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Beware the Integrative Pharmacy

pharmacy window

Imagine a retail pharmacy where some of the medicines on the shelves have been replaced with similar-looking packages that contain no active ingredients at all. There is no easy way to distinguish between the real and the fake.

Another section of the store offers a number of remedies with fantastic claims, such as “boosting” the immune system, “detoxifying” the body, or “cleansing” you of microscopic Candida. They look sciencey, unless you realize that they treat imaginary medical conditions.

A corner of the store offers unpurified drugs supplied as tinctures and teas. The active ingredients aren’t known, and the batch-to-batch consistency of the product is unclear. The store will suggest products for you based on your symptoms.

Walk past the enormous wall of vitamins and other supplements and you’ll find a nutritionist who will tell you what products you should be taking. You’ll also find a weight loss section. From a science-based perspective, this shouldn’t even exist, given no product has been shown to offer any meaningful benefit. But there are dozens of products for sale.

At the back of the store you’ll finally find the pharmacist. A sign on the counter offers blood- and saliva-based tests for food “intolerance” and adrenal “fatigue”, claiming to test for medical conditions that actually don’t exist or lack an evidence base. The pharmacy also offers a large compounding practice, advertising what it calls “personalized” approaches to hormone replacement with “bioidentical” hormones.

Welcome to the “integrative” pharmacy.

You may not see all these features in your local drug store, but they’re coming: claims of a new “integrative” way to provide health care that is changing the face of retail pharmacy. Unfortunately, it’s harkening back to the era of patent medicines and snake oil. It’s not good for the pharmacists and the profession of pharmacy, and it’s even worse for patients.

As the blog’s only pharmacist, I like to think I bring a different but (cough) complementary perspective to the contributions. Naturally I like to write about drug-related issues, and I’ll occasionally scrutinize the profession itself. One trend in the profession seems to be accelerating: It’s the increasing volume of scientifically-questionable products on pharmacy shelves. It hit home the other day when I found yet another local pharmacy that proudly advertises that it will sell you sugar pills and call it medicine. A twitter discussion ensued, with one pharmacist commenting that his own retail pharmacy looks behind-the-times simply because he puts patient care and ethics ahead of revenue, and refuses to sell products like homeopathy. Pharmacy is a health profession, but retail pharmacy is also a for-profit business. This is a continual conflict, and I fear the professional side may be losing ground in the drive to increase revenue.

While I don’t personally work regularly in retail pharmacy, I think of myself as a strong advocate for the community-based pharmacist’s role – and for their potential to do much more. Not only are pharmacists among the most accessible health professionals, they can also have close, supportive relationships with their patients. And pharmacists are well-positioned to do much more to enhance the safe and appropriate use of drugs – from managing doses and side effects, to simplifying regimens, and by ensuring that prescribed medications are being taken safely and appropriately. If you’re generally healthy and don’t need medication, you may not even know a pharmacist. But those with high medication needs tend to know their pharmacist well, and many rely on their pharmacist as a key member of their health care team. I know the impact a good pharmacist can have on the health of a patient. But I’m increasingly dismayed at retail pharmacy practices that call the credibility and good intentions of the pharmacist into question.

Old whine in a new bottle

Integrative medicine is ascendant. Terms like “alternative” and “complementary” are falling out of favor, in part because it’s increasingly recognized that these terms carry a stigma – they are not part of mainstream medicine. Integrative medicine seeks to explicitly embed complementary and alternative medical practices into conventional, science-based medical care. It purports to take a “best of both worlds” approach, mixing science-based treatments with a variety of unconventional treatments. The fundamental challenge with integrative medicine is that “integrative” products and services don’t have scientific evidence to support them: if they did, they’d simply be called “medicine”. Instead of evidence, promoters of integrative medicine rely on other standards – many are grounded in belief systems, such as the idea of “vitalism“. While ideas like vitalism are long-discarded from science-based medicine, they live on in the philosophies of practices like homeopathy, naturopathy, and chiropractic. And the retail part of the pharmacy profession sees an opportunity, like this advertisement seems to suggest. Never mind the evidence, you pharmacy has sugar pills to sell:

Rexall: “Trusted homeopathic remedies offer an alternative way to naturally treat symptoms”

Rexall: “Trusted homeopathic remedies offer an alternative way to naturally treat symptoms”

Misleading patients and selling them inert, ineffective products is unethical medical practice. But under an “integrative” framework, pharmacies are simply offering homeopathy – after all, it’s trusted by millions. Basing your medical advice on pre-scientific ideas is incompetence from a conventional, science-based perspective. But integrative medicine seems to mean the freedom to simply make up diseases, and then to sell treatments for them. Scientific evidence is no longer the basis for your practice – it’s become more holistic, embracing “different ways of knowing.” I’ve written before about the harms to hospitals and academic settings from the embrace of “integrative medicine”. In short, there is no medical standard with integrative medicine – and that’s why “integration” is so problematic. The bandwagon is growing, however. On Monday, David Gorski noted that the National Center for Complementary and Alternative Medicine is jumping on board, with a proposal to change its name to the National Center for Research on Complementary and Integrative Health (NCRCI). Change the standard of practice, and what was ethically verboten is now acceptable – and that’s what integrative medicine proponents are explicitly trying to do in health care.

Rexall sign

The integrative pharmacy

If you integrate unproven remedies with proven medicine in your pharmacy, it does not improve pharmacy practice or patient care – it makes that care worse.

- (paraphrasing Mark Crislip)

A HuffPo column a few years back was a call-to-action to pharmacies to embrace integrative medicine – it was a depressing read to anyone that advocates for science-based principles. Entitled “Who Will Own the Brand of Integrative Medicine? “, the column described integrative medicine as a business opportunity:

There is a revolution happening in North American medicine. If successful, it will educate and empower consumers, introduce us to a world of new cures, and leave most of us wondering, ‘Why didn’t we do this 50 years ago?’

It profiled the Pharmaca chain of pharmacies in the US. The CEO of Pharmaca was quoted:

The common US model is one pharmacist, and a bunch of clerks stocking shelves. In our case, we have the highly trained pharmacist, but also highly skilled practitioners with homeopathic or naturopathic backgrounds. No one expert has the full answer. Instead, we collaborate to offer our customers a more holistic approach to managing their health.

Not surprisingly, Pharmaca advertises a wide array of ineffective treatments, from products that claim to offer adrenal support” to homeopathy, detox kits and a weight loss selection that Dr. Oz would approve of. To their credit, they also offer important pharmacy services such as vaccines, including the whooping cough vaccine. It’s a shame they’re also actively promoting and profiting from selling pseudoscience.

Another integrative pharmacy that was profiled in the same column was Vancouver’s Pure Integrative Pharmacy:

Up to now, there’s been a polarization between advocates of traditional and conventional pharmacy. We believe the way forward lies in using treatments that are backed by evidence, regardless of their origin.

and the CEO continued:

I want to get rid of the whole east meets west stereotype. This isn’t about east meets west. It’s about getting the best product, or combination of products, for our customers. And those products come with proof of efficacy.

No argument there. It could have come from the authors at SBM – we have long argued that products need to be evaluated on their own merits, instead of a lower bar for products deemed “natural”, “herbal”, “alternative”, “complementary” or “integrative”. Science is science, and that doesn’t change if you’re in North America or Asia. So what kinds of products does Pure Pharmacy believe come with “proof of efficacy”? I didn’t have to search long to find homeopathic remedies, and products to treat adrenal fatigue, suggesting that “proof” seems to be a subjective term when it comes to “integrative” pharmacy practice.

