Homeopathy

TRC Editor, Dr. Lori Dickerson, PharmD, FCCP talks with Chelsey McIntyre, PharmD, Managing Editor of TRC’s Natural Medicines about homeopathy.

She’ll help clear up confusion about what homeopathic products are...and aren’t...and how they compare to supplements. 

You’ll also hear practical advice from panelists on TRC’s Editorial Advisory Board:

• Reid B. Blackwelder, MD, FAAFP, Associate Dean of Graduate and Continuing Medical Education at East Tennessee State University
• Andrea Darby-Stewart, MD, Associate Director, Family Medicine Residency at Honor Health
• Douglas S. Paauw, MD, MACP, Professor of Medicine at the University of Washington School of Medicine
• Joseph Scherger, MD, MPH, Family Physician, Primary Care 365, Eisenhower Health

None of the speakers, panelists, or staff you’ll hear in this episode have anything to disclose. 

Pharmacist’s Letter offers CE credit for this podcast. Log in to your Pharmacist’s Letter account and look for the title of this podcast in the list of available CE courses.

Email us: ContactUs@trchealthcare.com.

The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Medication Talk is a production of TRC Healthcare.

Find the show on YouTube by searching for ‘TRC Healthcare’ or clicking here.

Learn more about our product offerings at trchealthcare.com.

Transcript

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Narrator 0:05

Welcome to Medication Talk, the official podcast of TRC Healthcare, Homopharmacist Letter, Prescribers Letter, RX Advanced, and the most trusted clinical resources. On today's episode, we'll be delving into the alternative medicine practice of homeopathy. We'll get the insight scoop from Dr. Chelsea McIntyre of TRC's Natural Medicines, a clinical reference database focused on natural products and alternative therapies. She'll help clear up confusion about what homeopathic products are and aren't, and how they compare to supplements. You'll also hear practical advice from panelists on TRC's Editorial Advisory Board, Dr. Reed Blackwelder from East Tennessee State University, Dr. Andrea Darby Stewart from Honor Health, Dr. Douglas Powell of the University of Washington School of Medicine, and Dr. Joseph Schurger from Eisenhower Health. This podcast is an extract from TRC's Emerging Recommendations Panel webinar. Each month, a panel of experts and frontline providers discuss current medication therapy topics and suggest practical recommendations to include in TRC's letter articles for practicing clinicians. The webinar originally aired on March 21, 2022. Pharmacist Letter offers CE credit for this podcast. Please log into your Pharmacist Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers, panelists, or staff you'll hear today have anything to disclose. With that, let's join TRC editor, Dr. Lori Dickerson, and start a discussion.

Lori Dickerson 1:40

We're writing about this now because patients often don't realize some products on OTC shelves are homeopathic: ArnicaCare, Oslocoinum, semilosan, earache relief, etc. Can you get us started, Chelsea, by explaining to us what is homeopathy and what is this theory based upon?

Chelsey McIntyre 1:58

Yeah, so I think it's important to start out by reminding everyone that homeopathy is actually in its own entire system of medicine. So it operates off of its own theories and principles. And this can often be forgotten since it's so easy to find homeopathic products in the drugstore now. But the main principle of homeopathy is that like cures like. And this means that a symptom can be treated by a substance that causes the same symptom. So a fever might be treated by a botanical extract that can also cause fevers, or a fungal infection might be treated by that same fungus. However, that substance would be provided in a highly dilute form, which leads us to water memory, another important principle of homeopathy. And water memory means that as serial dilutions are conducted to produce the final product, and the product is shaken vigorously during those dilutions, the water in the mixture actually remembers the image or essence of the original active molecule. And that's why homeopathic products are typically diluted down to the point that no active substance actually remains in the finished product. There's also a principle called the law of infinitismals, which suggests that increasing levels of dilution are considered to yield a more potent final product.

Lori Dickerson 3:20

It's fascinating the background that you've shared with us, Chelsea. Now, um, Reed, I'm just curious in your practice, do your patients often ask you about homeopathic treatments or how uh how do you discover that they might be using them?

Reid B. Blackwelder 3:34

Well, yes. I think one of the things we know very clearly is that a significant number of patients will use things that are not routinely prescribed by physicians. And so the key here to figure out what your patients are doing is being non-judgmental and asking things like what over-the-counter or folk remedies. Um, and that'll usually uncover a patient's use. And then one of the next things I do is to ask, well, what have they heard about it or what are they using to uh evaluate um these different approaches? And then it can be a very interesting discussion because often patients who are using these substances have found things on the internet or the web or god knows where that are very uh compelling. Um, and so it's a really challenging discussion to make sure you keep the communication lines open without demeaning something that they may feel is helping them. Um and it takes some time to do.

