Profit and public health

Amid the abandonment of tariff protection and the continued assaults on trade unionism, one union/lobby group has been consistently victorious. The Pharmacy Guild has managed to restrict competition so successfully that it’s impossible to open a pharmacy if it might hurt the profitability of an existing business, even if that business is failing to serve a significant group of customers. I ran into an example when I was at James Cook University in Townsville. A request for an on-campus pharmacy was rejected because it was within the market area claimed by a suburban pharmacy, more than a kilometre away and inaccessible by public transport.

Far more important to the Guild is the imperative of keeping supermarkets out of the pharmacy business. The key argument is that supermarkets are just businesses, happy to sell anything to make a buck, whether it’s cigarettes or cancer medications.

So, I was interested to read the Guild’s reaction to a proposal that medical professionals should stop prescribing homeopathic products. Whatever you might think about alternative/complementary medicines in general, homoepathy is plain quackery, combining a magical theory of medicine with the preposterous physics of water memory. Unsurprisingly, research has proved beyond any doubt that it’s no better than a placebo. So, the Royal Australian College of General Practitioners (RACGP) has formally recommended GPs stop prescribing homeopathic remedies and says pharmacists must also stop stocking such products.

The Guild’s reaction:

it is not a regulatory authority, and as such there will be no recommendation backing RACGP’s call for homeopathic products to be taken off the market.

In other words, selling medicine in the same shop as alcohol is unthinkable, but it’s entirely OK for a health professional to promote and sell water as a treatment for serious illness.

This episode demonstrates, to anyone who cares to look, that the Pharmacy Guild is (and in fact claims to be) nothing more than a rent-seeking lobby group, whose sole concern is the profitability of its members. As the Tobacco Institute of Australia would be quick to point out (if it were still around), there’s nothing illegal about that. But when profits and public health come into conflict, the Guild and the Institute are on the same side.

74 thoughts on “Profit and public health

  1. Most of what pharmacies sell has nothing to do with health. But it could be worse. In the US, pharmacies sell cigarettes.

    The Pharmacy Guild is the most powerful lobby in the country. Apparently every time there is a new Prime Minister they Guild sends him (once, her) a very clear message not to mess with them or they will unleash the mother of all campaigns against them. The Guild, as far as I am aware, has not placed a horse’s head in a PM’s bed (yet), but there’s been no need. No PM has ever taken on the Pharmacy Guild.

    The power of the Pharmacy Guild comes from the extraordinary and undeserved esteem that local pharmacists hold in local communities. How it came to this is a story that needs to be researched and told.

  2. Hear hear. If they want special rights they should accept responsibility for promoting public health. Some chemists are full of “magnetic” bandages, aromatherapy treatments, homeopathic remedies and who knows what else.

  3. The “professional” organisations like pharmacists, surgeons, lawyers all wield much, much more power and market control than any trade union ever did, yet you never hear the business council types ever coming out decrying the lack of “flexibility” these organisations present in the market.

  4. I agree. Homeopathy is plain quackery as are several other alternative medicine fields. And the Pharmacy Guild is a rent-seeking lobby group. I would argue for calling them a “guild” as indeed they call themselves. They are not a union. Pharmacists, or at least the pharmacists influential in the Guild, are not worker-employees, they are owner-employers of small to medium sized and even large enterprises. The predominating or very likely total influence of pharmacy owners in the Guild is clearly shown by this;

    “Full membership is offered to qualified, registered pharmacists who own their own pharmacy. Membership is comprised of a ‘proprietor’ and a ‘premises’ component. The ‘premises’ component is based on the number of pharmacy premises owned.” – The Pharmacy Guild of Australia website.

    Without further information one can only assume that voting rights are linked to full membership. I cannot imagine them permitting employees to run the employer’s guild.

    The other levels of membership are as follows;

    “Associate membership is available to those pharmacists who do not own a pharmacy. This includes pharmacy managers, pharmacy staff or graduates.”

    “Student membership is available to any student currently studying pharmacy, allowing pharmacy students to take the first step toward participating and contributing to their future professional association.”

    We can see from this setup how proprietor or capitalist rights must predominate and how pharmacist employees can possibly be encouraged or induced to join the employers’ guild rather than a genuine workers’ union.

