Some pharmacists working in Canada’s top drugstores are recommending homeopathic products to consumers, even though, experts say, these products are essentially sugar water or sugar pills with no scientific evidence they can do what they claim, a CBC Marketplace investigation has found.
Host Asha Tomlinson and Marketplace producers spoke with 10 pharmacists at four major drugstore chains, chosen at random, in the Toronto area, including Rexall, Shoppers Drug Mart, Walmart and Metro, and documented what they heard on hidden camera.
Marketplace journalists approached pharmacists with a children’s homeopathic product that claims it’s for cough, runny nose, congestion, aches, pains and fever. Each pharmacist was asked if they would recommend it for a three-year-old child with cough and cold symptoms.
Six out of 10 did recommend the homeopathic remedy and indicated it would help provide symptom relief.
“I think it’s really, really important to emphasize that the whole idea behind homeopathy is scientifically absurd,” said Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta. Unlike vitamins and supplements, there is no debate in the scientific literature about homeopathic remedies, Caulfield says. “Homeopathy is [an] over billion-dollar industry, selling sugar water.”
“It’s pseudoscience at its worst.”
Most consumers don’t know the difference between homeopathic and natural products
That important distinction between natural products and homeopathic ones is not well-known.
According to a 2016 survey conducted by Health Canada, 95 per cent of Canadians were unable to correctly identify what homeopathy is, confusing homeopathic medicine with herbal products, believing it to be a natural, plant-based or herbal medicine with active ingredients.
Experts Marketplace spoke to about the hidden-camera survey were concerned about pharmacists’ endorsement of these bogus remedies, especially since it could prevent some parents from seeking more effective treatment.
“The pharmacist should say, ‘There’s no evidence to support this.’ Full stop,” said Caulfield.
“They should be telling parents, ‘You know what? It’s mostly just water.'”
But at the majority of pharmacies visited, that is not what Marketplace journalists heard.
“It’ll probably help with the symptoms like the discomfort,” said a pharmacist at one Rexall store.
“Absolutely,” responded a pharmacist at a different Rexall when asked if it would clear congestion. “It’s just for symptom relief, so if he finds that, it’s great.”
At one Shoppers Drug Mart location, the pharmacist said she uses a homeopathic remedy on her own child, saying it’s soothing when they have a runny nose.
“To me, it is completely unethical,” said Nova Scotia pharmacist Graham MacKenzie, who stopped selling homeopathic products in his independent drugstore three years ago.
“They come to us as a trusted, most accessible health-care professional, and here we are giving them something that has nothing at all in it.
“My response to anyone asking for homeopathy now is we took it out because it doesn’t have any ingredients that you’re actually paying me money for.”
Recommending homeopathy raises ethical concerns among experts
Mackenzie is not the only one concerned. Experts also told Marketplace that recommending homeopathic products goes against the Ontario College of Pharmacists’ Code of Ethics, which states: “Members ensure that information provided to patients is current and consistent with the standards of practice of the profession and best available evidence.”
“I do think that it falls against our code of ethics when we make recommendations that do not have evidence backing them,” said Candace Necyk, a pharmacist and clinical associate professor at the University of Alberta’s pharmaceutical program.
However, Necyk also suggests that pharmacists, especially those working in large drugstore chains where they don’t control what’s stocked on the shelves, may not be best positioned to advise on homeopathic products.
“They are put in the position where they are forced to educate on things they don’t have training on,” she said. “Pharmacists are taught about the pharmacology of pharmaceutical drugs. We don’t have training about all these other products on the market.”
The Canadian Pharmacists Association told Marketplace that pharmacists should be “clear that scientific evidence does not support the effectiveness of homeopathic products and that this should be factored into the patient’s decision.”
The Ontario College of Pharmacists, which regulates all pharmacists in that province, told Marketplace, “It would be impossible for the college to make a determination on whether the pharmacists you visited followed the Code of Ethics without fully investigating the specific facts and circumstances of each interaction.”
What is homeopathy?
While homeopathy is often referred to as natural medicine, it is far different from other traditional or complementary therapies such as herbal remedies, vitamins, minerals or traditional Chinese medicine.
Homeopathy has been around since the eighteenth century. The German creator, Samuel Hahnemann (1755–1843), believed that the more you dilute an active ingredient in water the more potent the treatment becomes. Under this premise, active ingredients are diluted until there is not a single molecule of active ingredient left. The idea is that the water retains the “dematerialized spiritual force,” or the “memory,” of the original ingredients used.
Marketplace contacted Homeocan, Hyland’s and Boiron about their products sold in drugstores. Homeocan did not comment, while Hylands and Boiron said they are offering consumers choice. Boiron also noted that “modern scientific evidence” exists to back up its claims.
Experts Marketplace spoke with, however, say such studies have been widely rejected or debunked.
“A rigorous assessment of these studies and others found there are no health conditions for which homeopathy has proven to be effective,” said Jason Busse, an epidemiologist and biostatistician at McMaster University in Hamilton, Ont., who has studied homeopathic evidence.
Licensing of homeopathic products
Before drugstore remedies, including homeopathic products, can be sold they must be licensed by Health Canada.
