The Pharmaceutical Journal
Vol 268 No 7188 p325-328
9 March 2002

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Letters to the Editor

Baddy chemists (5 letters)

Scientist on the rubbish heap

From Mr S. R. Carter, MRPharmS

Simon Whitaker wrote a rather interesting article about "Baddy Chemists" (PJ, 2 March, p288), those pharmacists that stock "quack medicines". It gets worse: some of them even sell shampoo, hair colours and cosmetics.

Mr Whitaker is of course entirely correct. This not only erodes the standing of pharmacists as scientists, but also as professionals. It saddens me greatly to see how we have allowed our profession to be reduced to tawdry retailers selling any old tat for which there might be a market. The degradation of pharmacy is even more surprising given the great support we continue to receive from central government and the NHS. The funding arrangements have always been fair, with the NHS receiving an excellent service from an extensive network of pharmacies, with a walk-in centre on every high street offering extended hours, delivery services, free advice and information. In exchange pharmacists have been well rewarded with the NHS always ensuring that we are amply funded to maintain a high quality professional service and realising that the service offered in these walk-in centres reduces the workload in general practitioners' surgeries and hospitals, not to mention the amount of free social work carried out by community pharmacists.

However, back to the real world ...

Pharmacies — especially the smaller independent pharmacies in poorer communities — are at breaking point. They do not want to sell non-pharmaceutical stock but must in order to survive. The NHS milks us like an old cow, always wanting more for less. It panders to the big chains allowing massive discounts, while clawing back every penny from the small independent pharmacies, the very pharmacies that actually give the community service — the Baddy Chemists.

I read repeatedly in the pages of The Journal and other professional journals about the brave new future of pharmacy. I read with fascination the ruminations of the Royal Pharmaceutical Society, but nobody is able to tell us how we are going to achieve this great change, and nobody is willing to pay for it. The NHS would rather start a whole new network of nurse-staffed walk-in centres devoid of pharmacists than inject any funding into our existing network. The British Medical Association is playing with the idea of drastically increasing nurse practitioners in surgeries in order to reduce the workload of general practitioners.

We know what we must do if we are to get back the respect of the public and to attain a position at the heart of the New NHS. We must spend time training. Every pharmacist should be spending every spare minute of every day studying. We must become nurses! They are the future. The scientist on the high street is a thing of the past; we are now the scientist on the rubbish heap.

Simon Carter
Datchet, Berkshire

Injustice to homoeopathy practitioners and the public

From Mr L. N. Collin, MRPharmS

As a pharmacist and practising homoeopath, I must take issue with the Broad Spectrum article by Simon Whitaker (PJ, 2 March, p288).

The equating of homoeopathic remedies to "highly priced placebos" does considerable injustice to the tens of thousands of both medical and lay practitioners of homoeopathy worldwide, as well as the general public who, I have discovered, are more interested in evidence-based medicine than scientific arguments. If homoeopathy really did only work by a placebo effect it would be difficult to explain the fact that some patients have strong aggravations following a homoeopathic remedy (indeed, some practitioners regard this as a good sign). Homoeopathic remedies can act in both babies and animals. Homoeopathy can act in unconscious and comatose patients. Sometimes there is no improvement after the first remedy, but only after subsequent remedies. Some patients do not respond to a placebo prescribed allopathically but, ultimately, show an improvement following homoeopathy (after all else fails). However, in terms of evidence-based medicine, one could do no better than cite the cholera epidemic of 1830. "In Russia, of 70 cases treated using Camphor homoeopathically, all were cured. And of 1,270 cases, 1,162 were cured and only 108 died. (The allopathic mortality in Russia was 60 to 70 per cent)."¹ A Dr Perrussel in Southern France found the mortality under homoeopathic treatment for cholera in that year was 5 to 7 per cent; the allopathic mortality there was 90 per cent.²

Mr Whitaker's teacher (Mr Robey) would probably still decry homoeopathy because it cannot be explained using our currently understood physicochemical laws of science. However, much research has taken place in the past couple of years into ultra-high dilutions — or UHDs — and their physical, biophysical and biological effects. This has the potential to turn science and medicine on its head by results which seems to indicate that water molecules appear to have a "memory" with increasing dilutions of solutes.³

As pharmacists, in the true interests of our customers, perhaps we need to adopt a more "broad spectrum" viewpoint on this dynamic system of medicine and escape from Mr Robey's rather cramped laboratory conditions.

Lawrence Collin
Westcliff on Sea, Essex

Vicious circle of remuneration

From Mr A. K. Armitage, MRPharmS

I read with some interest Simon Whitaker's article on "Baddy Chemists" (PJ, 2 March, p288). I also noted that he is a locum pharmacist and as such has merely to fulfil his professional obligations during the course of his working day. I am certain that Mr Whitaker treats each pharmacy in which he works as if it were his own business (as all good locums do), but it really does not matter one iota whether this pharmacy makes money, breaks even or loses money, as he will walk away with the same fee.