Lori Dickerson 4:33

You know, Chelsea, I think consumers often think of homeopathic products as supplements and get those mixed up, and I think that's part of where you were going too, Reeb, with your background. And so, Chelsea, I'm wondering, can you address this misconception about homeopathic products being, quote, the same as a supplement? And explain how the homeopathic products are regulated by the FDA and how that's different.

Chelsey McIntyre 5:01

Sure. So per the US government, um, homeopathic products are not considered dietary supplements. Dietary supplements are regulated under an entirely different pathway, which means that any of the rules we associate with supplements do not apply to homeopathic products. Although I will pause for a moment and point out one thing that these products do share is that neither of them must prove safety or efficacy before coming to market. But after that point, the regulations kind of split off in different directions. So with homeopathy specifically, the FDA has taken a very hands-off approach to oversight. The legislation governing homeopathic products basically states that as long as an ingredient is listed in the homeopathic pharmacopoe of the US, which is sometimes referred to as HPUS, it is considered a homeopathic drug that can be included in products. But an important note here is that the homeopathic pharmacopoeia is not created, maintained, or reviewed by the FDA. So the FDA is basically saying that they're okay with the use of any ingredients found in that reference, but that they haven't actually confirmed the accuracy of the information in that reference.

Lori Dickerson 6:14

It's fascinating. And, you know, Doug, I'd love to hear from you. Um, you know, what are your thoughts on your patients using these products given uh this background that Chelsea's just given us, and that I'm sure you know you faced before in discussions with patients.

Douglas S. Paauw 6:29

Oh, yeah, we have a lot of patients that are very interested in in alternative treatments. And and I have been encouraging homeopathic approaches, but I think as mentioned, which was so important, was brought up as you know, we have to I hear my patients out like tell me tell me why why you know you think this would be a good option. Most of it is because they had a neighbor or a friend that has had success. Um, and so you know, and we talk about it, and I I try to share, you know, my approach of wanting to offer something that I know has benefit and you know trying to be sure that whatever is done is not harmful. But I I clearly think the most important thing is listening first because the approach of we don't do that here really just I think encourages encourages patients to go full you know full force into something.

Lori Dickerson 7:23

That's great perspective, Doug. I appreciate that. And Joe, I'm just curious in your practice too, is this something that you face, you know, answering questions about and patients asking your opinion on homeopathic products?

Joseph Scherger 7:36

Well, yes, it it is quite common. I don't prescribe or recommend homeopathic products, uh, and I am not bashful to say that I think they're a placebo effect, which can be very strong. I I think the fact that people get attached to these products is a good sign that placebos uh often work, and uh and they're about the most harmless placebos that you could ever consider because of the dilution of the of the chemicals. So I I consider using them, or I don't really use them, but I consider their role in my practice as a manifestation of a placebo effect.

Lori Dickerson 8:17

Okay, that's a great perspective, Joe. We're gonna I want to come back to that um in in a little bit. But you know, Chelsea, let's get back to how these products are labeled and understand a little bit more of what we're gonna see when we look at the box. And and so they all have these levels of um dilution, uh, one times, 30 times, etc. And um what do those, I guess, I guess it makes sense what those levels of dilution mean, but I guess why are some of them labeled, I think, with X's and some with C's? And what is what does that all mean?

Chelsey McIntyre 8:51

Yeah, so X and C are the two most common dilution factors in homeopathy, and you kind of have that described here in the slide. Um X on its own indicates a one in ten dilution, whereas C on its own indicates a one in one hundred dilution. And then when there's a number coming in front of X or C, it indicates a dilution factor. So in the case of 3x here, it would mean that a product was diluted one in 10 three consecutive times. So when you get up to numbers of like 30 or 100, you can imagine how dilute those products are in the end.

Lori Dickerson 9:30

And you had mentioned to uh us, Chelsea, in the preparation of this article that homeopathics have a drug fax label, a quote, drug fax label, which looks very similar to OTC med labels instead of a quote supplement fax label, which looks quite different. And that seems sort of misleading to me. And I'm wondering if um you know that's a sub uh a source of confusion.

Chelsey McIntyre 9:56

I would think it is a source of confusion. I think it kind of um falsely implies that homeopathic products are on the same level as OTC drugs, which is very clearly not the case. Um, so I do think it's a bit uh confusing for consumers to see that drug fax panel with homeopathic products.

Lori Dickerson 10:13

Okay. Now we have an audience question coming in, and Andrea, I wanted your take on this one. This is a uh a pharmacist saying we have patients who coming in who want to use a quote, natural approach and use a homeopathic product instead of something that uh the doctor has prescribed. And so I guess I'm wondering when patients come to you uh and you know don't want to take what you're or aren't just in favor of what you want to prescribe, how how do you uh discuss this with those patients?

