Issues Magazine

Homeopathy: Have Consumers Wised Up?

By Rachael Dunlop

One in two Australian adults are turning to the internet to self-diagnose medical conditions, and two in three are investigating their medicines on the web, according to recent figures from Bupa Health Pulse. Health information on the internet is not regulated, so how do you determine what is right and what is not?

Something rather interesting happened in Australia recently, and curiously it seemed to slip by largely unnoticed. In an unprecedented move, the National Health and Medical Research Council (NHMRC), which is the Australian government body responsible for developing health advice for the community, health professionals and governments, released a draft statement on homeopathy that said in part: “The NHMRC’s position is … it is unethical for health practitioners to treat patients using homeopathy, for the reason that homeopathy – as a medicine or procedure – has been shown not to be efficacious”.

“Unethical” and “not efficacious” (simply meaning “it doesn’t work”) are strong statements indeed. Crucially, this is the first time the Australian government has issued any kind of statement about homeopathy, and reports suggest they may have been motivated by several recent occurrences.

First, there have been two recent deaths in Australia in which homeopathy was implicated, one involving 45-year-old Penelope Dingle who died from untreated bowel cancer, and the other, 9-month-old Gloria Sam, whose parents declined to treat her severe eczema with conventional medicine, resulting in her death from septicaemia.

In addition, misleading claims that “homeopathic vaccinations” are an effective substitute for conventional vaccines put people at risk of contracting and spreading infectious disease.

Finally are the damning findings of an exhaustive investigation in 2010 by the UK Science and Technology Committee, which concluded that homeopathy is scientifically implausible, it doesn’t work and the UK National Health Service should cease funding homeopathy at all levels, including any clinical trials.

In case you’re not familiar with homeopathy, it’s a 200-year old form of alternative therapy developed by German doctor Samuel Hahnemann and based on the belief that the more dilute a substance, the more potent it is. Practitioners use ultra-dilute solutions as treatment, including the common homeopathic dilution known as “30C” – 10 to the power of 60, or 1 with 60 zeros after it – which is approximately equivalent to 1 mL in 1,191,016 cubic light years. According to the laws of science, once a solution has been diluted beyond 1 to the power of 23 (called Avogadro’s constant) it is extremely unlikely that even one molecule of the original substance will remain.

Homeopaths justify this by claiming that water molecules retain a “memory” of the original substance. There is no science to explain that water has a memory.

If you find that hard to get your head around, try making sense of this. Homeopathy is also based on the philosophy of “like cures like”. So, if you can’t sleep, a homeopath may recommend you take some ultra-dilute caffeine, or if you have a bite or a sting then a homeopathic preparation of stinging nettle is just the ticket.

Although the Australian government does not fund homeopathy directly, $3 billion of taxpayers’ money is provided every year to fund private health insurance rebates. So if homeopathy is covered in your extras policy then the taxpayer is indirectly funding it. If the draft statement by the NHMRC becomes official, it’s anticipated the pressure will be on health funds to cease covering homeopathy in their policies.

It’s important to emphasise this does not mean homeopathy will be banned (which was the way some people perceived the UK findings). Indeed you will probably still be able to buy homeopathic remedies over the counter at your local pharmacy, but you just won’t be able to get a rebate from your health fund if it is prescribed by your doctor.

The government has indicated it will consult with several groups prior to making a final decision about the statement, including our drug regulator the Therapeutic Goods Administration (TGA), the UK Science and Technology Committee, the Department of Health and Ageing, and with consumers and patients via the Consumer Health Forum. Whatever its decision, it is certainly about time the Australian government made its position clear on homeopathy as, up until now, it has been very difficult to determine.

For example, during MedicineWise Week (which ran from 30 January to 6 February 2011), the government ran a television and radio advertising campaign telling us to “get medicinewise”. The ads directed consumers to a the National Prescriber Service website, where questions such as “What is the medicine for?” and “What is the active ingredient?” encouraged consumers to gain a better understanding of their medications.

I decided to pose as a consumer and see what the website could reveal about homeopathy. Technically, homeopathy is not a medicine since (in the majority of cases) it is too dilute to contain active ingredients, but since you can buy it in a pharmacy next to vitamins and cough medicine it would seem fair to presume that consumers might think it is. Not surprisingly (and not unlike homeopathy itself), what I turned up was minimal and not very useful.

I’ll explain more about this a bit later, but first, as I was surfing around the site, I came across an NPS press release describing a recent survey of Australians’ knowledge of medicines. Fifteen hundred consumers were surveyed about their use of medicines, and the results showed that in the previous 3 months 65% had used a prescription medicine, 60% had used an over-the-counter medicine and 45% had used an alternative or herbal medicine.

When it came to alternative medicines and supplements, of those surveyed less than half considered certain vitamins and herbs to be medicines; only 23% considered multivitamins to be medicines, only 24% thought echinacea was a medicine, and only 32% agreed that fish oil was medicine. Interestingly 41% of those surveyed thought Chinese herbal remedies were medicines (perhaps because they’re sometimes known as Chinese medicines).