Calls for pharmacy to change

The challenge to the profession and the ethically-troubling issue of “integrative” pharmacy practice hasn’t gone unnoticed. The recent publication of another comprehensive review of homeopathy is renewing questions about what pharmacies sell, and urging the profession to clean up its practice. The Australian National Health and Medical Research Council (NHMRC) report on the effectiveness of homeopathy for treating health conditions was recently reviewed by Steven Novella, so I’ll just touch on the highlights. The NHMRC is the Australian organization that promotes and maintains health standards, both by supporting health research and by creating evidence-based health guidelines. Part of its mandate includes the requirement to “advise the community”. In this case, the review set out to answer the following question:

Is homeopathy an effective treatment for health conditions, compared with no homeopathy, or compared to other treatments?

There were three sources of information assessed to answer this question:

  • published systematic reviews – a structured approach to filter out low-quality evidence and while analyzing all available published high-quality data
  • information provided by homeopaths and homeopathy-supporting groups and organizations – from the information submitted, only the highest-quality evidence was subsequently considered.
  • clinical practice guidelines and government reports published in other countries

To support the credibility of the data evaluation process, the NHMRC asked the Australasian Cochrane Centre to verify the processes used were rigorous, transparent, and consistently applied.

Cutting to the chase, the review concludes the following:

NHMRC concludes that the assessment of the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered.

Case closed, one would hope. Homeopathy has no place in modern pharmacy practice, except perhaps as a case study in history, ethics or perhaps most appropriately, critical thinking. Yet despite the ethical and medical problems that exist with homeopathy, I’m unaware of any pharmacy regulator, worldwide, every taking voluntary action to limit or restrict the sale of homeopathy in pharmacies. The impetus to change only seems to be coming from outside the profession:

Pressure is mounting on pharmacists to stop selling homeopathic products after a major review found there was no credible scientific evidence to support the alternative medicines.

Despite scepticism about homeopathy among pharmacists, many pharmacies sell homeopathic products that are marketed for illnesses including migraine headaches, bleeding, persistent nausea and vomiting, coughs and colds, insomnia and arthritic pain.

But there are now increasing calls for them to abandon the products after a major National Health and Medical Research Council review of homeopathy concluded there was no reliable evidence it could treat health conditions.

The review, released earlier this month, also stated: ”People who choose homeopathy, instead of proven conventional treatment, may put their health at risk if safe and evidence-based treatments are rejected or delayed in favour of homeopathic treatment.”

While the review has been criticised by homeopaths who are appealing the finding, some doctors and pharmacists say it should make it unethical for pharmacists to continue stocking and selling homeopathic products.

Under the Pharmacy Board of Australia code of conduct, pharmacists are required to practice ”in accordance with the current and accepted evidence base of the health profession, including clinical outcomes” and by ”facilitating the quality use of therapeutic products based on the best available evidence and the patient or client’s needs”.

While the professional bodies of pharmacy seem supportive, the retail arm of the profession is ignoring the advice:

Grant Kardachi, president of the Pharmaceutical Society of Australia, the professional body representing 18,000 pharmacists, said he planned to inform members about the review council’s report because homeopathy did not sit well with their aim for pharmacies to become more professional ”health hubs”.’

‘I think we’d be saying you should seriously consider, if you are stocking these products in your pharmacy, what that actually means, and you should be looking at other products in your pharmacy to treat patients’ health conditions where you know there is more evidence,” he said.

Greg Turnbull, from the Pharmacy Guild of Australia, which represents pharmacy owners, said it did not plan to do anything with the review.

The continued practice of ignoring the ethical responsibilities of the profession reminds me of this classic XKCD cartoon on “alternative literature”:

I just noticed CVS has started stocking homeopathic pills on the same shelves with--and labeled similarly to--their actual medicine. Telling someone who trusts you that you're giving them medicine, when you know you’re not, because you want their money, isn’t just lying--it’s like an example you’d make up if you had to illustrate for a child why lying is wrong

Alt-text: I just noticed CVS has started stocking homeopathic pills on the same shelves with–and labeled similarly to–their actual medicine. Telling someone who trusts you that you’re giving them medicine, when you know you’re not, because you want their money, isn’t just lying–it’s like an example you’d make up if you had to illustrate for a child why lying is wrong.

Conclusion

The idea that pharmacy practice is at a crossroads is a tired cliché in the profession, but I’m seeing the retail component of the profession deciding between one of two paths: One path will involve retail pharmacists, supported by pharmacy regulators, taking greater responsibility for their own profession and professional standards. In doing so, pharmacists will recommit to a professional service model that puts patient care responsibilities first. On this path, professional ethics trump retail pressures, and the practice of retail pharmacy changes to a new equilibrium, where products and services offered are focused on optimizing health, based on the best scientific evidence. There is no more question about the motivation of pharmacists, or the profession. It has happened before. Canadian pharmacies fought moves to ban cigarette sales. The bans prevailed – and pharmacy practice continued. The same can happen with “alternative” medicine and “integrative” practices, starting with the most egregious practices, like homeopathy.

The alternative path for pharmacy is quite different than the other. It’s the “anything for a buck” model, otherwise known as the “integrative” pharmacy. In this model, the retail practice of pharmacy becomes a loss-leader to get customers into stores, and there is a growing disconnect between the practice of dispensing and selling prescription drugs, and the rest of a pharmacy’s offerings. The pharmacy is a retailer first, and abandons any scientific standards or justification for products and services offered. Customers may be pleased, but they won’t be well-served. Pharmacists and pharmacies may profit in the short-term, but this self-sabotage will effectively and ultimately ostracize the retail pharmacy from science-based medicine.

Personally, I see only one path that is tenable. First, the profession needs to stop embarrassing itself, and get the most egregious quackery, like homeopathy, out of the pharmacy. Second, it needs to stop confusing and misleading customers into the sloppy (and potentially dangerous) thinking that underlies “integrative” care. Finally, it needs to recommit to putting the patient at the center of its practice – and to start making choices about the products and services the profession will profit from. As a pharmacist I want retail pharmacy to thrive – but in a framework that is grounded in the best science and the best medical care. “Integrative” pharmacy isn’t that path.

Posted in: Homeopathy, Medical Ethics, Politics and Regulation, Science and Medicine

Leave a Comment (99) ↓

99 thoughts on “Beware the Integrative Pharmacy

  1. Pat says:

    I was cheering when I read this, because it’s perturbed me for years to see homeopathic remedies on the shelves at my local Walgreen’s. But then I was perturbed anew when you wrote that adrenal dysfunction didn’t exist — especially since I just taught my students about Addison’s and Cushing’s diseases a week ago. Whether this was a misprint or just an argument against the term dysfunction, it makes me view the rest of the article with less sympathy.

    Could you explain more about your beef with the concept of adrenal dysfunction?

    1. Scott Gavura says:

      Addison’s and Cushing’s do exist. I’m referring to adrenal “fatigue”, a non-specific diagnosis and a fake disease. I’ve corrected the text to make that point more clear. Thanks.

      1. soraya says:

        adrenal “fatigue” exists about as much as “PRE biotics” do, ie: Don’t! Great article. thank you!

        1. James says:

          Soraya

          I am confused by your suggestion that there is no such thing as prebiotics.
          From my understanding prebiotics is a special type of fiber that helps feed probiotics.

          I could be 100% wrong if I am please correct me.
          I would rather have the right information than be “right”.

  2. Chris Hickie says:

    You’ve had some depressingly eye-opening articles recently on how quackery has increased in our hospitals and cancer centers. Seeing woo like homeopathy and naturopathy flaunted by pharmacies is even more discouraging. There have to be pharmacists who are upset with this, but I think most pharmacists work for large retail chains now, where the decisions of quick quack $$$ sales over science/ethics is made at a corporate level. Add to that a not unlikely fear of losing one’s job as a pharmacist for speaking up, and you have a lot of quiet pharmacists (with the same going for physicians working for hospitals that are letting the quacks run the show).

    At least that’s what I’d like to think–as opposed to this happening in pharmacies because pharmacists actually believe this crap.