Andrea Darby-Stewart 10:43

Yeah, I think that's a a great question, and I and I love the um kind of and I I'm hoping Joe will jump into this as well. You know, there are so many things that we can do and recommend that are very natural, that allow people to have, you know, focus on better dietary uh changes that may support their goals for health, looking at their sleep patterns, looking at their levels of stress and mindfulness. And there are many things that we can do that are very natural that don't involve writing a prescription. Um, and so I generally try and explore why my patient wants a pill for something, because that's essentially right, there's a tincture, there's a pill, there's something you're going to take to make this better, um, as opposed to um completing an action or what are the barriers to completing an action that might be more beneficial to them in the long run. And so that that those I just I try and meet people where they are and try and figure out what their motivation is for this. One, where does their distrust from allopathic medicine come from and how can we get past that? But also where are they in terms of understanding natural versus non-allopathic? Because I think that they're misunderstanding homeopathic products as natural when they're just a different pill for tincture to take.

Lori Dickerson 12:13

And Joe, I think this is where your point came in about the placebo effect. And actually, we have that term in our article, and we say explain that many homeopathic products contain little to no active ingredients, so patients are often paying for a placebo. And I think that's um not necessarily a bad thing if you're talking about symptom management as opposed to sort of treatment of hypertension and improvement of outcomes. And, you know, Chelsea, I want to come back to you here on this statement. Um, actually, just above this in the article, we say tell patients not to rely on homeopathic products and never to use them instead of proven options. There's no good evidence that any homeopathic helps treat or prevent specific conditions. And so I just want to ensure that you agree with that statement that this is the case, that there's no evidence for these agents.

Chelsey McIntyre 13:01

Yeah, I do agree with this statement. Um, as you've already discussed, you know, homeopathic products for the most part are intended not to include any active ingredient. Um, so we would expect nothing more than a placebo effect. And thus far in the research, that's really what's been shown. So the the biggest danger that we'd be concerned about is use of these products in place of something that has been proven to work.

Lori Dickerson 13:23

Okay, very good.

Andrea Darby-Stewart 13:25

Yes, can I guess I'm a little worried about using the word never. I think never is a conversation stopper. Um, and while we definitely don't think people should use this, um that's I mean, I'm not sure I would say never use these because basically what people are gonna do is they're gonna use whatever they want and they're not gonna tell me about it. Um, or they're gonna leave and they're not gonna explore other options with me, um, or they're gonna stop telling me about some of the other things that they're taking that actually could have some bad side effects that I really want to know about. So I I guess I would I would just be cautious using that language.

Lori Dickerson 14:03

And I think we might want to soften that, Andrea, to say, you know, not to use them instead of proven options, or to not favor them over proven options. Maybe that would be uh a softer language. Again, we're talking about, you know, if someone has diabetes, we don't want someone to do this as opposed to their metformin, I think is where we're going there. Right. Yeah. For for outcome-based treatments, but maybe not for symptom-based conditions. Do you sort of see that differentiation?

Andrea Darby-Stewart 14:31

Does that work? It does. And you know, and the honestly, the pragmatic approach is would I if somebody's got arthritis and they think their homeopathic salve or something is working for them, are they at higher risk from the homeopathic product or from the NSAID that they've been chronically taking that's tanking their kidneys and giving them an ulcer? Like I think there's some balance here that we need to acknowledge that we cause harm too.

Lori Dickerson 14:54

Very good. Great practical discussion, and I'm so glad we we dug into that. And uh, so I do want to talk about some specifics now, um, Chelsea, and and uh so Oslo Coconum, it's interesting. We make the point that it's being touted for flu-like symptoms in our article. Um, and but the final product typically contains no measurable amount of any of the components. So, um, how did this product end up with something as something that would be touted for flu?

Chelsey McIntyre 15:22

Um, this is just a traditional homeopathic product, and it you're right, the labeling all says that it can reduce or shorten the duration of flu symptoms, and it's very widely available around flu season. Um, it's definitely an interesting one since it comes from an animal. Um, we typically see homeopathic products that come from botanical ingredients, but this is made from the heart and liver of duck, even though there is none remaining in the final dilution. This one is labeled to have a dilution of 200 C, which means it's diluted one to 100, 200 consecutive times, which is obviously quite dilute.

Lori Dickerson 15:58

And um, we also talk in our article uh about more popular products that contain zinc as homeopathic, like Caldees and Zycam. I think most of us would have thought of zinc as a supplement as opposed to a homeopathic agent. So I'm curious about you know why it's labeled as a homeopathic product as opposed to, you know, being labeled as a supplement.

