-fold again. If the dilution is to be 30C, this is done 30 times one after the other. Obviously you have essentially nothing of the original substance in the final solution.

This was originally premised on the idea of ever-smaller substances, something that even in the day of homeopathy founder, Hahnemann, was being to be known as wrong—that there were atoms. Atoms don’t break down to smaller atoms, they are the smallest unit.

In the same way you can’t make ever-increasingly small dilutions—at some point you’ll remove the last molecule of the substance from the solution and have none of the original active ingredient.

There’s some homeopaths appealing to ‘spiritual healing’ notions or odd claims about quantum physics being involved. (I’m not making that up.)

These are trivially known as unsound today and any reasonable pharmacist should, surely, say ‘That’s bunk’.

There’s the shifting defense, a sign of clinging to a belief rather than recognise it as wrong-headed. Homeopaths recognised that the infinite dilution argument conflicted with the laws of physics many years ago. In response, they shifted to the argument to that ‘water has a memory’, that—somehow—water ‘recalls’ what was in it. This, too, is nonsense. This illustrates the ‘nice story’ aspect to the pitch for homeopathy: that when one story fails, another is held up. More recently this has shifted again, to evoking quantum physics as a defense.

Ben Goldacre has noted that the ‘success’ of homeopathy in Hahnemann’s day was not due to effectiveness of the ‘remedy’, but that it caused less harm that (most of) the alternatives of the day.

Some may feel these remedies do no harm, but ineffective treatments can allow an illness or disease to progress, making them harder to treat later. At an extreme patients with treatable illnesses might suffer unnecessarily (possibly even die in the case of serious illnesses).

Homeopathy is not the same as herbal remedies. This seems a common confusion among consumers seeking out these remedies. Herbal remedies, with all the faults they can have, at least have some active ingredients.

You might think that such remedies would be limited to trivial illnesses, in particular ones that would be expected to come right over time. In practice you’ll find homeopathic remedies from these right through to homeopaths treating very serious illness, like Claire Bleakley homeopath and head of GE Free NZ (formerly RAGE: revolt against genetic engineering) treating cancer patients.

There may well be those who believe in homeopathy, but organisations whose products and practices are supposed to be based on evidenced practices should not be selling or offering it and should respond to evidence reports when they arise.


1. Thanks to Mark Hanna for pointing this out.

2. You might quibble about the meaning of ‘obliged’ here, I’m not going to. The moral issue is enough for me, the legal aspects simply add weight to an already morally dubious position.

3. A winkle to this might be how the stock being offered for sale is chosen. It’s possible that pharmacies being chains or franchises are ‘obliged’ to carry the stock that their parent companies supply. I’m not familiar with this. If this is an issue, this needs attending to.

4. Perhaps that this would also leave a traceable record of prescribing a placebo is also useful?

5. This is off-topic here, but for the curious I’ll be offering more on this soon: one longer piece covering the full report and, hopefully, a more informal piece pulling out the arguments for those less keen on formal reports!

6. Salespeople may not have a background in chemistry, but they’re still obliged to be accurate in describing the products.

Some of the articles on Homeopathy in Code for life:

Homeopathic remedies in NZ pharmacies

Homeopathy in NZ pharmacies revisited: Wartoff and more

Homeopathy check-up: Not in the health system, disclaimers on labels

Homeopathy – practical remedies to address it?

Homeopathy and farming; let’s do better, media

Supporting homeopathy for Ebola loses natural health brief but more needed

Message to Otago Daily Times: homeopath is not a sound career option*

Undiluted humour: If Homeopathy Beats Science

Homeopath, Ebola and New Zealand – a follow-up Grant Jacobs Nov 23


About three weeks ago I wrote in a comment following a post about a New Zealand member of Parliament supporting homeopathy to treat Ebola:

Also, it would be interesting to see if governments (internationally) will step up and condemn these homeopaths that aim to push their remedies on Ebola patients, in a similar way that governments condemn those that join Islamic militant groups or do similar counterproductive activities. I suspect they’ll simply say nothing despite the obvious trouble this may cause. (See the Guardian article for some background on this. The Homeopathy Without Borders group also took some members to Haiti after the earthquake, aiming the treat cholera…)

I’m learning belatedly and second-hand (or third-hand…) that the World Health Organisation has blocked homeopaths from offering their remedies in Liberia. These look to be members of another homeopathy group, the Liga Medicorum Homeopathica Internationalis.