    One can view The Constitution of the Pharmacy Guild of Australia.—the-guild/About-the-Guild/The-Constitution/constitution-of-the-pharmacy-guild-of-australia.pdf?sfvrsn=2

    “At all meetings of the National Council each member except the National President shall
    have one vote.”

    I assume this means full members only. Where pharmacies or pharmacy chains are partnerships of pharmacist-owners, it looks like each partnership member gets a vote.

    Professional Pharmacists Australia (PPA) “is the union that represents non owner pharmacists who work in community pharmacies right across Australia”.

    I expect the SDA (Shop, Distributive and Allied Employees Association) represents non-pharmacist workers in the pharmacy industry.

    I hope people can see the good reasons for insisting on a strong definitional separation between the term “guild” and the term “union” in the modern IR landscape. Guilds are for capitalists. Unions are for workers.

  5. There is no real problem with establishing economic territories under some form of social regulation. Cooperatives may need such provisions.

    The real problem is that exclusion of other suppliers may create economic rent which then appears as a return on Capital after normal costs have been paid.

    Surely a government can review territories every so often based on financial data from the particular businesses.

    The real problem, at root, is rent seeking, not the symptoms.

  6. @Ivor

    Good points. Technically, a pharmacy or pharmacy chain owned and run entirely by pharmacist owner-workers would be a cooperative. A Guild of cooperatives could and almost certainly would also rent-seek by pressuring government to keep the licensed number of cooperatives down.

    The issue would then still be how to regulate to meet multiple stakeholder objectives. Stakeholders would include Guild members (be they cooperative or capitalist enterprises), workers where applicable, the community as a whole and other affected groups (e.g. health professionals in general).

    In turn the next question becomes how to regulate market competition. Markets never operate in a vacuum. All markets are regulated and conditioned by institutional arrangements. Competition law and regulation in the area of Pharmacies would have to consider what maximum permissible size of site or chain of sites constitutes the borderline for an oligopoly (locally or regionally). At the same time it would have to consider what minimum size supports a pharmacy which can meet all health, welfare and safety regulatory requirements for all stakeholders while still remaining a viable single-owner or cooperative business.

  7. Pithy. Exactly the sort of thing that has me back here again and again, year after year.

    God bless you, Big John.

  8. @Ikonoclast

    You could have made your point much more simply just by quoting from the Constitution you linked to (emphasis added by me):

    ‘The Pharmacy Guild of Australia is a not for profit employers organisation registered under the Fair Work (Registered Organisations) Act 2009.’

  9. It always irks me when I walk into a pharmacy and see homeopathic crap for sale. The homeopathic industry will argue that, because placebos can be beneficial, their homeopathic rubbish should be allowed as well. It is a lousy argument for a product that can prevent people from seeking the help they really need, fooled into using something which, under the known laws of chemistry and physics, cannot work—except perhaps briefly, as a placebo. Placebo effect and cancer vs chemotherapy and cancer…I know which I’d choose. Same goes for chronic disease: see a GP, a specialist if need be, but don’t put faith in the physical impossibility of homeopathic water. Cue the anecdotal evidence stories…

    I have some sympathy for people who have not had success with the standard medical system, but that’s no reason to pour money into something that cannot work in the first place. Medicine, like other scientific and technological fields, advances through experiment, thought, analysis, and peer review, arguments, more experiment, etc. There are no shortcuts to knowledge. Homeopathy is a hustle which succeeds only because it promises a shortcut solution to often desperate people. Shame on the pharmacies that stock this shite.

  10. I wonder how much the war on drugs plays into this.

    Recently I asked for some over-the-counter analgesics that contain codeine, and they wanted to record my license details, claiming it’s a regulatory requirement, which it absolutely is not.

    The only way they can get away with that is if the public thinks it’s reasonable, and they only way it sounds reasonable is by invoking the spectre of drug users getting high off generic Panadeine.

    Does the Guild thrive on the belief that a small chemists’ market is necessary to keep close watch on schedule 8 drugs?