  3. fxh says:

    Sadly pharmacists, called chemists here in australia,sell all sorts of nonsense. Many make more money out of cosmetics than useful medications. One of my local ones mixes their own homeopathic remedies, plus compounding, and also promotes slimming teas and magnetic wristbands etc. Not to mention their referrals for Reiki, acupuncture, candling etc. And these are trained scientists!

  4. brewandferment says:

    I complained the other day at Dr. Gorski’s “friend’s” site about seeing a reference copy of the book by fake nutrition person Phyllis Balch (Prescription for Nutritional Healing) out on a table at a Walgreens! Eesh.

  5. The fundamental concepts of supply and demand elude Scott once again.

    The pharmacy chains face a simple choice:
    1) give the customers what they want to buy at a competitive price or
    2) tell the customer “Sorry sir but…” and watch him go to a competitor store to purchase his homeopathic tinctures AND his prescription fills as well

    Did you know that USA has the highest concentration of drug stores per capita in the world? Its a competitive world. Adapt or get out of the way!

    1. Lawrence says:

      Wonderful viewpoint you have there – perhaps it would be better if no one sold Homeopathic remedies….since we already get what they sell for free – right out of our facets.

      1. Well, a part of me wishes we did go back to the days when I was an exclusive distributor of homeopathic remedies in the area, nowadays I have to compete with every drugstore, including online distributors, on price and product selection. Get all nostalgic thinking of the price premiums that were available 20 years ago!

        However, its all for the greater good! Increased competition brings increased advertising, A lot of people new to homeotherapies discovered our craft at their local drugstor. This in turn pushed them to seek a homeopathy-friendly medical practice and get involved in the integrative medical events.

        The increasing volume of customers is creating a grassroots movement for promotion of integrative medicine at all levels. For example The World Health Organisation now advises integration of homeopathy into health systems in over 40 countries.

        1. Scott Gavura says:

          Actually, WHO makes no such recommendation. That’s a paper written by a homeopath in the WHO Bulletin – not a position statement from the organization. The WHO notes:

          The Bulletin of the World Health Organization was created by WHO as a forum for public health experts to publish their findings, express their views and engage a wider audience on critical public health issues of the day. Consequently, the views expressed by the writers in these pages do not necessarily represent the views of WHO.

          1. The official WHO recommendation to its member states is to include the full range of CAM pharmaceutical products in state-subsidised health insurance coverage. From World Health Organisation Traditional and Complimentary Medicine Strategy 2014-2023:

            Strategic objective 3: To promote universal
            health coverage by integrating T&CM services into
            health care service delivery and self-health care

            It is increasingly recognised that safe and effective T&CM could contribute to the health of our populations. One of the most significant questions raised about T&CM in recent years is how it might contribute to universal health coverage by improving service delivery in the health system, particularly PHC: patient accessibility to health services, and greater awareness of health promotion and disease prevention are key issues here. Insurance coverage of T&CM products, practices and practitioners varies widely from full inclusion within insurance plans to total exclusion, with consumers having to pay for all T&CM out of pocket. Simultaneously, there is emerging evidence that T&CM, when included in UHC plans, may reduce pressure on the system and diminish costs. This shows why it is important for Member States to consider how to integrate T&CM into their health systems and UHC plans more comprehensively.

            1. Lawrence says:

              Well, at least he seems to be honest (especially with his ‘nym) that he’s only it in for the money…..

            2. WilliamLawrenceUtridge says:

              Of course, if you look into the actual recommendations regarding what to do with traditional medicines, unlike the American approach of “hey, just sell it, OK?” the WHO’s stance is “support research and development for safety and efficacy testing, and identify the pharmacological properties involved”. In other words – this is a recommendation to fund pharmacognosy. Calling it traditional medicine is giving weight and recognition to source, but it’s conventional research into currently understudied plants. It’s not homeopathy.

        2. WilliamLawrenceUtridge says:

          The casual eagerness you express to profit on the credulousness of patients is chilling and repellent.

    2. Windriven says:

      Interesting ethics you have there, Fast Buck.

      1. WilliamLawrenceUtridge says:

        FastBuckArtist is a CAM practitioner, why would you expect him or her to prioritize ethics over making money?

    3. Stephen H says:

      FBA, my local pharmacy has decided to focus upon providing the best service possible to its customers. I have asked – they do not and will not stock any crap masquerading as having medicinal value. They are comfortable selling cosmetics and shampoos, but happily I will never see water sold as wine on their shelves.

      Of course there is another pharmacy just a few minutes’ drive away that sells all sorts of the kind of crap you think it’s okay to peddle. Since the subject has been raised, I am tempted to commence a pamphlet campaign to get unscientific crap taken off their shelves – accompanying some information about said crap.

      “Supply and demand” is the final refuge of those with no moral sensibilities – why aren’t you an economist? Oh yeah – so much competition for selling crap bottled as truth.

      1. WilliamLawrenceUtridge says:

        Indeed, there is a demand for child prostitution, I wonder if FastBuckArtist would throw his support behind more lax regulations in that area? Probably more profitable than homeopathy.

  6. Greg says:

    While I agree that homeopathy is bunk, i seriously doubt anyone in Canada will ever view a pharmacy as a “health hub”. They are much more akin to a variety store and as such they will continue to sell anything that is profitable for their business model. To be honest (no offence intended) i don’t even view pharmacists as healthcare professionals. I know they are, but I don’t view them in the same light as doctors or nurses.

    1. Frederick says:

      Indeed they are, Jean coutu have more space for cosmectics and any other things, than products related to health ( fake or true). My local jean coutu do have a huge section of fake, supplement and eveything. ANd at least the sugar pills have their own section, a small one.

  7. Catherine says:

    Aspirin is an amazing and useful drug, but nobody makes enough money selling it to keep the lights on so that they are open to dispense the PlanB that you might someday actually need. If our collective wish came true and the major drug stores like Duane Reade, CVS, Wallgreen, Target, RiteAid & Wallmart all collectively stripped their shelves of homeopathic snake-oil, each and every one will still have Vitaminwater in their beverage section alongside some anti-oxidant laden goji berry juice. When you think about it, not only is their homeopathic cold remedy not going to cure your cold, neither are the OTC remedies containing actual drugs with actual side effects or the prescription drug that a beleaguered doctor finally hands a patient. In other words, the horse has not only left the barn, he’s been out for weeks and suddenly we’re wringing our hands that some kittens have wandered off as well.

    1. Paul Latouche says:

      The reason to focus on homeopathy first is because its flawed principles and inefficacy are widely known.
      You won’t get rid of vitamin supplements in pharmacies, because some people do indeed have vitamin deficiencies (although most customers don’t). The largely ineffective cough remedies you wrote about have FDA approval, and some (not really significant) clinical benefits, so are untouchable. Herbal remedies are not useful or evidence based most of the time, but it is a much more complicated issue than homeopathy.
      Thus, if one wants to pressure pharmacies to stop selling quackery, homeopathy should be the place to start.

      1. Windriven says:

        Spot on!

      2. Catherine says:

        I think targeting a specific class of products plays right into the hands of a Kevin Trudeau type of marketer. Like you say, it really is more complicated than homeopathy. The Vitaminwater I referred to, is not supplements, but the Coca Cola product that is essentially sugar water. Marketing itself as a beverage it still appeals to the alt-health seeking consumer. Like every other fortified juice making dubious health claims on the label, this crap is ever where. Even SCOTUS justices have been duped. And there is a new one, hawked by some doctors that is competing for market share, touting itself as a hangover remedy. Ultimately, however, the answer is education. When you know it’s useless and potentially harmful, you won’t buy it, whether it’s pomegranate flavored sugar water, homeopathic elixir or Robitussin’s new and improved all-in-one cold remedy.

        1. Windriven says:

          Re: education versus regulation: ” When you know it’s useless and potentially harmful, you won’t buy it, whether it’s pomegranate flavored sugar water, homeopathic elixir or Robitussin’s new and improved all-in-one cold remedy.”