The writer of that blog is an oncologist writing under a pseudonym. (As he points out himself from time to time, it’s not hard to find out who he is.) He takes his lead from a Daily Mail piece that, to be very polite, gives the homeopathy group too much leeway and in his article he expresses shame that some of these homeopaths were physicians.

Those interested should read ‘Orac’s take on this; I would only end up repeating points he’s already made. (It’s also not as long as some of his missives!)

The Daily Mail is often known to the science communication community as the Daily Fail for it’s habit of regularly producing articles with spectacularly wrong science.* For example, in that article they quote this straight-out false claim by Dr Lindemann (Marenostrum private natural therapies clinic, Calle Fontanella, Barcelona), but make no effort to check or challenge it -

‘There is not yet one specific medicine widely available for the treatment of Ebola but there are homeopathic remedies that have been proven successful in treating other epidemics such as cholera.’

Simply not true. (Similarly you’ll see a reference to research on “various epidemics including Yellow fever”.)

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Good governance, democracy and investment in science Grant Jacobs Aug 28

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From what others have written here at sciblogs most readers will know that we have elections on in New Zealand soon.

While reading the newspaper last weekend I encountered an opinion piece by political commenter Colin James that includes commentary on investing in science that readers might be interested in.

His essay opens by talking about democracy,* governance and good longer-term policy, and closes on the same topic. Sandwiched in between, the central portion of the essay offers strong investment in science as an example of properly supporting longer-term policy that is good for the nation as opposed to short-term electioneering,

Good government has both short-term and long-term perspectives. Durable, long-term policies are the pillars of government. Longer-lived governments maintain those pillars (Bill English is this lot’s main maintenance man). But election campaigners often divert into the short term.

So the campaign will pay little attention to investment in science.

Ministers in recent governments of all stripes have kept scientists on short rations. The Key government has spent more energy restructuring institutions than money for good science.

Comments welcome, of course. What do you think is good science policy?

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Gene editing and GMOs in NZ, part two – is the law out of date? Grant Jacobs Jun 02


(If you’re not a biologist, you may prefer to start with part one. There’s also a third part.)

Are the GMO-related clauses of the Hazardous Substances and New Organisms (HSNO) Act 1996 out of date? Perhaps it’s time to start working on a replacement.

Recently a legal ruling in New Zealand overturned a previous opinion that using gene editing to create variants would not create genetically-modified organisms (GMOs). The key documents are gathered at the EPA website page for that query.

In part one, I offered a non-scientist’s introduction to what is intended with the type work being considered. I’ve since spent more time browsing the Act and the ruling than is healthy for someone who is not a lawyer. Here I’d like to offer some initial thoughts from this reading.

The HSNO Act (1996) also deals with hazardous chemicals. For simplicity, when I write ‘the Act’ below, I mean the portion of the Act referring to GMOs not the whole HSNO Act.

In a nutshell

The court noted difficulties in interpreting the Act. The court was very polite and modest about the difficulties it encountered: my reading suggests these difficulties run deeper and indicate the Act is not up to it’s task.

My opinion is that Act is out of date in fundamental ways. It will also expire on one of it’s founding premises at some time. Thus it would seem an opportune time to work towards what would follow the current Act. (To my reading the Act is time-limited, in that it uses a premise that once a class of techniques have stood the test of time organisms made using them are exempted from consideration; in time the techniques that create GMOs themselves will have stood this ‘test of time’ and be exempted, closing the Act. Consistent with this, a replacement for the Act would not be GMO-specific, but sit within food safety in general.)

On the ruling

Given the problems with the Act the court ruling noted, I was left wondering if a call to make no ruling could not have been made. I believe the issues run deeper than those noted in the ruling (see below).

I found the approach that the advisory experts were used was unexpected. This will reflect my not being familiar with law practices, but it left me wondering if this was the best way to resolve interpretation of an Act. In addition, I feel more comfortable with advisory experts drawn from overseas and independently of the parties involved.

On the Act

The process to add new techniques to those that are considered exempt from GMO status seems (to this non-lawyer) to be ill-defined and problematic. There appears to be no explicit provision in the Act for new techniques that will arise. (The current ruling was caught out on this.) It feels as if a constructive mechanism to add new techniques is needed.

The Act was written at a time when testing if a technique created unexpected genetic changes was challenging and seems to reflect this in it’s design. This has changed, and will continue to change. My feeling is that this leaves the Act out of date in a fundamental way.

One premise in drafting the current Act is that organisms derived from classes of techniques that have stood the test of time are considered acceptable. This means makes Act is self-limiting in time: once GMOs have been around a suitable length of time the techniques that make GMOs as a class must also be considered acceptable. Given GMOs have been around approximately 20 years now, it would seem prudent to start work towards a more appropriate longer-term solution fitting them within food safety in general rather than as a special case.

