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IF you visit most Australian pharmacies these days you are likely to be confronted by a slough of highly suspect supplements and therapies.
From detoxing to fat burning to immune boosting, it appears that no claim is too outlandish to be chanced upon a credulous public. That our government regulators and pharmacy bodies have been sitting quietly on their hands over this is unfortunate and distressing.
Recently the NHMRC published a draft information paper of the evidence on homeopathy, finding that it cannot be proven to be more effective than placebo. Submissions on the review closed last week.
While homeopaths are likely to dismiss the findings of the review, we supporters of science in medicine should only regret that it was necessary for this august body to expend time, energy and funding to lay to rest a pseudoscience which had had no basis for plausibility.
So why do pharmacies sell homeopathic medicines?
First, there are a (very) few pharmacists who have training in homeopathy, specialise in it, or are convinced by its claims.
I have no problem with allowing anyone their delusion of choice, as long as it is an informed choice. However, these pharmacists should separate their homeopathic practices from their jobs in community pharmacy.
Second, there have been major changes in the retail management of pharmacies in the past 20 years or so. Previously, most pharmacies had been independent businesses, albeit sometimes branded with the logo of a marketing group.
Recent years have seen a rise in retail management, which means more emphasis on discounting, advertising, online sales and closer ties to major brands. With this change, many pharmacies have introduced the retail manager, an expert in business, retailing and merchandising, whose role is to run the “front of shop”, leaving qualified pharmacists free — in theory — to concentrate on their professional duties.
In practice, these arrangements appear to have resulted in pharmacies stocking their shelves with anything that sells. And therein lies a challenge to the profession.
As an independent pharmacist proprietor, I do not stock homeopathic medicines, diet pills or ear candles. I am free to recommend therapies where I am convinced of an evidence base.
However, were I an employee pharmacist in a discount chain, would I have the same opportunity to exercise my professional discretion and conscience? Or would I be encouraged to companion sell and recommend the chain’s favoured brands? Could I tell the truth and expect to keep my job?
An answer might lie in the recent newsletter from the Pharmacy Board of Australia, which warns: “Action by non-pharmacists (such as managerial staff) which impinges on the ability of pharmacists to meet their legal and ethical responsibilities may be subject to action under the Health Practitioner Regulation National Law”.
Another category of pharmacist which allows for the profusion of nonsense products is the uninvolved pharmacist, who sees no need to interfere with what goes on in the front of shop. Staff training is handed over to any company that offers it, with no oversight of quality or ethics.
Given the multimillion dollar advertising by vitamin and supplement companies, the exponential growth of complementary and alternative medicines and folk cures, and the extreme level of science and health illiteracy in the populace, this laissez faire approach is not acceptable.
Pharmacists are well placed to be at the forefront of science-based medicine, trained and ready to counsel, explain and teach our clients, and help give them informed control of their health.
My call to fellow pharmacists is stop being seen as tarrying with the dark art of homeopathy. Let’s declare our intention to treat our patients based on the best evidence, and honesty.
Mr Ian Carr has been a community pharmacist for 35 years. He is a supporter of evidence-based medicine and is a member of Friends of Science in Medicine. His pharmacy does not sell homeopathy, detox regimens or fat burners.
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Quite funny seeing some of the outrage. Personally when I go into a pharmacy I see the pharmacist to get a script filled. I also can talk to him about the drug. I don’t give a tinkers about what other stuff might be on the shelves. I know he is professional. I know I will get accurate advice and info from him. What others go in for is their business and if they wish to waste their money on these false medicines then that is their concern. Chemist shops sell this stuff because people want it and the chemist wants to remain in business. Also by selling these products in a pharmacy where there is a possibility of the customer being persueded to change their mind by getting advice from a health professional. No hope for that happening in a supermarket.