          Catherine, I would love to sign on to this, to embrace it and fight the good fight for it. But where do I find evidence that it is true?

          Wall Street recently drove the world economy to the brink of collapse, a cataclysm from which we still have not fully recovered … except on Wall Street. No one was prosecuted, Glass-Steagall was not resurrected, no meaningful new laws were crafted to prevent a do-over. Yet voters saunter bovine-like to the voting booths to vote for the same boobs.

          Anyone who is paying attention knows that homeopathy has no basis in science. It is not improbable, it is impossible. It isn’t embraced because of credulity anymore it is embraced because of stupidity. Another commenter in another thread bemoaned the alacrity with which her intelligent and educated friends consumed woo. As if.

          You can school everyone but you can’t educate everyone.

    2. goodnightirene says:

      The same is true with “food” marketing. Unregulated marketing–ugh. It’s the Pied Piper and Wizard of Oz all rolled into one. The steeple get in line for more.

  8. Thor says:

    The integrative pharmacy is the only model used in Germany. In every German Apotheke, there are two main sections—one for allopathy and one for homeopathy.
    It’s been like this for decades, at least, and is simply the way it is. It goes unquestioned as it’s never been otherwise. The Apotheke is the main place to get anything complementary or alternative—vitamins, minerals, herbs, toiletries, cosmetics.
    So, we are following in Germany’s footsteps.

    It’s irony of the highest degree that two of the most ambitiously advanced, scientifically astute, and technologically developed countries in the world systemically subscribe to fairy-tale medicine and pharmacology. Disheartening, to say the least.

    1. Pacopicopiedra says:

      The German obsession with “alternative” treatments like homeopathy apparently dates to WWII when the Nazi’s sent all the real doctors off to the front and trained a bunch of laymen in fake medicine to keep the folks at home happy. Propaganda worked too well, and even though the Nazi’s knew it was all bullshit, when the war ended, people continued to think it was real. Still do. At least that’s what I read somewhere. I’ve never bothered to really investigate.

      1. WilliamLawrenceUtridge says:

        Support for homeopathy probably more strongly results because of national pride. Hahnemann was German after all.

      2. Frederick says:

        The article on this subject on Quackwatch is, indeed, very interesting. My Sister ,who lived 8 years in Germany/Austria 10 years ago, believe a little too much in Homeopathy and Acupunture. The “it is part of the health system in germany” Argument is always part of those conversation, I did not know about the Nazi stuff the last time. Next time the subject will be on the Table, it will be such a pleasure to point that out to her, that will probably make her think twice about it.

    2. Andrey Pavlov says:

      @Thor:

      It’s irony of the highest degree…

      Actually I would say that the even higher irony is that the impetus for Abraham Flexner’s work in making his 1910 report and the basis for the standards of medical education in the US was explicitly due to the German scientific standards of medicine at the time. They were, very much so, quite literally the world leaders and earliest adopters of science based medicine and Flexner explicitly said as much.

  9. jre says:

    I did actually buy “The Book of the Book”, and am delighted to have it. “Why is this relevant to xkcd?” you ask.

    http://www.amazon.com/The-Book-Idries-Shah/dp/090086012X

    1. weing says:

      I have it too.

      1. Windriven says:

        Does that make us a menage a trois of dumb?

    2. Windriven says:

      OK jre and weing, I bought it on the strength of your recommendations. $60 for a used book! For that money I ought to come away with a degree in comparative theology, tips on the best ways to pick up girls at truck stops, and a surefire recipe for tollhouse cookies.

      1. jre says:

        In the words of one revered Sufi master, “Rut ro.”

      2. zwrdl says:

        Dear Windriven,

        If you send me $60, I will be most happy to send you a degree in comparative theology, tips on the best ways to pick up girls at truck stops, and a surefire recipe for tollhouse cookies.

        1. Windriven says:

          I’d do it zwrdl, but Mrs. Windriven casts a cold eye on me cruising truck stops.

      3. Windriven says:

        @jre and weing

        Windriven is mildly amused – if not boundlessly happy. The Book of Books arrived today.

        Windriven has an ugly, vengeful side! He now understands jre’s “rut-ro.”

        ;-)

        1. Windriven says:

          Pardon, Book of the Book.

          1. WilliamLawrenceUtridge says:

            What is that anyway, I tried to figure it out by looking online and came up naught. Is it just blank pages?

            1. n brownlee says:

              Pretty much.

            2. Windriven says:

              It is a (small) handful of parables followed by 200 or so blank pages. I’ll read the parables tonight. Tomorrow I start taking bids from rollers*. Unless the parables are worth 10 or 15 bucks a piece.

              * There is an horrific lingering problem of unemployed young people (16-25)(See Chart 7). I propose to to relieve some of them from the ravages of unemployment by arming them with large packages of inexpensive toilet paper from Costco or Sam’s and pointing them to the grounds and exteriors of domiciles of certain individuals who have raised my ire. Preferably immediately before a torrential rain.

          2. MadisonMD says:

            I thought Windriven was being facetious when he said he spent $60 on the book. Some of the Amazon reviews gave strong hints about what wasn’t inside… as did jre’s initial comment.

            1. Windriven says:

              You are exactly correct, Madison. Windriven has more dollars than sense. I went to the Amazon site and “1-Clicked” the purchase on two suggestions and without further ado. Perhaps the Book of the Book has made its point.

  10. Scote says:

    Finally, I’ll be able to got to the pharmacy to by solutions to balance my four humors! I’ve been thinking my black bile may be a little high for a while. Thank goodness the medievalization of modern pharmacies will make it easy to treat all the pre-scientiifc causes of disease I have.

    /s :-p

    Non-scientific medicine in pharmacies really is a problem, especially when some of the “homeopathic” remedies can’t even be counted on to have no harmful active ingredients. Zicam has zinc gluconate in 10% concentration, completely counter to the Law of Infinitesimals so key to the imaginary science of homeopathy.

  11. Lytrigian says:

    Well, this isn’t new in my area.

    My neighborhood pharmacy was in a section of the local organic food store. Just one aisle over were all the herbs, supplements, and homeopathic remedies, complete with a staff naturopath sitting in a kiosk at the end, within spitting distance of the pharmacy counter.

    He eventually quit in disgust because the management wouldn’t allow him to make positive health claims for his products. Of course, with a real licensed pharmacist within listening distance they could hardly have gotten away with that, but of course he couldn’t see it that way.

    There’s only one compounding pharmacy in the county. They make a good deal of their income compounding homeopathic remedies. The do real medicine too, but that’s not mostly what you see when you go in there.

    Ah, Santa Cruz. Forever weird.

    1. Windriven says:

      “There’s only one compounding pharmacy in the county. They make a good deal of their income compounding homeopathic remedies. ”

      Is it even ethical for a pharmacist to do that?

      1. Lytrigian says:

        It’s possible I was mistaken about that, since when I look on their website they only list real medications under “Compounding Services”. But I certainly got that impression when I stopped by there a few years ago to inquire about a compounded omeprazole suspension for my son. Possibly I was misled by the vast array of homeopathic stuff they sold OTC.

        I’d provide a link, but I don’t want to get moderated.

        1. Windriven says:

          My interest was entirely academic anyway, Lytrigian. I’m guessing that pharmacy, like any other profession, has practitioners who don’t hold as close to the line as one might like to believe. My son-in-law is dean of the School of Pharmacy at a Canadian university. I’ll ask him about the ethics of compounding homeopathics next time we’re together if I think of it.

  12. Roman says:

    By buying snake oil, the gullibles are paying a strictly voluntary “stupid tax”. This cannot be halted. But what if the revenues from such sales were channelled, at least in part, to the benefit of the taxpayer? Could this be a more achieveable goal?

    1. Windriven says:

      “. But what if the revenues from such sales were channelled, at least in part, to the benefit of the taxpayer?”