Finally, and to be fairly brutal about it, parts of the argument used in the Act look ill-formed, possibly even fallacious. This is not helped by that it’s not clear precisely what the argument is, as it’s not made explicit; the court noted similar difficulties. Perhaps symptomatically, some labels and terms are not used in a self-consistent way (to this reader), confusing different positions and at odds with what they might ordinarily mean.

Other commentary

The New Zealand Science Media Centre has gathered some expert commentary on the court ruling,

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Sir Joseph Bank’s journal and account of New Zealand Grant Jacobs May 25

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Readers interested in historic scientific voyages and New Zealand history might like to know that Sir Joseph Bank’s journals of 25 August 1768 — 12 July 1771 aboard the HMS Endeavour under the command of Lieutenant James Cook are available on line from the University of Sydney Australia Digital Collections website.

This voyage observed the Transit of Venus (3 June 1769) and undertook geographical and natural history observation (including a search for the southern continent). According to the notes the natural history observation aspect to the voyage was an innovation “inspired, financed and directed by the 25 year old Joseph Banks.”

These journals include accounts of several islands, including a long account of New Zealand from their circumnavigation in 1770.

You can view the journal either as a web page or a PDF file. I find the latter more readable, but I wish they’d put the many-pages long series contents as an appendix rather than before to the body text. After reading the introduction, skip to page 26!

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Homeopathy Awareness Week: how do you approve a course for something known not to work? Grant Jacobs Apr 15


Homeopathy[1] uses solutions diluted until the active ingredients are no longer present—water basically[2]—to treat illnesses.[3]

Poison-ivy-homeopathic-remedyThe premise of homeopathy is so absurd, it opens itself to parody.[4]

More seriously, homeopathy has been examined and found to be ineffective with several formal reports saying so. Fellow blogger Siouxsie mentions one such report from the Australian National Health and Medical Research Council. Similarly, the British House of Commons Science and Technology Committee’s report Evidence Check 2: Homeopathy gave a very firm “no” to homeopathy.

Coming forward and saying that homeopathy is ‘bunk’ isn’t a new development. Homeopathy has long been considered worthless. Take for example Oliver Holmes’ words this vectorial speech to medical students in 1871:[5]

  Some of you will probably be more or less troubled by the pretensions of that parody of mediaeval theology which finds its dogma of hereditary depravity in the doctrine of psora [homeopathy], its miracle of transubstantiation in the mystery of its triturations and dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling. You can do little with persons who are disposed to accept these curious medical superstitions. The saturation-point of individual minds with reference to evidence, and especially medical evidence, differs, and must always continue to differ, very widely. There are those whose minds are satisfied with the decillionth dilution of a scientific proof. No wonder they believe in the efficacy of a similar attenuation of bryony or pulsatilla. You have no fulcrum you can rest upon to lift an error out of such minds as these, often highly endowed with knowledge and talent, sometimes with genius, but commonly richer in the imaginative than the observing and reasoning faculties.

[Oliver Wendell Holmes, Medical Essays. From The Young Practitioner, A Valedictory Address delivered to the Graduating Class of the Bellevue Hospital College, March 2, 1871.]

Modern statements that homeopathy is no better than placebo offerings are backed by studies. You might think that this would lead to no standards bodies approving courses teaching it.

However, in New Zealand the NZ Qualifications Authority (NZQA) approves courses in homeopathy.[6]

A question, then. How do you approve a course in something that is known not to work? Known not to have therapeutic value beyond a placebo effect.

If you search the NZQA website for ‘homeopathy’ you’ll be offered five pages among them listing courses and institutes that they have approved. As one example, they approved a ‘Certificate in Acute Prescribing with Homeopathy’. You don’t have to be a medical practitioner to realise ‘acute prescribing’ of homeopathic remedies makes little sense.

Elsewhere I have argued that homeopathic remedies should not be present in pharmacies. Should courses in homeopathy not be formally approved by NZQA?

You’re welcome to offer your thoughts in the comments below.

My feeling is that veneers of respectability and soundness ought to not to be given to practices like this as it may give consumers the misleading impression that the treatments ‘must’ have some merit if a formal accrediting agency has put their weight behind the courses teaching it.


Thanks to Alison Campbell for bringing the NZQA approval of homeopathy courses to my attention.

1. Or homoeopathy, but I prefer the simpler and more common form. (I confess, also, that for a while I found myself occasionally mistyping homeopathetic.)