  11. @Ivor
    I don’t think rent seeking is the root of the problem. “Seekers gonna seek” as young people probably say. The root of the problem is that our institutions are too amenable to rent seeking. But then the same people who could reform those institutions are also harvesting the rents. That’s why I tend to think that every economic problem is a political economic problem. Break that influence of money on politics and reform becomes possible.

  12. @Ikonoclast

    If you had read Rule 6, Rule 6B, Rule 7, and Rule 9, you would have found that they gave a clearer picture than you succeeded in doing. You wouldn’t have had to ‘assume’ this or that; the answers were all there in the document.

  13. I don’t know how the location laws work in Victoria. A pharmacy opened up across the road from another in my suburb of Melbourne this year. Generally in the suburbs there seems to be lots of competition. The newcomer is a discounter and clearly applying competitive pressure to the other firm.

    The original pharmacy runs a coffee shop and sells lottery tickets. At least half the store is devoted to the sale of high-profit lines such as cosmetics and perfumes.

  14. First let me declare that I have a specific interest in this area. As Business Manager of a large rural medical practice I prevailed upon the practice partners to invest heavily in what amounts to ‘super clinic’. Our practice facility is of a high standard, modern and with the latest equipment. We have co-located radiology and pathology collection.

    When we tried to introduce a Pharmacy as part of the overall service we were unable to do so because two other pharmacies existed in town and were not the minimum 500 metres away from our practice. However, there is absolutely no constraint on the pharmacies employing general practitioners or nurse practitioners and providing such services from the pharmacy.

    Then there is the matter of the price of prescription medicines. Basically the Australian PBS/public is being ripped off by the pharmaceutical industry and by pharmacists. Many common medications are substantially cheaper in the UK and even NZ. The difference in costs is for some medications a factor of ten times! This is literally costing the Australian government billions of dollars. In Australia generic medications provide a saving which I understand to be about 20% whereas in the UK generics are on average much much cheaper, in fact I understand that the average is closer to 80% cheaper.

    So there is plenty of room for competition to come in with lower prices and still be profitable. it is about time the industry was opened up more competition. If we need to preserve a pharmacy presence in small rural towns where there could be market failure then I suggest that these are subsidised directly. That should be possible with the massive savings that are possible.

    With regard to the comments about homeopathy and other quackery I could not agree more with JQ’s comments. However it surely should not go unnoticed that universities and TAFE colleges are churning out courses in this utter nonsense, courses that are subsidised by the public purse.

  15. @hc

    More than likely the newcomer owns the original pharmacy and will shut it down in due course.

  16. @Sancho
    As someone who deals with chronic pain, I would be pretty miffed if a pharmacist gave me the third degree like that. These days, it is extremely difficult to get good treatment for chronic pain, especially if there isn’t a clear external injury evident.

    My view is that so long as the pharmacist explains the risks associated with using a given painkiller, asked what other medications you are on, and told you what to do if the worst happens, then they have done what is necessary. If a drug is so dangerous that this isn’t enough, it shouldn’t be issued from a pharmacy without prescription. Quite frankly though, far more people seriously injure themselves or die as a result of car accident, smoking, drinking, and illicit drugs, than come a cropper using the over-the-counter pain medications as instructed (which isn’t to say there is no risk).

  17. @Sancho

    In Western Australia you have to show your license for items containing pseudoephedrine, as this can be used to make methamphetamine. I’m pretty sure it is a law.

  18. It is pretty obvious that pharmacies are a protected species. There are lots of them. They are well staffed. The staff are helpful. They have good opening hours.

    All of these things suggest an oversupply and a lack of competition. It also makes them quite nice places to go. They’ll do things like get stuff in for you and text you when it arrives.

    One of my friends knows someone who owns a pharmacy. They are rolling in money.

  19. @J-D

    Only employers can be members; associates are not members and don’t have members’ voting rights; the National Council is the supreme governing body of the Guild, elected by its members (the fact that the National Council has a different name from the Guild should be a big honking clue, even for those who haven’t looked at the rules, that it’s a different thing from the Guild).

  20. True story from a law firm I used to work at:

    One day a letter came in from an eccentric and elderly client. The handwriting was unintelligible and several people were trying to decipher it without any luck.