      How about NIH?

    2. Denise B says:

      You know, I’ve kind of given up caring that most of the people I know are receptive to woo in varying degrees. I figure they’re intelligent people and it’s their choice if they want visit acupuncturists and chiropractors and homeopaths.

      But as a patient, it terrifies me that the wall is coming down between the real and the fake. You can only blame the gullible for buying snake oil if you keep the distinction between the snake oil and the medicine clear. I depend on the professionals I consult. If the MD or the PharmD or the imprimatur of a university medical center doesn’t tell me the difference between science and quackery, then what will?

      1. Windriven says:

        “I figure they’re intelligent people…”

        Yeah, huh?

        1. Denise B says:

          Actually, yes. Definitely smarter than me, and I’m no slouch. I’m talking about lawyers, college professors, lots of computer people because that was my field. My cousin is a judge and normally as rational a person as I know, but she reads Dr. Weil’s books. One of my friends is business consultant with a PhD who travels around the world and makes $300k/year, and she told me one day that she thought “some” homeopathic remedies worked.

          It’s a constant source of amazement to me what goes on in other people’s heads. Humans are so fascinating.

          1. WilliamLawrenceUtridge says:

            You could try arguing that the experts think it’s stupid, then make an analogy they would understand. Tell the judge, “Would you take legal advice from a pharmacist? Because actual pharmacists think these things are stupid.”

            Make the point that the real experts, as expert in their field as your friends are in theirs, think they’re dumb.

          2. Windriven says:

            But it still boils down to Dunning-Kruger at best and the arrogance of ignorance at worst.

            I would argue that truly knowledgable people are remarkably aware of the limits of their knowledge. In descending order of strength there is expertise, knowledge, awareness, ignorance and belief. A person whom I would consider ‘smart’ knows where on this continuum his understanding of something falls.

  13. MTDoc says:

    Practicing in a small town, I knew the two local pharmacists well, and I understood the problems they had making a living. One had a rexall franchise and was thus a variety store under corporate obligation. The other one, I thought had an ingenious idea. He secured the town state liquor franchise and ran his pharmacy in it. No phony meds or supplements, and no need to claim health benefits for his nonprescription business. It raised my eyebrows at first, but I realized it did not promote drinking and might even provided some control of illegal purchases. And with medicare/medicade reimbursement it was the only way a small independent pharmacy could survive.

    My present pharmacy is in a supermarket, but is totally independent, and very professional. Being inside a business open 24 hours a day provides security and the supermarket benefits from its presence, thus providing space at a reasonable cost. Of course the supermarket can still sell the other stuff, but fortunately this has not been much of a problem to date.

  14. Ije says:

    Very well said Scott, kudos on this article. I can only hope that amidst the competing priorities of certain establishments that employ pharmacists, there will one day again exist a modicum of professionalism that allows pharmacists to practice true evidence- and science-based medicine without having to go up against “integrative” medicine.

  15. Hi, i’ve just read “the detox scam” i really liked it, is there any chance that i could translate it into swedish and publish it on my blog?

    Of course i’ll credit SBM and refer my readers to your site! :)

    With love from sweden
    /Robin

      1. Will do, i’ll make sure to follow the guidelines and let you know!:)

  16. thor says:

    Do you have any more information on the new compounding trend.? A local pharmacy in my town is advertising like crazy for their all new custom topical compounding products, some of the items listed sound a bit benign, the antifingals and -cains for local pain, till I heard they were compounding Ketamine as well. Thank you

    1. WilliamLawrenceUtridge says:

      Compounding is legitimate, some people need a different delivery mechanism (i.e. allergic to peanut oil, or require a topical cream rather than a swallowed fluid). It used to be big in days of yore, and a necessary skill for pharmacists, but now it’s no longer common. I think a major factor is Big Pharma producing a wider variety of delivery mechanisms but perhaps Scott could correct me. Compounding pharmacists are now embracing quackery in a big way too, in the form of bioidentical hormones (there’s articles on SBM but the current wikipedia page is good too). This has resulted in problems – unlike the quality control of Pfizer or GSK, which produces a standard product whose purity and concentration you can rely on, compounding has serious batch-to-batch problems. When you’re only working with micrograms of material, it’s easy to mess up – and the FDA has tested and flagged compounding products for this very problem. Plus, you can get the same hormones from actual Big Pharma companies for the most part, and the hormones you can’t get from Pfizer or GSK are untested variants of existing hormones.

  17. cloudskimmer says:

    I greatly appreciate your contributions to this blog and the education you provide. My mother’s pharmicist is great, and works in a small pharmacy, very busy so I haven’t had the opportunity to ask why they stock homeopathic medicines (outside the pharmacy counter, but still extremely annoying.). I can only assume that the place is owned by someone else who dictates the over-the-counter side of the business. I don’t mind the jewelry, shampoo, soft drinks, candy and sandwiches they sell, but the herbal/homeopathic stuff is there and I need to ask why.

    Even worse, this is woo-full Santa Monica, and just a few blocks away is the Santa Monica Homeopathic Pharmacy. They also sell a lot of herbal stuff, not just sugar pills and water, but it’s an irritant nonetheless. Do you think it’s better to have it plainly on the shingle and sell nothing else than to have it part of a real pharmacy where real medicine is sold? One day I may go undercover and visit to see what they really do. Their website says their professionals (there is a real pharmicist on staff, but more naturopaths and homeopaths work there) spend lots of time with each patient. If they are diagnosing and prescribing, isn’t this a violation of some laws in California? It sounds as if they are pretending to be doctors, looking at your tongue and taking your pulses. (Not a typo–evidently there are many pulses in some forms of woo.)

    Of course we have the usual rubbish in CVS and Walgreens. Sadly woo has infiltrated practically everywhere. And don’t get me started on the Reiki practitioners, acupuncturists, etc. who have practices around here. Not to mention the storefront psychics. The place is full of this garbage, but hardly any bookstores. One more thing before I stop this rant: before shopping at soulless Amazon, please give powells.com a try. It’s a huge, independent bookstore that does excellent mail order–new and used. I have no connection other than as a customer, so my shilling is uncompensated; I just want people to support independent bookstores.

    1. MTDoc says:

      You raise good questions . A pharmacist in this day and age has to either be employed by someone, and is then beholding to his employers, or he has to have some sideline business in order to pay the rent. Please see my comment above to see how one pharmacist was able to stay in business and still stay professionally independent. The easy way out is to become an employee. As a physician, I took that way out many years ago and I still suffer guilt for leaving a thriving if unprofitable practice. So I can not throw stones.

      An even bigger issue is that private practice in medicine is also on the way out. Almost all the local clinics are now owned by the hospitals, including one I built in 1978. As private primary care clinics were swallowed up by the hospitals, the first thing that happened was fees went up! OK, so we were not charging enough. Hospitals have always had ways to charge for services that private docs were supposed to absorb.

      I grew up when individual responsibility was expected. I see very little of that now when government is expected to provide cradle to grave support. I was shocked to realize that I now qualified for food stamps, not that I would ever take them. As health care becomes more political, I don’t see how it can help but
      become less science based.

      It is indeed sad when professionals have to peddle quackery in order to survive.
      become less science based.

      1. MTDoc says:

        That last fragment of a sentence should have been deleted, but the sun set over the yardarm, and I consumed my nightly martini. Sorry.

  18. Krutiis says:

    As a retail pharmacist, I can say that this post hits close to home. I work for a large chain, and have no say about what is stocked outside of my dispensary. I HATE the fact that we carry homeopathic products. I go out of my way to discourage anyone that is looking at those products from buying them, sometimes when the patient asks me about a completely unrelated product but happen to already have a bottle of snake oil in their hand.

    The large supplement aisle is also a source of grief for me, although slightly less so; there are legitimate needs for things like calcium and vitamin D, for example. My most common advice for people in that area is still some variant of “I don’t recommend the powdered eyeball of newt, there is no evidence that it will help with your leg cramps” or whatever other crazy remedy my patient wants to try.