NPS clinical adviser Dr Danielle Stowasser said that the results “show it’s time Australians started asking more questions about their medicines”.

“The first step to being medicinewise is knowing what is a medicine... Medicines don’t just come on prescriptions but include things bought in a pharmacy, supermarket and other stores, and from naturopaths and herbalists.”

Which brings me back to homeopathy, which you can buy at just about every pharmacy in Australia. According to a question about where to go to find accurate information about medicines, 64% said a pharmacist and 60% said a doctor. While I have no doubt that pharmacists give accurate advice about conventional medicines (why not, that’s what they’re trained to do), sadly I have been dissatisfied when it comes to information about homeopathy. Indeed, only once was I given an accurate description by a pharmacist (to be fair, my sample size is less than 20); often I am told it is “herbal” (it’s not) and once I was politely shuffled to the door by an assistant when I asked too many questions about how homeopathy works.

Indeed, in my experience (and again I emphasise the small sample size) it appears consumers cannot rely on pharmacists to accurately inform them about homeopathy.
 Thus, I was hoping that a quick trip to the heavily promoted NPS website would do the trick. Not so. A search for “homeopathy” turns up one link that leads to a generic page on complementary medicines where homeopathy is mentioned but not explained. A search for “homeopathic” turns up a link to a video that, likewise, doesn’t address homeopathy directly, and in fact could even be construed as misleading. The following is an excerpt from the transcript (my emphasis):

Manufacturers of non-prescription medicines sold in Australia must ensure that their products meet certain quality and safety standards. However, when it comes to providing evidence of their effectiveness they’re not tested as thoroughly as prescription and pharmacy medicines. The less thorough testing does not mean that these medicines don’t work; rather it means that the manufacturers don’t have to provide as much scientific evidence as they do for prescription and pharmacy medicines.

I doubt anyone would confuse homeopathic “remedies” with prescription medicines, but they might confuse them with pharmacy medicines. After all, they are sold in pharmacies in the mix with other science-based remedies. So this video implies that since homeopathy – for all intents and purposes – is a pharmacy medicine, then it is tested just like prescription medicines.

Of course this is simply not true. In fact, some homeopathic remedies can still be sold in pharmacies without even being approved by the government.

There are two arms of drug regulation in Australia. To get a prescription drug on the government list (called the Australian Register of Therapeutic Goods, or ARTG), manufacturers must provide extensive evidence for safety and efficacy before they are assigned an official-looking number beginning with “R” (indicating the drug is registered for use), which is then printed on the side of the packet. For lower-risk drugs like supplements and vitamins, manufacturers apply online, where much lower levels of evidence are required (and indeed, they need to state they have evidence but not necessarily produce it) before the product is assigned with an “L” for “listed”. Both these processes presume that your product has some type of active ingredient (after all, this is what the government is regulating). Thus for ultra-dilute homeopathic remedies, where this not the case, no government regulation is required. Put simply, there is nothing to regulate if there is nothing in the “medicine”.

This is stated on the government website, which says that homeopathic preparations are exempt from the ARTG if “[they are] more dilute than a one thousand fold dilution”.

We’ve already established that a common homeopathic preparation is diluted 10 to the power of 60, which is significantly more than 1000-fold, so the government is not particularly concerned with the regulation of these drugs.

All this is really quite complicated, and could easily confuse an uninformed consumer. It’s also not made any easier by the description of what homeopathy is according to the TGA website:

Homoeopathic preparation is … formulated for use on the principle that it is capable of producing in a healthy person symptoms similar to those which it is administered to alleviate; and prepared according to the practices of homoeopathic pharmacy using the methods of serial dilution and succussion of a mother tincture in water, ethanol, aqueous ethanol or glycerol; or serial trituration in lactose.

Even for someone familiar with the principles of homeopathy, this looks like a sprinkling of random words on a page. It seems to me it would be much simpler to state that homeopathy is not a herbal medicine; in fact it’s not even medicine and there’s nothing in it.

But the facts remain that some homeopathic preparations are included on the Australian government drug list the ARTG; some are assigned official-looking government numbers; those without one can still be sold in pharmacies; and all of this gives the impression that homeopathy is a legitimate form of treatment, which it is not. After 200 years and 200 clinical trials there is still no evidence that homeopathy is any more effective than a placebo.

With statistics showing that many of us are now turning to the internet for medical information, it’s a worry when even official government websites and regulators appear to be confused about homeopathy. From my observations, the Australian government seems to be bundling homeopathy in with pharmacy medicines, thereby implying that it works and further lending it legitimacy by assigning it official-looking numbers on the register of government approved medicines.

Just like the definitive statements made by the UK Science and Technology Committee, the Australian government would be well advised to make the draft NHMRC statement official. Because, as the tragedies of Penelope Dingle and Gloria Sam demonstrate, while the public (and some pharmacists) remain confused about homeopathy, peoples’ lives are at risk.