    I took a copy across the road to the pharmacy and asked the pharmacist to read it for me while I transcribed it. Worked a charm!

    The ability to read scribble is obviously a worthwhile talent, but that doesn’t justify the closed shop they run.

    Also, when I was a kid the local “Chemist” sold clove cigarettes. I suppose it was considered a healthy alternative to tobacco – plus it wasn’t regulated or taxed the same way.

  21. I rather like the fact that the Pharmacy Guild call themselves a guild. It is quaintly accurate.

    Guild – an association of people with similar interests or pursuits; especially : a medieval association of merchants or craftsmen. – Merriam-Webster.

    “The continental system of guilds and merchants arrived in England after the Norman Conquest, with incorporated societies of merchants in each town or city holding exclusive rights of doing business there.” – Wikipedia.

    We see that the pharmacists retain the medieval notion that they ought to hold exclusive rights to do business in a given craft in a given area without regard for other community needs. Nevertheless, this discussion is modified by some of the issues Ivor and I mentioned. The rights of the guild or cooperative ought not be predominating. Rather, they should be balanced with those of all other stakeholders.

  22. I’m old enough to remember the Hawke government trying to get rid of the exemptions for pharmacies under the Trade Practices Act. The campaign was vicious (pharmacists accompanying prescriptions for little old ladies with horror stories) and effective – Hawke backed down, much to the disgust of his Treasurer (maybe one reason for his jibe that Hawke was “a shiver looking for a spine to run up”).

    But then a couple of years earlier Fraser had tried to take on the newsagents, with a similar sequence of events. At least Fraser had the excuse for his backdown that his National coalition partners wouldn’t cop it (for the same reasons that no coalition government will take on the pharmacists ).

  23. @derrida derider

    The current government has a report in their in-trays from Ian Harper recommending they take on the pharmacists. Whaddya reckon the chances are they do it?

  24. I respect your right to your opinion regarding homeopathy (and clearly you are not alone). However I am concerned that you may have arrived at a strongly held opinion without being in full possession of the ‘facts’ (ie. background to the debate). To this end I refer you to the media release from the Australian Homeopathic Association addressed to the NHMRC (see link below). I acknowledge they obviously have a barrow to push (& we already live in a society drowning in ‘spin’), however I believe it is worth reading the letter.

    Click to access Open_response_letter_by_AHA_to_NHMRC.pdf

  25. The case is;

    1,800 Studies Later, Scientists Conclude Homeopathy Doesn’t Work

    Either your view of the physical world is informed by adherence to science or it is misinformed by adherence to magic. What other magical remedies and systems of magic should we admit to modern medicine? That’s a rhetorical question.

    Alternative remedies or folk remedies are sometimes found to have a basis in empirical fact. A clear set of cases involves traditional use of plants with medicinal or drug qualities (useful pharmacological properties). There are also biochemical reasons for certain pain reduction effects of acupuncture though it has to be said that the wider curative claims for acupuncture do not stack up.

    Homeopathy is based on magical thinking.

    “Edward Burnett Tylor coined the term “associative thinking”, characterizing it as pre-logical, in which the “magician’s folly” is in mistaking an ideal connection with a real one. The magician believes that thematically linked items can influence one another by virtue of their similarity.[5] For example, in E. E. Evans-Pritchard’s account, amongst the Azande[6] tribe members rub crocodile teeth on banana plants to invoke a fruitful crop. Because crocodile teeth are curved (like bananas) and grow back if they fall out, the Azande observe this similarity and want to impart this capacity of regeneration to their bananas. To them, the rubbing constitutes a means of transference.