    As has been mentioned by others, it can be exceedingly difficult for a pharmacist to practice in the community setting completely independently unless they own their own store. That is more stress and risk than I want to take on at this point in my life, so short of that I try to provide the best advice and information for my patients as possible. This often means less sales for the store, and if the powers that be knew that I might get a bit of a talking-to, but it lets me sleep at night.

    On the topic of compounding pharmacies I must express profound disappointment. I enjoyed compounding class in school very much, and the idea of creating unique dosage forms for children, cancer patients, pets and other special populations was quite appealing. Sadly the majority of their business is straight up quackery, notably bioidentical hormones as mentioned above. The female sex hormones is a topic covered exhaustively here and elsewhere. What I found most shocking of all was how the pharmacy would compound “delayed release” thyroid hormone capsules, the idea being to carefully tailor the doses of T3 and T4 to the patient. There is no evidence that this is necessary and T4 alone is considered the standard of care. What really shocked me was the cost: synthetic T4, sold as Synthroid or Eltroxin, is one of the cheapest drugs we sell, going for as little $15 for a three month supply. The crooks at the compounding pharmacy charged over $100 for a single month. It was with great disappointment that I realized specialty compounding was one pharmacy interest I could not pursue any further.

    1. weing says:

      @Krutiis,
      I feel you pain. I have to wonder, that as more and more PCPs are becoming employees of hospitals and other entities whose interests may not necessarily align with the physician. Will we end up offering supplements in our offices, and allow CAM to be offered alongside us blurring the distinction further, all in service of increasing the bottom line and the profits of the owners? We may very well end up like you.

  19. Matt Fluger says:

    The integrative pharmacy also minimizes the relevancy of legitimate holistic approaches. Selling snake oil makes people mistrust certain natural remedies that could be helpful. Also, some people may wrongly believe these lotions and potions are a substitute for medications they need. It can certainly become a dangerous road for patients to navigate.

    1. Egstra says:

      “The integrative pharmacy also minimizes the relevancy of legitimate holistic approaches”

      For example?

    2. WilliamLawrenceUtridge says:

      I’m never clear on what is “holistic” about natural remedies. I mean, do they magically treat mental and physical symptoms? Do they improve religious faith? Aren’t you using them in exactly the way you would use a drug, but there’s less proof of safety and efficacy, and zero quality control? What’s “holistic” about swallowing some dried leaves rather than a capsule?

      And, of course, most natural remedies are simply unproven and thus indistinguishable from snake oil. You’ve got a rather substantial case of “double standard” going on there – “your supplements are snake oil, but my unproven natural remedies are holistic and magical!”

  20. Mark Burger says:

    Some of you may be wondering why the author didn’t warn you about made up, Scientific, Medically acceptable diagnoses. Like “GERD”. Like “RLS” aka Restless Leg Syndrome”. Like “ADHD”. It goes on.
    The author, apparently, also forgot to reveal the lie that is DIABETES: Once you get it (sob) you’ll have to be on insulin … The Rest Of Your Life! … {it’s not true … it’s reversible}.
    About how SSRIs are less effective than a good dose of Vitamin D?
    You all might also be wondering how the author omitted the fact that you doctors can, and do, prescribe medications for indications (illnesses) for which they have never been proven. “Witchcraft!”, you say? My doctor know what s/he’s doing!”, you say.
    How about the failure of chemotherapy and radiation therapy to make even a ‘dent’ in cancer survival (yeah, there’s a little progress in pediatric lymphomas and blood cancers, I know … pshaw! … great for the kiddies, but the burden of cancers is in the elderly).
    How about Laser Fat Freezing?
    How about Lap-Banding?
    Anyone for unecessary C-Sections? {good you your doc’s schedule, bad for baby!}
    Anyone hear of using ANTIBIOTICS to cure Acne? {ever hear of Clostridium difficile? Look it up. Now most hospitals have a “C-Diff” ward from all the doctors prescribing antibioitcs for ear infections (they’ve been told NOT to do that for, oh, about 20 years now). Acute bronchitis? Same thing: They’ve been told not to Rx antibiotics for AB for over 30 years. Still doin’ it! How Scientific.
    Psychiatrists are taught to DOUBLE the dose if the patient doesn’t respond. If s/he STILL doesn’t respond, DOUBLE it again. Still no response? Add another anti-psychotic or SSRI? Still no repsonse? DOUBLE the dose of the 2nd drug. {until the patient becomes morbidly obese and dies of a heart attack or goes on a killing rampage or commits suicide (or both).
    PTSD? Just give them narcotics, Ambien, and 5 anti-psychotics. That’ll hold ‘em.
    This guy is a tool (he lumps everything together in the ‘homeopathy’ category … though, there’s nothing wrong with homeopathy). He’s brainwashed. Worthless But Wordy.

    1. WilliamLawrenceUtridge says:

      Medically acceptable diagnoses. Like “GERD”. Like “RLS” aka Restless Leg Syndrome”. Like “ADHD”. It goes on.

      Those are all real diseases. Some are possibly overdiagnosed, but they’re real diseases, and as someone with a relative whose esophagus is being eaten away by stomach acid and in danger of bleeding into their torso, go fuck yourself.

      The author, apparently, also forgot to reveal the lie that is DIABETES: Once you get it (sob) you’ll have to be on insulin … The Rest Of Your Life! … {it’s not true … it’s reversible}.

      No you won’t. For type I diabetes, yes, for type II diabetes, if those fat fuckers would get off their asses, put down the chips and exercise, they could get off the insulin in a couple months. Every doctor knows this, and every doctor tries, often futilely, to get their patients to improve their lifestyles. You’re blaming the doctors for patients being unwilling to follow their doctor’s advice.

      About how SSRIs are less effective than a good dose of Vitamin D?

      Citation needed? But yes – outdoor exercise can be beneficial to patients with depression. If only you could convince them to get out of bed…

      You all might also be wondering how the author omitted the fact that you doctors can, and do, prescribe medications for indications (illnesses) for which they have never been proven.

      Off-label prescribing is a recognized fact that can be helpful and can be abused. If you want this practice to go away – advocate for more funding for the NIH to run clinical trials for independent testing to expand the uses of existing drugs. Or, y’know, ignorantly crow about a known fact on the internet. Whatever, both are fine.

      How about the failure of chemotherapy and radiation therapy to make even a ‘dent’ in cancer survival (yeah, there’s a little progress in pediatric lymphomas and blood cancers, I know … pshaw! … great for the kiddies, but the burden of cancers is in the elderly).

      Death rates due to cancer, on a per-capita basis, have been declining for the past couple decades. Absolute rates are increasing, but that’s because cancer is a disease of aging, and people are now living long enough for it to develop. Jebus, read a book, I recommend The Emperor of All Maladies. Turns out cancer is not only complicated, it actually evolves in response to chemotherapy.

      How about Lap-Banding?

      Helps people lose weight by reducing the amount of food they can eat. What about it? Too bad patients don’t simply eat less on their own but what can you do?

      Anyone for unecessary C-Sections? {good you your doc’s schedule, bad for baby!}

      What’s an unnecessary C-section? Can you tell us which indications for C-sections are unnecessary?

      Anyone hear of using ANTIBIOTICS to cure Acne? {ever hear of Clostridium difficile? Look it up. Now most hospitals have a “C-Diff” ward from all the doctors prescribing antibioitcs for ear infections (they’ve been told NOT to do that for, oh, about 20 years now). Acute bronchitis? Same thing: They’ve been told not to Rx antibiotics for AB for over 30 years. Still doin’ it! How Scientific.

      1) Antibiotics can cure acne. Perhaps not the best use of it, but at least it’s a real thing.