While pharmaceutical drugs require years of clinical research before they are approved for sale, Health Canada allows manufacturers of homeopathic products to make similar health claims based on the ingredient or ingredients’ traditional use in homeopathic remedies, or based on textbook information, instead of scientific evidence.
Health Canada has approved more than 8,500 homeopathic products. All licensed homeopathic products in Canada have a Drug Identification Number (DIN-HM) specific to homeopathic remedies on their label.
In 2015, Marketplace proved just how low the bar is to get a homeopathic product and its claims approved when journalists created their own bogus children’s remedy that claimed to effectively treat fever and pain and got it licensed as “safe and effective” by Health Canada.
To back up those claims, Marketplace journalists submitted to Health Canada photocopied pages from a homeopathic reference book published in 1902. The references did not provide any actual evidence the product could work; they merely cited the ingredients and what they purport to treat.
In response to Marketplace‘s investigation, in 2015 Health Canada implemented new rules requiring the packaging for homeopathic products for children’s cough, cold and flu to carry a notice that says: “This claim is based on traditional homeopathic references and not modern scientific evidence.”
Health Canada said it made the change as the “labelling for some homeopathic products may not be adequate for Canadians to make informed choices.”
The agency is now proposing that this same label be extended to all homeopathic products for sale in Canada and will be reviewing the issue, as well as its licensing guidelines, until 2024.
Medical experts, including Dr. Matthew Stanbrook, deputy editor of the Canadian Medical Journal, say the labelling change falls short of what’s needed.
“The average consumer will continue to have great difficulty in distinguishing a treatment that is based on science from a treatment that is based on nothing.”
Consumer confusion over homeopathic products
Adding to consumer confusion is the fact that many homeopathic products are displayed next to over-the-counter medications that are scientifically proven. The products are also often packaged similarly, and make similar claims. As a result, many consumers often pick up homeopathic products without realizing what they are.
A survey conducted by The Center for Inquiry, a non-profit organization in the U.S. dedicated to defending science, found that once consumers were told the facts about homeopathic remedies purchased in the drugstore, 41 per cent described their feelings in negative terms and 15 per cent said they felt “ripped off,” “cheated,” “deceived,” “scammed,” or entitled to a refund.
Nevin Thompson of Victoria, B.C., would also like to see drugstores and Health Canada do more to ensure consumers are not being duped. Thompson inadvertently purchased a homeopathic product claiming to treat fever and pain in children.
For Nevin, the stakes were high. When his son was 18 months old, he suffered a febrile seizure — a convulsion or seizure that occurs in young children and is triggered by a fever.
“He had a bit of a cold, but he bounced back, and, you know, we were just sitting and watching TV, and then we noticed he wasn’t breathing and then turned blue and we’re like, ‘Oh my god, what do we do?'”
His son recovered, but Thompson was careful to ensure it never happened again. So when his son spiked another fever a few years later, he went rushing out to London Drugs.
“I want to go home to give it to him, and I see the package says ‘kids pain and fever.’ The ‘fever’ is what I sort of latched onto, so it’s like, ‘OK, this is what I need.'”
When Nevin got home he realized the product was homeopathic and had no ability to treat his son.
“If Health Canada licenses it and it’s for sale in a pharmacy, I expect it’s going to do what it says on the box and relieve pain and fever in my kid,” he said. “They shouldn’t be placed near regular conventional over-the-counter remedies for cold and flu treatment. It’s very confusing. ”
London Drugs says it is no longer stocking Homeocan Kids 0-9 Pain and Fever, the product Thompson purchased, across its stores.
Marketplace reached out to Shoppers Drug Mart, Rexall, London Drugs, Walmart and Metro.
All five drugstores said the products they sell are approved by Health Canada.
After Marketplace contacted Metro, it informed us they will now stop selling Homeocan Kids 0-9 Fever and Pain. Metro added that the discontinuation of its own Personnelle line of homeopathic remedies was already underway. Overall, Metro stands by its product placement of homeopathic remedies, and London Drugs said it does as well. Shoppers Drug Mart said it “will use this opportunity to review our product placement.”
None of the drugstores addressed the findings of Marketplace‘s hidden camera test, but Shoppers Drug Mart, Rexall, Metro and London Drugs had suggested consumers talk to their pharmacists for “advice based on scientific evidence” and for help choosing a product that is “suited to their needs.”
However, when Marketplace staff asked pharmacists for clarity around the Health Canada label on the cold product, saying the claims are based on “traditional homeopathic reference, and not modern scientific evidence,” the majority did not accurately convey what homeopathy or homeopathic references are.
“I wouldn’t know exactly what that is, all the ingredients are listed here,” said a Shoppers Drug pharmacist before recommending the product.
“It just helps boost immunity more or less,” said another Shoppers Drug Mart pharmacist. “The natural stuff just helps the body to do its job that it needs to do … so it’s worth a try.”
Hearing that concerns Caulfield.
“This is a pharmacist [who is] wrong about immune-boosting, doesn’t seem to really understand what homeopathy is. She conflates it with herbal remedies, adding to the confusion of exactly what this product is,” he said.
In Caulfield’s view, pharmacy schools and regulators “aren’t doing enough.”
“It also tells us that regulators like Health Canada need to do more in order to ensure that there’s appropriate labelling and that even pharmacists have enough information to inform their consumers.”