    Sir James Frazer later elaborated upon this principle by dividing magic into the categories of sympathetic and contagious magic. The latter is based upon the law of contagion or contact, in which two things that were once connected retain this link and have the ability to affect their supposedly related objects, such as harming a person by harming a lock of his hair. Sympathetic magic and homeopathy operate upon the premise that “like affects like”, or that one can impart characteristics of one object to a similar object. Frazer believed that these individuals think the entire world functions according to these mimetic, or homeopathic, principles.[7] – Wikipedia

    It is worth reading the entire Wikipedia entry on Homeopathy. Here is a quote of the opening paragraphs;

    “Homeopathy (Listeni/?ho?mi??p??i/; also spelled homoeopathy; from the Greek: ?????? hómoios, “-like” and ????? páthos, “suffering”) is a form of alternative medicine created in 1796 by Samuel Hahnemann based on his doctrine of like cures like (similia similibus curentur), whereby a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people.[1] Homeopathy is pseudoscience.[2][3][4][5] It is not effective for any condition, and no homeopathic remedy has been proven to be more effective than placebo.[6][7][8]

    Hahnemann believed the underlying causes of disease were phenomena that he termed miasms, and that homeopathic remedies addressed these. The remedies are prepared using a process of homeopathic dilution, which involves repeatedly diluting a chosen substance in alcohol or distilled water, followed by forceful striking on an elastic body.[9] Dilution usually continues well past the point where no molecules of the original substance remain.[10] Homeopaths select remedies by consulting reference books known as repertories, and by considering the totality of the patient’s symptoms, personal traits, physical and psychological state, and life history.[11]

    Homeopathy lacks biological plausibility,[12] and its axioms are contradicted by scientific facts.[13] The postulated mechanisms of action of homeopathic remedies are both scientifically implausible[7][14] and physically impossible.[15] Although some clinical trials produce positive results,[16][17] systematic reviews reveal that this is because of chance, flawed research methods, and reporting bias. Continued homeopathic practice, despite the evidence that it does not work, has been criticized as unethical because it discourages the use of effective treatments,[18] with the World Health Organisation warning against using homeopathy to try to treat severe diseases such as HIV and malaria.[19] The continued practice of homeopathy, despite a lack of evidence of efficacy,[6][7][20] has led to it being characterized within the scientific and medical communities as nonsense,[21] quackery,[4][22][23] and a sham.[24]”

    It is very clear that the acceptance of scientific principles and the acceptance of homeopathic principles are incompatible. You must either accept science or accept magic.

  26. @derrida derider

    Paul Keating used the description ‘a shiver waiting for a spine to crawl up’ of John Howard. He used the description ‘Old Jellyback’ of Bob Hawke.

  27. In Britain, the big supermarket chains have won the battle to have in-store pharmacies. The sky has not fallen in. France and Spain don’t have them. I don’t know about other European countries.
    Homeopathic remedies and vitamins are essentially placebos. (It is possible to injure yourself with vitamins, but you have to take a lot.) But placebos are known to work for many minor ailments. What is the moral basis for denying people access to them?

  28. @James Wimberley WIMBERLEY

    But placebos are known to work for many minor ailments.

    You’re assuming that the placebo effect is a real effect, rather than a statistical artifact.
    More obviously, the problems with marketing a placebo to consumers using false claims that it is an effective treatment for real medical conditions are that (a) this may lead to consumers foregoing effective treatment in favour of placebos for conditions that do not resolve themselves, causing harm to their health; and (b) misleading and deceptive marketing is unethical and, arguably, illegal.

  29. @Tim Macknay
    “You’re assuming that the placebo effect is a real effect, rather than a statistical artifact.”

    Yes, I am. This is not controversial. WebMD for instance:

    There are some conditions in which a placebo can produce results even when people know they are taking a placebo. Studies show that placebos can have an effect on conditions such as: depression, pain, sleep disorders, irritable bowel syndrome, menopause.

  30. @David C

    Best comment in the comments thread of that video:

    “I only watched a billionth of a nanosecond of this video, and now I believe in homeopathy.”

  31. If – ‘Unsurprisingly, research has proved beyond any doubt that it’s [homeopathy is] no better than a placebo.’ ,then homeopathy could be useful given the great power of placebo. It seems that anti-depressants and many other medications ,and some surgical procedures, may be no better than placebo too. (I am pointing out the status of placebo, not making an argument for homeopathy or against anti-depressants and surgery !).

  32. @sunshine

    I quite like the idea. For example, research shows that people in Perth who barrack for Freo or the Eagles are happier than people who don’t care for the footy. So just develop a belief in either team, and you’ll be happier. No logic to it, other than that it works.