      2) Maybe if patients didn’t bitch and moan about not getting a prescription when their doctor tells them their kid probably has an ear infection, things might be better.

      3) Antibiotic resistant bacteria is inevitable, at best we could have slowed it down, not eliminated it completely. Read a book.

      though, there’s nothing wrong with homeopathy

      Except for the fact that it doesn’t work, it can’t work, and there is a double-standard that doesn’t require proof of efficacy before being sold. But no, you’re right – the problem is with the medical system. Certainly not ignorant assholes willing to repeat everything their homeopath tells them without actually knowing how the body works.

      1. n brownlee says:

        ” for type II diabetes, if those fat fuckers would get off their asses, put down the chips and exercise, they could get off the insulin in a couple months. ”

        I beg your pardon, this is a gross oversimplification and for many is simply untrue. As a person with drug induced Type II, who has a half-dozen skinny relatives with Type II, I invite you to investigate your misconceptions. For a start, Type IIs have no shortage of insulin- we are instead insulin insensitive. I bet you could learn a lot about it just reading Wiki…

        1. WilliamLawrenceUtridge says:

          Yeah, I know, and I’m guilty of using that phrase many times despite knowing it is inaccurate – but I try to match the nuance and complexity to the level of the poster, and Mr. Burger didn’t show signs of budding genius or an awareness of even basic biology. Hence the exaggeration.

          With a skull as thick as his appears to be – sometimes one uses a sledgehammer.

          1. n brownlee says:

            Really? Is that what you were doing? Because it appeared, for all the world, as if you felt qualified to decide who deserves disease and early death and who does not.

            Are you comfortable with that apparent assumption, just to score an easy point on a dim witted true believer? Because I don’t think anybody won this one.

            1. WilliamLawrenceUtridge says:

              Ugh, you are correct and I owe you a personal apology. In my haste to defend myself I barely even skimmed your initial comment. I wasn’t even aware that type II diabetes could be drug-induced.

              I’m very sorry for my comment and my follow-up comment, and thank you for teaching me something new about type II diabetes. This unfortunately means I lose my favourite example to rebut claims that doctors do not pay attention to lifestyle factors.

              I’ll try to do better in the future, thank you for the much-deserved correction.

              1. n brownlee says:

                Not only can drugs induce it, so can some cancers and some neuroendocrine diseases. Even obesity is unlikely to cause Type II in people who aren’t genetically predisposed. Of course, that’s a whole lot of people… and more and more people are now both. But it’s a more complex problem than usually presented, even by medical professionals.

                No problem, WLU. I always follow your comments with great interest, and I’ve learned a lot from your willingness to engage trolls and the common or garden dumbasses.

              2. WilliamLawrenceUtridge says:

                I appreciate the correction. I was wrong, ignorant, and hurtful (and not strategically hurtful, which is sometimes my aim). I was a dumbass and now I’ll try to do better, and the best way for me to learn is for someone to point out that I’m wrong.

    2. Windriven says:

      So Mr. Burger, did you get your medical information from a comic book? How about your science education?

      There is so much wrong with your comment that I’m not inclined to wade into any of the details. Life is short and there are some stupidities too inane to waste time with. I’f you’d care to throttle your vacuity nozzle, compose your thoughts for a moment (or an hour – whatever it takes – maybe breath into a paper bag for a bit) and come up with the single most cogent argument that you can muster, I – and probably several others – will be happy to engage with you. But for now you’re just braying like an ass with its head caught in a gate.

      1. Woo Fighter says:

        The sad, and frightening part, is that Mr. Burger appears to have been a real pharmacist, with the science education that goes along with that title. Somewhere along the way, however, he turned toward the dark side of quackery and is now an “integrated pharmacist” shilling nutriceuticals and all kinds of bogus tests.

        From his LinkedIn page:

        President & CEO
        LifeGuard Integrative Pharmacies, Inc.
        December 2003 – Present (10 years 7 months)
        Along with my partner and wife, Terri, I manage LifeGuard Integrative Pharmacies, Inc. d/b/a Health First! Pharmacy in Windsor, CA. Health First! is an integrative compounding pharmacy providing pharmacist one-on-one consultations, Medication Therapy Management consultation, Nutrition & Lifestyle consultations, Neurotransmitter testing (NeuroScience, Inc), hormone testing (ZRT Lab), Genetic (GeneSNP) testing, Nutrition testing (Spectracell), Veterinary Compounds, and pain management.

        http://www.linkedin.com/in/marktburger

        1. WilliamLawrenceUtridge says:

          Veterinary compounds? Are pharmacists allowed to dose for animals? One would think there would be some sort of restriction on human pharmacists delivering care to animals.

          1. Windriven says:

            The barber that I went to as a kid had a print of a poker game being played by dogs on his wall. When I read your comment my mind snapped to the bulldog putting his hand face down on the green felt table while announcing, “goddamit, I’ve got to go prepare a prescription for mange for that scummy Chihuahua over on 52nd Street.”

            I don’t know if human pharmacists do the lick, stick, count and pour for animals – but I know you need a prescription for certain of their meds.

          2. n brownlee says:

            Sure, they dispense animal meds, too – at least, the larger pharmacies do. The drugs are usually made by the same companies that make human meds- and of course, they’re often the same drugs. Most of the drugs used to treat pets were first used on humans.

            1. KayMarie says:

              My grandpa and his little dog were on the same heart pills. Radically different doses, but the same drug. I knew you were supposed to look more like your pet over time…

          3. Angora Rabbit says:

            A significant challenge in veterinary medicine is getting the right drug in the right formulation for the species that needs it. Even big market species like cats, dogs, horses, cattle still don’t have the wide range of options that humans have, and it’s worse for species like bunnies that are a much smaller market (as in, fergeddiboutit!).

            Since dicural left the market and baytril become liver-flavor only, we depend on compounders to make liquid antibiotics in nice bunny-approved flavors like bubble gum and pina colada. (Pilling a rabbit is no fun – they have huge tongues and are super at spitting out pills.) We recently needed a special lasix formulation for an elderbun with end-stage heart failure. There’s a Milwaukee-area compounder who advertises that he works with the zoo there. So it’s an important market.

            But this is a very different purpose than the folks who are whacking up snake oils and so-called bioidenticals for the purpose of fleecing the patient and lining the purse.

            1. n brownlee says:

              Oh, man. I’ve never even thought about pilling a rabbit. I’ve pilled large animals (in ag studies) and cats lots of times- and I would have claimed cats as the worst. Obviously, buns have them beaten.

          4. brewandferment says:

            and for those cats who simply can’t keep pills down–as in retching until foaming and hacking up the offending pill after it was involuntarily swallowed–some of the compounding pharmacists make a syringe-application of a goo that goes in the ear to be absorbed through the skin. pricey stuff, that! and I imagine not all drugs can be absorbed that way…

            1. n brownlee says:

              Yeah, and it’s so much fun to put stuff in their ears. Mine bite me, run away, and shake their heads until they sling ear goo into the ceiling fan, your mouth, and your pre-dinner martini. Then they rub their heads on my silk shirt.

              1. brewandferment says:

                what a funny vision you gave me! and so true…still, guess it gets some meds in them.

                I found that straddling said cat on a vinyl or wood floor (low traction, you know) so that they were trapped when they tried to back up at least kept them from escaping a little while longer while the ear got smooshed to rub in the meds.

              2. Chris says:

                Our big mellow “sort of a Maine Coon” cat who loves everyone will not even let the vet check his ears. So she just checked them when he was under anesthesia for dental work.

                I have been the official family cat piller since I was nine years old. My trick has been to wrap a towel around the cat first. We do have a cat in the house that is difficult even for me to pill, she is nicknamed “psycho cat” (name given to her when the animal hospital said she was no longer to be boarded there since she got out and caused havoc, which includes clawing the vet techs, getting out of the cage and tearing around the vet’s office clearing the shelves of books, etc.)

