victorian Pharmacy - Royal Pharmaceutical Society

p r a c t i c e g u i d a n c e h o m e o p at h y
Homeopathic and
Herbal Preparations
There are strongly held views for and against.
The RPS Science and Research team report
HoMEoPATHy is a topic that
invokes strongly held views both
for and against its benefits, and
this polarisation of views also extends to
the interpretation of data from randomised
clinical trials, systematic reviews, and metaanalyses
in which the clinical efficacy of
homeopathy is assessed.
In January 2009, RPSGB’s Science
Committee decided to examine the science
and published clinical evidence for
homeopathy as part of its work programme.
At its meeting in May 2009, Science
Committee reviewed the evidence for
homeopathy and concluded that there was
no scientific basis for homeopathy and no
convincing evidence for its clinical efficacy
from randomised clinical trials.
Coincidently, in early November 2009
RPSGB received an invitation to give oral
evidence to the House of Commons Science
and Technology (S&T) Select Committee in
their evidence check on homoeopathy; Prof
Jayne Lawrence, Chief Scientific Advisor
presented the RPSGB’s oral evidence late
November 2009. To support the RPSGB’s
oral evidence, written evidence was prepared
by the RPSGB’s Science and Research team
which drew heavily from the work of, and
external expertise available on, Science
Committee (http://www.rpsgb.org.uk/pdfs/
homeopathyRPSGBrespHoC.pdf).
Placebo effect
The House of Commons S&T Select
Committee published its findings on its
evidence check on homeopathy in February
2010 (http://www.publications.parliament.uk/
pa/cm200910/cmselect/cmsctech/45/45.pdf)
and reported that the evidence base shows
that homeopathy is not efficacious beyond
the placebo effect, and that explanations
for why homeopathy would work are
scientifically implausible. The report also
concluded that further clinical trials of
homeopathy could not be justified, that the
NHS should stop funding homeopathy, and
that the Medicines and Healthcare products
Regulatory Agency (MHRA) should not
allow homeopathic product labels to make
medical claims without evidence of efficacy.
Indeed as homeopathic products are not
medicines, the Committee suggested they
should not be licensed by the MHRA. The
evidence submitted by RPSGB agreed with
the majority of the findings of the House of
Commons S&T Committee.
In advance of the publication of the
Science and Technology Committee’s
report on homeopathy, RPSGB’s Science
and Research team prepared Advice for
Pharmacists on Homeopathic and Herbal
Products (http://www.rpsgb.org.uk/pdfs/
homeoherbalprodadviceforpharmacists.pdf)
that included information to support and
prepare pharmacists for enquiries likely to
be received from the public regarding media
reports of the S&T committee findings.
This document was based on the main
recommendations in the House of Commons
report together with what is considered to be
good pharmacy practice.
This concept goes
against scientific
understanding of
how medicines act
at a molecular level
Whilst the RPSGB does not endorse
homeopathy as a form of treatment,
it does accept that patient choice is
important and realises that patients often
turn to complementary medicines, such
as homoeopathy, when conventional
medicine has been unable or unsuccessful in
controlling disease or symptoms.
When reviewing the literature for
homeopathy and other complementary
medicines for the Science Committee
meeting in September 2009, several
references noted that the public frequently
confuse homeopathy with herbal medicine, a
situation with which many pharmacists will
be familiar. This confusion is most probably
a consequence of homoeopathic products
often being derived from herbs and called
by their botanical name e.g. both herbal
and homoeopathic preparations prepared
using aloe will be called aloe, and because
a single manufacturer may produce both
homoeopathic and herbal products.
Homoeopathy is a holistic complementary
therapy based on three main principles,
namely that like cures like, the minimal
dose, and the use of a single medicine.
Homeopaths believe that the more dilute
a homeopathic product, the more potent
it becomes, and that this potentisation
requires a series of dilution and succussion
stages. This concept goes against scientific
understanding of how medicines act at a
molecular level. While most homeopathic
preparations are highly diluted, or ultradilute,
some preparations can be of low dilution,
giving them compositions similar to herbal
preparations.
Herbal medicine is the use of plant remedies
in the treatment of disease, and many currently
used conventional medicines have their origins
in herbal preparations and plant materials.
Herbal medicines subscribe to dose-response
pharmacology where the biological response
varies in direct proportion to the dose or
concentration of the remedy.
Prescription
Thus, the main difference between herbal
and homoeopathic preparations is that with
herbal medicines, increasing the dose would
be expected to increase the therapeutic
effect, while for homoeopathic products, the
more the preparation is diluted, the greater
the effect homeopaths expect the product to
have. In addition, homeopaths believe the
dilution and succussion steps involved in the
preparation of a homoeopathic product are
critical to the effectiveness of the preparation.
Furthermore, due to the different philosophies
used in selecting a treatment for a condition,
it would be reasonably expected that herbal
and homoeopathic preparations could not be
used to treat the same condition, although this
is not always the case in practice.
The differences between homeopathic and
herbal preparations are described in a table in
the Advice for Pharmacists on Homeopathic
and Herbal Products guidance document on
the RPSGB website. Examples of differences
include how a particular product is selected,
how the dose affects the efficacy of the
remedy, the safety of the products and their
potential side effects, whether they are
likely to interact with prescription or other
medicines, and whether they are safe to take
in pregnancy or while breastfeeding.
In the future, and based on the findings of
the House of Commons Select Committee
report on homeopathy, RPSGB would
support approaching the MHRA regarding
the labelling and licensing of herbal and
homeopathic products, to strive for the
removal of indications from homeopathic
products, and to ensure labelling makes the
difference between herbal and homeopathic
products clear, all of which would help in
ensuring the public understand the differences
between herbal and homeopathic products. n
l For a quick reference guide go to
www.rpharms.com
32 Pharmacy Professional | July/August 2010 July/August 2010 | Pharmacy Professional 33