    But as for placebo and anti-depressants being equivalent, I don’t believe it.

  33. @John Brookes
    “But as for placebo and anti-depressants being equivalent, I don’t believe it.”
    Unfortunately, there is evidence that for mild depression, they are. Brown W.A., Neuropsychopharmacology, 1994 Jul;10(4):265-9:

    . … among less severely depressed patients and those with a relatively short episode duration the placebo response rate is close to 50% and often indistinguishable from the response rate to antidepressants.

    This is a real issue. You can’t snigger it away.

  34. @John Brookes
    There’s been quite a lot of research (review of clinical trials) on this that suggests anti- depressants aren’t all that much better than placebos. I’m not going to search for it now but if you’re interested you can probably do so. This is one of the reasons why all clinical trials are now supposed to be registered and available, because of problems like selective publication.

  35. @John Brookes

    “research shows that people in Perth who barrack for Freo or the Eagles are happier than people who don’t care for the footy. So just develop a belief in either team, and you’ll be happier. No logic to it, other than that it works.”

    If that phenomenon were properly analysed in psychological and sociological terms (including political economy terms) I suggest that logical reasons could be found for it. Possibilities include;

    1. One might hypothesise the “Happy fool effect” which can also be called the “Sad Socrates effect”. In a nutshell, this hypothesis suggests that people who think more deeply are sadder. John Stuart Mill once argued, “It is better to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied.”

    The ancients noted it. “For in much wisdom is much grief: and he that increaseth knowledge increaseth sorrow.” – Ecclesiastes 1:18.

    That last quote has to taken in context. Ecclesiastes expounds that wisdom and foolishness both lead to grief; that futility attends all human efforts and there is finally no effective difference between the paths of wisdom and foolishness. This is while its reasoning remains on an effectively human and material plane and before its (rather conventional and unconvincing) introduction of “God” at the end to resolve its philosophical quandries. Talk about Deus ex machina. 😉

    People who are unintelligent enough or misled enough to believe that outcomes in elite sport really matter are likely to be “happy fools”. Most of us at some stage(s) in our development have been such happy fools. It’s difficult to escape this kind of enculteration until you become more society-critical and more self-critical.

    2. Consumer capitalism in a sense rewards those who consume un-reflectively. They feel validated (doing what everyone else does as directed by the moral entrepreneurs of capitalism and of ” tribalism”) and they are not shunned by their peers. This shunning is very real. If you don’t share the obsessions of a class or clique and if you express disinterest, reservations or criticisms about the obsessions you will be rapidly shunned and expelled. Those who don’t share the obsessions of their class are socially excluded. Exclusion tends to make people unhappy.

    So you can see, there are certainly logical reasons for the finding.

  36. @Val

    Everyone should follow the rule of taking as few drugs as possible. The key thing to avoid is being on multiple drug courses. I take absolutely nothing recreational except coffee and nothing medicinal except a rare paracetamol (maybe 6 per year at most) and rare course of antibiotics if necessary (less than one course a year on average).

    Maybe I am lucky to some extent not needing constant medication of any kind at 60. However, if you get on the pharmacological merry-go-round your health will rapidly get worse and worse in most cases. There is plenty of evidence that painkillers, anti-depressants, blood pressure medications and arthritis medications (especially in combination) will all seriously mess up your physiology long-term. I actually believe all these medications now cause more damage than they prevent on a population wide basis though of course they do help some individuals when used “strictly in accordance” etc. etc.

    In many cases, people would get better results with a no-drug regimen combined with weight-loss, exercise, proper food, proper sleep etc.

  37. @J-D
    Hi J-D,
    A couple of points made in the paper are:
    The author discusses a number of reasons that homeopathy does not generally lend itself to RCT’s. This is because there is generally not a 1:1 causality (eg. flucloxacillin kills golden staph). There are other methodologies that are more effective in examining the efficacy of homeopathy, these are briefly discussed in the paper. Unfortunately the NHMRC chose not to include these (see paper for more details).
    Also, the NHMRC chose to base it’s conclusions on the UK Committee findings, but ignored the finding of the Swiss Govt research which arrived at very different conclusions. I suggest that if one committee finds homeopathy to be effective and the other finds it to be ineffective, then it is presumptive to say that ‘research has proved beyond any doubt that it’s no better than a placebo.’
    Finally, I would just like to say that I do not want to enter into a debate, as that is a waste of everybody’s time. I respect your right to disagree with my opinion.