Correction: Sue Ieraci is not, and has never been, a member of Australian Skeptics. Thankfully, Europe is gradually moving away from homeopathy, as evidence-based medicine takes greater hold. It’s true that many people are satisfied with relatively harmless placebo – except for those who avoided effective treatment and have suffered or died. Huge numbers of people world-wide, and for a long time, have continued to read their horoscope or wear amulets against the evil eye. The duration or popularity of a belief does not make it valid.
Sue Ieraci’s time would be better spent studying cured clinical cases and actually communicating with some MD Homeopaths (54,000 in Europe alone) than posting unsubstantiated rumors/opinions about a field clearly outside her expertise. Being a member of Australian Skeptics does not improve her case, in fact it seriously shows a lack of judgment.
The public needs protection from the hundreds of thousands of incidents of emergency hospitalizations from adverse drug reactions and preventable deaths. Homeopathy consumers are in the upper income and educational brackets and use it because pharma treatments have failed or carry too high a risk. They are not asking for, neither do they need a Skepti-Nanny boyscout interfering with their choices.
In fact, it’s not the patients who are complaining at all. They’re offering nothing but positive feedback with an over 70% rate of satisfaction.
In Mr Carr’s opening ‘cannot be proven’ is an incorrect choice of word. The reality was that although half of the RCT’s in the review demonstrated that homeopathy was effective with a p value less than 0.05, the quality and /or size of the most of the studies was insufficient to satisfy the NHMRC of the efficacy in any one condition. This doesn’t mean that homeopathy is ineffective, and until all of these positive studies have been demonstrated by higher quality / larger studies to be wrong, the evidence remains in support of the effectiveness of homeopathy. And of course, every few months another positive study appears. There is also the issue of all the positive studies excluded by the NHMRC from their review…veterinary and animal & cell culture laboratory RCTs, and cost effectiveness studies… it seems to me that although the NHMRC is not yet satisfied that homeopathy has been proven to be more effective than placebo, maybe it will be satisfied in the future, and that is why ‘cannot’ is a poor word choice, as it suggests that it is ‘impossible to be proven to be more effective than placebo’.
The sentence in the draft report that the FoSiM want to forget is on Page 10:
Time will tell.
What is it that singles out homeopathy for ”scathing” attacks? The combined implausibility and lack of evidence (beyond placebo effect). Homeopathy is not unique in this, however. Iridology would be another example that combines impausibility with lack of efficacy. Most physiological processes can be directly measured and visualised. With electron microscopy, we can see cell membranes and organelles. With laboratory equipment, we can measure the precise sodium or magnesium content of blood or urine, or its pH. In that way, we can see that ultra-dilute solutions have no physiological effect. In addition, none of the studies conducted have shown effiicacy beyond placebo – despite homeopathy being a multi-billion dollar world-wide industry. Manufacturers and marketers of homeopathic ”remedies” have a huge profit margin, selling what is essentially infinitely dilutable water and/or alcohol at prices commonly approaching $1000 per litre.
There is a difference between complementary and alternative therapies. COmplementary therapies are those that improve well-being when used in conjunction with effective medicine – such as massage, meditation or yoga. These therapies don’t claim to be curative. They are often recommended. ALternative medicine, on the other hand, has not shown to be plausible or effective. If it had, it would be incorporated as medicine – not ”alternative” medicine.
COnsumers have rights, but also need protection. Products put up for sale should be fit for purpose and demonstrably contain what is written on the label. Homeopathic ”remedies” do neither. People can be free to buy what they like, but purveyors should not be free to deceive.
What is it about homeopathy that singles it out more than any other complementary and alternative medicine for the type of scathing attack that we would hope had been confined to the witch hunts perpetrated by the Church in what has fondly become known as the Dark Ages?
The findings of the NHMRC seem to have added fuel to the fire, yet if we turn to the conclusion of the report in question, there is no mention of homeopathy as a pseudoscience, nor as being no better than placebo. The report concludes that there is not enough evidence that met their criteria upon which to base their findings. In the world of robust scientific methodology this points to the need for more studies so that an unbiased conclusion can be drawn. In the current climate, who is going to fund these studies? The pharmaceutical companies?