                The med I was attempting to give her was a pet Prozac to deal with her anxiety of the other mellow cat (she leaves piddle puddles around the house). Apparently administering the med was more traumatizing than living with another cat. The better solution was the small portable “pet spot bot cleaner”… a small carpet cleaner. Best purchase ever.

  21. drfeelgoodgoingtothebank says:

    I read the article with great interest. I am in great agreement with your post. I was out of the profession of pharmacy for 13 years and came back to it a decade ago only to find homeopathic products on shelves that would not have been there 13 years prior. It was CVS but then Walmart had the same thing (in US). Responding to the first chapter of Goodman and Gilman’s Pharmacological Basis for Therapeutics, it discusses in the opening chapter a dose dependent relationship between a drug intervention and its response. Essentially saying, pharmacology does not believe in homeopathy. OK, there are a lot of cultures that do traditional (herbs, ground up antelope horn, etc etc to cure all kinds of stuff and people swear by it. Short of seeing a study of homeopathy where we find that the “magnetic imprint” left by the minutiae of ingredient that you are treating yourself with likely does not contain a single atom of said selected ingredient, perhaps it is really the magnetic imprint of all the sewage and agricultural chemicals that the same water was drawn from. How do you tell, after all its still hydrogen and oxygen, even if you distilled it, it still might have the magnetic imprint of million year old dead crustaceans in it (calcium carbonate). You get my point.

    However, lots of cultures want to buy this stuff to the east it is traditional medicine, to us in the west statin drugs are now traditional medicine. Lots of people like to drink soda pop, once prescribed for physical ailments. Coca Cola, even without the cocaine did help relieve gas, people did feel better after drinking 7UP when nauseous. Health claim, ?? it made me feel better.

    Pharmacy compounding: A lot of people swear by getting their hormones “balanced”. I think they know if they think they feel better, or at least thats what would be on the self report survey on the research. I’m not so sure about slamming the bioidentical. If someone likes paying a bunch of money for a perceived value proposition of bioidentical over premarin, I’d say let them, or if they took progesterone capsules or used wild yam cream. Some say they get a bigger dose of estrogen from eating an egg than from some topically applied compounded prep. Want to buy a Tesla, want to buy a Yaris, want to buy a Jeep. Your money, each one gets you somewhere in the style you prefer. Maybe I should demand they walk, better for not getting Type II.

    So, as I’ve written this, its made me think. I wonder if I should start my own pharmacy, do some compounding, integrate some medicine, and get some complements to go with my supplements. (Wasn’t that in sophomore geometry, something about triangles.)

    Seriously though, I do have one question. Pain relief and compounding. Ah, hear tell, from the other side of the mountain that there are these topical pain “cocktails” that include some NSAID, some lidocaine, some gabapentin, some kitchen sink, eye of newt, hair of dog, and you can bill insurance for it, and help pay for your own mercedes benz. The patient, who is now being denied his/her opiates because of some crazy stuff that went on in Florida and some other states with CVS and Walgreens (slam) says it relieves their pain. What should I be doing, calling their MD and saying get this guy back on his opiates or compound the Rx. Oh, yeah, I get reimbursed hugely for the compound. Its a tough call, toss a coin, comes up compound. OK I compound it, bill insurance make $2600. Gee, almost a weeks pay. Hmmm, wonder if they any “friends” with pain that are being denied opiates. Bring em round.

    Seriously, I do believe in multivariate regression and outcomes analysis and quality of life studies. People are not bad at all about knowing if they are having a good outcome. And sometimes in certain health conditions (pain), if you think you are you are.

    Finally, profits are a bit like DNA in a Darwinian perspective on business. Its tough out there, if people want it, you’d be wise to sell it. Imagine if the difference between your firm and the one that stayed in business was that they sold cigarettes and you didn’t. All the opportunities to do good for peoples health are gone when you go out of business without the profit. ProfIts are the oxygen in the blood that keeps the organism alive.

    I think I’d like to feel good while I’m going to the bank.

    1. WilliamLawrenceUtridge says:

      Pharmacy compounding: A lot of people swear by getting their hormones “balanced”. I think they know if they think they feel better, or at least thats what would be on the self report survey on the research.

      The funny thing is, BHRT promoters claim that it is “uniquely tailored” and stuff, but when you look at what they actually do, all that testing is worthless (there’s no salivary “baseline” or “best” level of estrogens you can test for) and they essentially titrate on the basis of symptoms. Which is exactly what real doctors do with evidence-based HRT.

      I’m not so sure about slamming the bioidentical. If someone likes paying a bunch of money for a perceived value proposition of bioidentical over premarin, I’d say let them, or if they took progesterone capsules or used wild yam cream.

      I would still slam bioidentical, on the basis that it is deceptive marketing. Even if it’s not phrased as “it’s better”, it’s still nudge-nudge, wink-wink sold as superior because it’s said or implied to be natural, or tailored, or specific, or safer, or whatever. Shut ‘em all down if you ask me.

  22. RetailPhm says:

    Being a relatively new pharmacist in Canada, it was a bit of a culture shock being forced into a pharmacy that sold homeopathic and naturopathic therapies right beside the pharmacies. I worked as a relief pharmacist to get experience and pay bills and almost all of these new-concept stores seem to have them.

    I won’t explicitly say what stores I’m referring to, but it rhymes with Maxalt.

    It’s funny, really. Students are all prepped up to rejecting non-science-based-therapies in pharmacy school, but once you get out, the first thing your employer does in your training is tell you that naturopathy is awesome, profitable and “safe”. Don’t even get me started on what they say about homeopathy.

    I think the most awkward part is explaining to patients why you don’t recommend anything homeopathic. It’s almost easier to just say “yeah, that’s fine”, and send them on their way. I experimented with this myself (not a RCT so take it by a grain of salt) and it takes me probably a good 10 minutes to tell someone not to use something homeopathic and use a damn frozen spoon if a baby is honestly teething.

    However, I find that once you explain what homeopathy is to patients, they tend to put whatever they had back and ask you for advice. I’ve got the explanation down to an art and it only really takes me like 30 seconds to explain it now. And if they call me a moron – well, negligence charges against me are probably modest since I wasn’t willing to sell overpriced tap water.

    I’m just frustrated with what we end up getting pushed around with. But we’re big bad pharma, so no one sympathizes. Right?

  23. jacy says:

    Any true scientist and believer in science would love homeopathy as it really works, see the truth at http://adidarwinian.com/father-of-human-pharmacology/ to know why it works.

    1. Chris says:

      Um, that is just a short blog post that is just an argument from blatant assertion.

      Where is the actual randomly controlled test on rats that proves Andre Saine’s assertion that homeopathy works for rabies better than real medicine? Where is the actual scientific proof that homeopathy works for other non-self-limiting conditions like type 1 diabetes and bacterial diseases such as syphilis?

      A true scientist would want the true evidence, not a short random blog post.

    2. WilliamLawrenceUtridge says:

      The funny thing is Jacy, that true scientists don’t believe it works. They think it’s stupid. And if homeopathy is actually effective, why do well-controlled trials never work? Why do homeopaths alwasy rely on uncontrolled or unblinded trials?

      The page you link to seems to be authored by Aditya Sardana, who seems big on self-promotion, but shows no pubmed publications* (i.e. he’s not a scientist). Amazon shows he has two books published by Adidarwinian, which is owned and operated by…Aditya Sardana! Sardana’s got lots of quotes about homeopathy, but no actual evidence cited. He claims the greatest advance in pharmacology were homeopathic provings – provings aren’t a great advance, it merely consists of taking a homeopathic sugar pill then monitoring all the unblinded minutea that hypervigilence can deliver, producing a massively long list of incredibly subjective items that is impossible to parse. So you’re not really proving (ahahaha) much beyond Sardana being better at self-promotion than science (and he’s terrible at self-promotion).

      *The two links are to different A. Sardanas.

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