Chelsey McIntyre 16:24

Yes, so there is a pretty significant reason that it could be advantageous for a manufacturer to market a product as homeopathic rather than as a supplement, even if the product does contain a measurable quantity of that ingredient. And that is the fact that homeopathic products can technically make health claims. Dietary supplements, on the other hand, are not permitted to do so. So coldease and zycam can claim to shorten the duration of cold symptoms, and there is no really repercussion for them doing that. So that's one of the reasons this is a bit of a loophole for manufacturers if they would prefer to market homeopathic.

Lori Dickerson 17:04

And uh, Andrea, I'm just curious if you've encountered this thought about Caldease and Zycam and zinc products being homeopathic versus supplements. And, you know, do you see that that is a loophole that's being used to sort of introduce um uh efficacy claims?

Andrea Darby-Stewart 17:21

Well, it sounds like a loophole. Um I just know my patients feel like that's what they turn to and that that's the thing that's gotten them through flu and COVID and everything else. And yes. You know, it's it's honestly it's hard to do anything other than nod and smile because I'm not gonna convince them otherwise.

Lori Dickerson 17:40

Yeah, and it doesn't seem harmful, uh, you know, and and many of these are not harmful. You did ask a question though, Andrea, uh, about um some of these are any of these products harmful specifically? And and uh you had a question about the Highlands um teething tabs, and so maybe you can pose that to Chelsea for us.

Andrea Darby-Stewart 18:00

Yeah, no, I several years ago, Highlands um got into trouble with their teething tabs. I think they had some Belladona um products that were in them, obviously something we don't want to give to kids when they're teething that was actually detectable. And are there are there any other products or manufacturers that um have been recently recalled or that we should be aware of? Is there a buyer beware list that we can give to our patients who truly want to use these products?

Chelsey McIntyre 18:28

Yeah, that was that is a great question. Um, the Belladonna, the teething tablets that had belladonna in them was like a very significant cause for concern when that was happening. And it went on for about six or seven years before the product was finally pulled from the market, which is obviously incredibly concerning. Um, I think it also raises uh an issue that some people might not be aware of, which is that because of the like treats like um principle in homeopathy, many of these products are actually developed with the use of toxic ingredients. So a product containing something like belladonna is not at all unusual. It's just supposed to be diluted out of the product, which would not present a safety concern if it's appropriately diluted. In the case of Highlands, they did not appropriately dilute. And the analysis of different lots of the product actually found that the scopolamine content, because belladonna contains scopolamine and atropine, varied up to 4,000-fold between lots. Um, so manufacturing practices are incredibly important for homeopathic products. I'm not aware of any major recalls since the teething tablets that we are all familiar with. I do know that there have been a handful of recalls over the years because homeopathic products contain allergens. There was one at one point in time that contained penicillin in quantities large enough to stimulate a reaction for people with an allergy. But I don't know about buyer beware list, and I don't actually know that we've seen a lot of recalls on these products.

Lori Dickerson 20:01

Reed, you have been chatting in some points to me too, so I wondered if you want to share those with us also.

Reid B. Blackwelder 20:08

Well, some of these are my usual editorials, and some of it I understand is the way we just phrase things. But anytime you tell patients anything is pretty paternalistic. And in a challenging discussion, that ain't gonna work, as uh Andrea and others have said. We also have to recognize that we've we're calling homeopathics placebo, and yet evidence-based medicine already accounts for uh placebo as being a very real effect. So, in some ways, homeopathics have some evidence, which should help us feel a little bit okay if a patient's truly gonna use something. It's it's probably safer rather than risky because this is really a difficult conversation. Um, one of the things I also mentioned is that we we call this alternative, and yet it's not really alternative because patients who are seeing us are using or respecting us enough to or trusting us enough to listen to what we have to say. So we have some opportunities if we don't know it to really gauge patients because this is people doing true alternative medicine do not see us. So whether you call it integrative or whatever you want to call it, I think it's a tremendous opportunity to try to help talk through things as long as we're open and and aware. We've got to be very careful about being defensive. The last comment I made is you know, like cures like we go, yeah, yeah, that makes sure, whatever, homeopathy. Well, our anti-arrhythmics cause dysrhythmias. Um just one of those things we have to be aware of that we're not we're we don't have all the knowledge. Um I just think it's a it's a tremendous opportunity, yet frustrating, to have conversations with patients about these substances.

Narrator 21:51

We hope you have enjoyed and gained practical insights from listening into this discussion. Now that you've listened, you can receive CE credit from Pharmacist Letter. Just log into your Pharmacist Letter account and look for the title of this podcast in the list of available CE courses. If you're not yet a Pharmacist Letter subscriber, find out more about our product offerings at trchealthcare.com. Be sure to follow or subscribe, rate, and review this show in your favorite podcast app. It helps spread the word about our show and is a great way for you to let us know how we're doing. You can also reach out to provide feedback or make suggestions by emailing us at contact us at trchealthcare dot com. Thanks for listening to the Medication Talk Podcast.