Feel free to blog your own take on it, I’m not convinced I did a particularly good job of it and another perspective would be interesting.

It is true that the banner of altmed has a large range of therapies under it, I chose homeopathy to focus on as it has been much in the news (and all the examples that I remembered off the top of my head were homeopathy related).

While we should not be dismissive purely on ideological grounds (which I don’t think I was, and this cuts both ways) neither should we be expected to give therapies a free pass simply because of their background either. “Conventional” modern medicine has to prove itself in being safe and effective, so should alternative therapies. This is a continual process and even practices that were implemented before proper controls were implemented and continued to be used because of conventional wisdom are put under the microscope. Sometimes mainstream medicine does not live up to this ideal but at least the principle exists and encouraged.

Zicam is marketed as homeopathic, the label refers to the method of preparation not the dose. It got a free pass from providing evidence of safety based on this. From the Zicam website:

“Regarding questions from consumers as to whether Zicam Cold Remedy products are really homeopathic, let me simply state, yes, they are. If you read the packaging on our Cold Remedy products, you’ll see that the active ingredient is a compound called Zinc gluconate. This compound is listed as a drug in the Homeopathic Pharmacopeia of the United States (HPUS) (a compendium of the FDA). To be clear, this ingredient and its concentration in Zicam intranasal Cold Remedy products are in compliance with this reference guide. Zicam intranasal products are labeled, marketed and sold in accordance with the Homeopathic Pharmacopeia of the United States and the Federal Trade Commission. You can read more about the chemistry and pharmacology of Zinc gluconate at http://www.Zicam.com and http://www.Zicamlawsuits.com.”

That is part of the harm.

Fine, we have different opinions on this.

Yes, we are largely an irrational lot. I’d counsel acceptance – I suspect it would be more than a life’s work to fix that particular foible! (T’would be a better approach than regulation, though). I have a friend who is determinedly anti-conventional – you know the type, falls hook line and sinker for any passing theory (as long as it’s rebellious, I suspect). I once tried to argue against his “you can run your car on water” theory – a complete waste of an hour. I wouldn’t bother arguing a more complex issue like homoeopathy with him, tbh. I just accept him as he is, nutty or no.

The Zicam issue sounds like a simple failure to regulate – it seems to do direct harm so I’d agree it should go. But it seems to have discernible active ingredients so I’m not sure how it’s the same thing as other homoeopathic substances.

If I ask my (highly trusted) pharmacist to recommend me something, I doubt he’d offer a homoeopathic remedy; he does have them for sale though, and if I insisted on buying one he’d certainly take my money. I could not comment on other pharmacists, although I’m prepared to believe they would suggest things based on what they genuinely think is best. It’s not about them, though – if you stop homoeopathic preps from being sold in pharmacies, they would just be sold elsewhere. If you want to ban them, you need solid evidence of direct harm – hard to do while maintaining they do nothing. Indirect harm doesn’t cut it – people do stupid and harmful things all the time, to themselves and others. Homoeopathic lolly-water would seem to me to be quite far down the list.

I don’t contend that both sides in the “battle of faith” are objectively equally valid – merely that objective reality (if such a thing exists) is of less concern to many people’s decisions than you and Grant seem to allow. You certainly have the right to express your views and lobby to have pharmacists only carry proven effective remedies, but in a democracy, so do the other parties. Perhaps over time well-articulated reason will win out and more people will be persuaded of the exclusive virtue of modern medicine, and perhaps homoeopathic goods will go the way of Grant’s mausoleums – but perhaps not in our lifetimes.

The best of us still suffer from the cognitive biases the human race is prone to, one of which is a poor ability to attribute causation. If we are feeling ill and we take something we think should help and we feel better it is natural for us to think that there is a causal relationship, perhaps, perhaps not. A single instance is not enough to draw a meaningful conclusion but we do it in our personal lives all of the time. I expect medical interventions to have a higher level of evidence than this. There are enough people getting sick and trying all sorts of remedies that it is likely at least a few of them will commit this type of error.

You agree with me that direct harm should be legislated, but such is the power of the natural medicines zeitgeist that they tend to bypass this sort of scrutiny prior to sale (part of the point of my Zicam example). The Therapeutic Medicines Bill that was to attempt this was roundly criticised for “Restricting freedom of choice”. The tobacco and alcohol examples, while I do agree cause great harm, 1. are not the focus of this post and 2. no-one (any more) claims that they are beneficial to your health (frequent reports about the protective effects of a glass of wine etc. not withstanding. In any case there is no claim that the alcohol itself is the cause of any benefit)

Pharmacies market themselves as health professionals with your best interests at heart and run by well trained personnel, slogans tend to be of the “Ask your Pharmacist” sort, not “We’ll sell any crap you’re willing to buy”. At least some pharmacist organisations agree with me on that point as evidenced by the National Association of Pharmacy Regulatory Authorities in Canada that released a position statement on this issue that includes the following:

“Pharmacists are obliged to hold the health and safety of the public or patient as their first and foremost consideration. As such, they must follow very specific standards of practice to fulfill this role. When presented with a product that does not bear a number issued by Health Canada, it leaves the pharmacist and their patient with no confirmation that the product was properly assessed for its safety, efficacy and quality nor granted approval for sale.”

So I have to disagree with you there. As I suspect would the Pharmacy Council of New Zealand.

On the suggestion that I’m for “freedom of choice, unless the chooser picks something you don’t believe in. “, well it’s not about belief I’m afraid it’s about evidence. Phrasing it this way turns it into a battle of faith with each side equally valid. Will it is true that I don’t believe homeopathy is effective it is a belief based upon evidence (and not the anecdotal kind).

Surely the escalation in use of homoeopathic remedies (to be applied to more serious conditions) would only take place if the patient was happy with the results on lesser ailments – at least for rational patients? (And you probably can’t help the irrational as they base their decisions on something other than effectiveness of the treatment…). As homoeopathic remedies probably don’t work, surely there’s no risk of that? Sounds awfully like you’re saying you respect freedom of choice, unless the chooser picks something you don’t believe in.

If there is direct harm done by a product, by all means, restrict it or legislate against it – perhaps you could start with alcohol or tobacco if you want to make a real improvement in social outcomes. But you cannot legislate to prevent human stupidity, and to attempt to do so is either arrogance or folly.

And I hate to tell you this, but pharmacies are merely stores to buy drugs, and have been so for ever. Finding a product on the pharmacy shelf is hardly an endorsement as to it’s effectiveness!

Disclosure: I am deeply sceptical about homoeopathy, to say the least, and have only used a homoeopathic product once – when “prescribed” by a podiatrist to treat a wart. It had as much effectiveness as all of the other treatments I have tried, natural, herbal, synthetic, alternative, or mainstream – which is to say none at all.