  38. @Jed

    I interpret ‘This is because there is generally not a 1:1 causality (eg flucloxacillin kills golden staph)’ to mean ‘This because it doesn’t work (eg homeopathy does not kill golden staph)’.

    The Swiss government commissioned homeopaths to report on whether homeopathy works. It should come as no surprise that homeopaths report that homeopathy works.

  39. @J-D
    I was unaware that the Swiss Govt commissioned homeopath’s for the investigation. If that is true then you make a fair point. It is also apparently true to say that the study NHMRC based its conclusions on included anti-homeopathy lobby groups, but refused inclusion of homeopaths. This is also pretty poor.
    Regarding your interpretation of 1:1 causality: This is understandable, however I should point out that this highlights a lack of understanding of homeopathy. (Very briefly; there are any number of homeopathic medicines that may treat a golden staph infection, and it depends upon the individual’s somewhat unique response to the infection. So there may be any one of (eg.)50 medicines that would be effective in any given circumstance, and it is the job of the homeopath to work out which one. It is difficult to adequately explain this and I don’t expect to accept this, but I offer it anyway.)

  40. @Jed

    The efficacy of a treatment on a subset of the population is just as much testable by randomised controlled trials as efficacy with all patients. ‘It only works with some individuals’ is not a reason why it can’t be the subject of randomised controlled trials.

  41. @James Wimberley

    About 10 years ago I was depressed, and went on SSRI’s. Maybe it was just a placebo effect, but after 3 weeks I felt better. I noticed two specific improvements. Firstly I did not get upset as easily. Secondly, the confusion I had felt driving through even simple intersections was gone. I also noticed some changes in the, ahem, functionality below the waist. This was not welcome, but perhaps that too was a placebo effect? Luckily that bit was only temporary.

    I dare say that on some officially approved scale by which depression is measured, a placebo would have done just as well, but not, I think, in terms of real life functioning. And of course there is no guarantee that others would feel the benefits I felt.

    Anyway, I am now giving them up, not for really any other reason than I want to see how I go without them. Curiosity if you will. The withdrawal effects of the one I’m on are pretty mild, but definitely interesting, and today is a week since my last small dose. And while I feel fine, I do already notice that I get angrier at people more easily. The driving still seems fine though.

    I’m usually very keen on careful scientific studies, but on this one I will trust my experience.

  42. @James Wimberley

    Yes, I am. This is not controversial.

    I don’t think it’s that simple. Obviously there is a well-established phenomenon observed in controlled studies that generally goes by the name “the placebo effect”.

    It’s also true that there’s a widespread belief (including, apparently, among many health professionals) that the “placebo effect” is some kind of actual therapeutic effect that arises from taking placebo medicine. But from what I’ve read of the medical research, it is far from clear that the latter belief is justified. There is an increasing body of research which suggests that this idea of the “placebo effect” is based on mistaken assumptions by early researchers, and which casts doubt on the proposition that any genuine therapeutic “placebo effect” exists.

    The WEBMD article you refer to contains some examples that illustrate some of the problems with the concept. For example, compare two of the studies mentioned in that article.

    One involved asthma sufferers and found that patients given placebo reported subjectively feeling better, but physiological testing did not reveal any improvement in respiration compared with no treatment. In another, subjects were given placebo while being told they were receiving either stimulants or sedatives. The subjects showed identifiable (non-therapeutic) physiological changes which varied depending on what they had been told. How does it make sense for the results of these two studies to be lumped together as illustrating the same effect? Aside from the superficial fact that both studies involved the use of placebos, they are entirely different.

    The first example also pretty clearly shows the ethical problems with selling placebos as over-the-counter medicines. Asthma patients using the placebo medicine from that study (assuming they responded in the same way as the patients in the study) would be likely to subjectively feel better, but without any genuine improvement in their risk of asthma attacks. In effect, they would be given a false sense of security, which is dangerous.

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