I am sure there is not a pharmacist manager or proprietor pharmacist (with accompanying mortgages, bank loans etc) in Britain who would not want to fill their pharmacy with "scientific" medicinal products and nothing else, but in reality we need people through the door to purchase what they want to buy, not what we think they ought to buy. And once more we return to the vicious circle of the remuneration argument: for as long as we continue to be poorly recompensed for all the services we provide, we resort to other sources of income or what Mr Whitaker would term "quack cures and spurious remedies" and as such fail to be recognised as true health care professionals.

I am not a locum pharmacist, a branch manager, or a proprietor, but if such products are to be sold, then from where better than a pharmacy where suitably qualified personnel can ascertain the appropriateness of an item for each individual?

Andrew Armitage
Cardiff

An uninformed tirade against homoeopathy

From Mr D. B. Needleman, MRPharmS

When I began to read Simon Whitaker's article under the banner "Baddy Chemists" (PJ, 2 March, p288) I thought I was to be treated to a tongue-in-cheek exposition. However, I was wrong. What I got was an uninformed tirade about areas of health care that are obviously alien to him. Thankfully, most of us have a less blinkered outlook with, I hope, a level of scientific curiosity. Simon, the Earth is not flat.

If a debate on science is what he wants then at least make an argument and offer a modicum of evidence. What about the evidence for homoeopathy and herbal medicine? Well, with regards to mode of action, this is still unknown as is true for many chemical drugs including aspirin. Is this a product he refuses to sell?

As for published clinical trials, what about amoxicillin and the hundreds of other "medicinal products" that have never been put through trials? There are in excess of 9,000 on file on the Ciscom network in respect of homoeopathy, which, I am reliably informed, is accessible through the Royal Pharmaceutical Society's information department. Let us also not forget the millions of people cured over the last 200 years or so with homoeopathic medicines and the millions also cured over the millennia by herbal remedies.

Let me now move on to "previously unheard of herbal preparations". Unheard of by whom? Has Simon never studied pharmacognosy? Has he never read any scientific journals that report on the millions of pounds being spent by the chemical giants on research into plant chemicals and herbal remedies in an attempt to replicate in the laboratory the results obtained from the natural plant? Has he never heard of digitalis, St John's wort, cocaine, opium and, again, aspirin? Here are five of the most valuable medicines we now possess; are these also not stocked?

Please, let us have balance in articles and not just propaganda without even any anecdotal evidence.

David Needleman
Dean of Studies
British Institute of Homeopathy

Uninformed statements about homoeopathy benefit no one

From Dr S. B. Kayne, FRPharmS

Although I accept totally that Simon Whitaker (PJ, 2 March, p288) has every right to express his personal criticisms of what he chooses to call "alternative medicine" (but which most health professionals prefer to call "complementary and alternative medicine"), I strongly dispute his assertion that the profession as a whole should adopt his views. Merely dismissing homoeopathy as being quackery and including it alongside "fat busters" and spiritualism shows a complete lack of understanding of the discipline. Referral to the House of Lord's Report on Complementary Medicine will show that homoeopathy and herbal medicine are classified alongside acupuncture, chiropractic and osteopathy in "Group 1", characterised as "having established research into their effectiveness and being increasingly provided by the National Health Service".¹

Mr Whitaker talks about "scientific evidence" without specifying the exact nature of the data he seeks. I assume he is thinking of randomised clinical trials. Yet RCTs are not the gold standard many researchers would have us believe. In the first place RCTs are carried out under standard conditions on a carefully selected population. Patients who self-treat rarely follow these standard conditions so the results may bear little relationship to what happens in practice. How many over-the-counter products have good quality RCT evidence of efficacy available from the manufacturers? Very few. The BNF advises that expectorants are unlikely to have any effect at all, yet many products containing them are still being sold in pharmacies. Turning to prescription drugs, some RCTs, particularly those for potent chemotherapeutic agents, involve numbers well below statistical requirements.

Mr Whitaker states that "there is also an onus on each and every practising pharmacist to examine the scientific basis of the remedies they advocate and sell". It would appear that there are many orthodox medicines with little or no scientific evidence of efficacy that are being sold daily. Where does that leave us all in community pharmacy?

There is of course another method of measuring outcomes, based on patient perceptions of improvement. This is usually referred to as being a measure of "effectiveness" and often results from our experience of case studies. In fact sophisticated methods have now been developed at Glasgow Homoeopathic Hospital to assess whether non-orthodox interventions work.² Evidence is starting to emerge, albeit slowly. In some cases it is possible to predict how long it is likely to take before an improvement can be expected.

I strongly support Mr Whitaker's view that pharmacists, along with their fellow health professionals, have a duty of care towards their patients, and this includes a responsibility for giving correct and appropriate advice. To do this effectively one must have the necessary knowledge and that is why complementary therapies are included in undergraduate and postgraduate education programmes, the latter being undertaken by pharmacists, doctors and other health care professionals in increasing numbers. Uninformed and biased statements are of no benefit to anyone, least of all to our patients.

There is absolutely no doubt that many of the complementary therapies suffer from a lack of good quality research based evidence supporting their use. However, many of the holistic concepts involved are consistent with those advocated by pharmaceutical care programmes and fit in well with our day-to-day activities.³ It is not just about selling a pill for every ill.

Steven Kayne
Glasgow

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