2. Some seem to use alcohol as the solvent, in which case you might just as well take a nip of your favourite (strong) alcoholic drink.

3. The mixtures are, apparently, shaken between each serial dilution. My recollection is that this originated from a variant of his remedy that Samuel Hahnemann, the ‘inventor’ of homeopathy, introduced to help sell his remedy where a strong brand of Christianity appealed to faith healing. This variant was to whack the mixture against a bible after each dilution so that the power of the good book might enter the remedy. (Or so the sales pitch went.) The (few!) homeopath websites I have viewed made no mention of a bible but do mention shaking the mixture.

4. There are many other examples; this one isn’t by any means the best but I hope it gives readers the general idea.

5. I like the allusion to Archimedes, although I suppose you could say it really wants ‘nor a lever long enough’ added to it, rather than (just) the size of the fulcrum.

6. We could also look at other things NZQA approve such as courses in such as naturopathy and so on, but let’s stick to homeopathy for now. They have a section ‘Complementary Therapies’.

Other articles on homeopathy on Code for Life:

Homeopathy check-up: Not in the health system, disclaimers on labels

Homeopathy – practical remedies to address it?

Homeopathic remedies in NZ pharmacies

Undiluted humour: If Homeopathy Beats Science

Message to Otago Daily Times: homeopath is not a sound career option*

Homeopathy and farming; let’s do better, media

Homeopathy check-up: Not in the health system, disclaimers on labels

Medical DIY…

Homeopathy in NZ pharmacies revisited: Wartoff and more

Any New Zealand schools want to help judge the Flame Challenge? Grant Jacobs Dec 13

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(Crowd-sourcing how best to let NZ schools join in the judging of the Flame Challenge.)

The Flame challenge is an international competition that challenges scientists to explain to 11 year-old students a question. The results are judged by children. (There is more on the Flame Challenge in my previous post.)

This year’s question is ‘What is colour?’ Explanations are in two categories, written or visual. The visual entries include short videos.

The question was drawn from more than 800 suggestions from around the world. Last year there were over 20,000 student judges.

I have been asked by the Alan Alda Center for Communicating Science who run the Flame Challenge for suggestions how New Zealand schools might get involved in judging — apparently no New Zealand schools have been involved in judging the entries before.

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AgResearch moving house – let’s have the full picture Grant Jacobs Aug 01


Further details of AgResearch’s plans to move (large) parts of its operation to create ‘hubs’ were released yesterday. As I had suspected earlier this involves substantially reducing operations in some parts of the country.

One hub will be created at Lincoln, which I introduced earlier; the Grasslands campus at Palmerston North is also to be expanded. I won’t speak much of the North Island part of this as I’m less familiar with the locations and science done there. (Fellow blogger Ken Perrott has written of the downscaling of the Ruakura campus.)

One of my concerns after the initial announcement of the hubs several months ago was that the disruptions and negatives of this would cause were glossed over in the initial announcement in a ‘positive spin’ exercise.

As Crown Research Institutes (CRIs), they are effectively owned by the public and I personally would have liked to see more complete communication of all aspects, not just a sales pitch, given the public monies involved.

In particular, I have been unable locate a document laying out the overall plan with an examination of the key issues and the estimated costs and benefits. I would like to have seen a publicly-released case for this before it was decided, but it seems that these actions have been decided at a high level as, for all practical purposes, a fait accompli.

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Terry Speed on Epigenetics Grant Jacobs Jun 21


Epigenetics is an increasingly used jazz word, and I don’t just mean by scientists. You can see it in magazine articles, marketing spiels, and so on.*

It’s touted as some kind of new, special genetics.

Epigenetics itself isn’t new. It’s basically the business of how our cells express their genetics, how the characteristics of a particular cell type (or organ or animal) are realised from it’s genes.

Some things we’re learning about epigenetics are new, however.

But you don’t have to hear these from me.** You can listen to Terry Speed’s public lecture on epigenetics, given during a particularly strong winter storm in New Zealand’s capital city, Wellington. (Given that, we ought to praise those who attended too.)

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Citizen science: how deep is your snow? Grant Jacobs Jun 20


If you live below 300m in New Zealand you can help NIWA out by measuring how deep the snow is at your place. Instructions are on their website. Go to it!


This must be my shortest post ever! Still to short on free time to write… (but I will be back…)

Other articles on Code for life:

The inheritance of face recognition (should you blame your parents if you can’t recognise faces?)

Temperature-induced hearing loss

From science PhD to careers outside academia: what might help?

Thieves in gold-mining era campsites

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