Mr Carr, whether you like it or not, you are just a pharmacist, a shop-keeper if you like and as such, you have the right to sell whatever you like in your pharmacy. However, that does not qualify you to make choices for other people who, as research into the socio-economic backgrounds of CAM users has consistently demonstrated, are not as you assert health and science illiterate, but predominantly highly educated people with college or university degrees, who have been consistently taught to intelligently question the world in which they live. I think that if these people, a large number of whom possibly form your customer base were to stumble across your seriously misinformed article, I believe that they would be seriously insulted by your views that question not only their right to choose the form of healthcare that they wish to use, but their very ability to arrive at such a decision.
Lets get back to Mr Carr’s contribution, which he concludes by saying “My call to my fellow pharmacists is to stop being seen as tarrying with the dark art of homeopathy. Lets declare our intention to treat our patients based on the best evidence, and honesty”.
Mr Carr, and his “friends” in FOSIM should be made to read the facts about the pharmaceutical paradigm which he (and they) seek to impose upon Australians to the exclusion of all complimentary medicines – and he would find that at least some of what he advocates is simply based on a tissue of lies – not my finding but Harvard University (J. Law, Medicine, Ethics 41(3) 2013) and Prof John Ioannidis (Eur J Clin Invest, 2013, 43(5)). Will he honestly reveal this to his patients?
Will he honestly tell his patients that homeopathy is available in pharmacies in many European countries, and in Indian and South American pharmacies. Will he honestly tell his patients that the WHO (Trad Med Strategy 2014-2023) supports the “need to develop a cohesive and integrative approach to health care”, and that he and his “friends” oppose this enlightened and modern international view. Will he honestly tell is patients that homeopathy is currently used by 500 million people, and is part of national health systems, because it is safe and cost-effective? I presume not.
We need the best of all healing modalities. We excell in emergency medicine (such as Dr Ieraci does), and drugs are essential at times, but we have an epidemic of chronic disease and drugs are not the solution. We need evidence and honesty, and Mr Carr’s contribution provides neither
Laurie Willberg, another public proponent of homeopathy, asserts that “The regulatory standards in most jurisdictions only require an effectiveness rate of 5%”. That is clearly nonsense, but, even if it were so, it would place the products well above the efficacy of homeopathic ”remedies”, whose effectiveness beyond placebo is 0%.
Evidence-based medicine is a lofty goal but is very far from having been achieved. Pharmacists might think twice about dispensing drugs if they were legally on the hook for adverse toxic reactions, hospital admissions or deaths from prescription drugs. This is a far more serious concern than the distorted notion that the sales of non-drug competing products are unethical for the sketchy reasons stated by the writer.
Pharma is a poor pretender to the umbrella of “science” — it’s all about sales and marketing. The regulatory standards in most jurisdictions only require an effectiveness rate of 5% (based on the manuf. reports) for drug approval while manufacturers hide their raw data from independent scrutiny. To say this is problematic is an understatement.
The NH&MRC inclusion/exclusion criteria are exactly why we know their findings are biased – they chose to leave out information needed to make a balanced, objective, scientific examination of homeopathy – whether it promoted wellbeing and health, whether it could prevent disease, whether it was cost effective, and whether it was safe and the medicines were of high quality.
Homoeoprophylaxis is being used on millons of people with proven efectiveness. I am off again to Cuba in August to work at the Finlay Institute to collect more data – but then I assume that Ms Ieraci (apologies for previous typo) will be as interested in this real-world data produced by orthodox scientists and doctors as the NHMRC are – i.e. not at all. And according to the NH&MRC approach, if actual real-world data is defined away then evidence doesn’t exist, and if evidence doesn’t exist then that is PROOF that the method doesn’t work (even though evidence exists that it does) – as I said before, it’s non-science.
Hi Sue,
My comment was about the misuse of scientific method. Many people do not understand it. The NHMRC is not immune to the demads of accurate, logical science. Your own conclusons about my position are surprisig: Do they mean that anyone who criticises the methodology of the revew which would include Ben Goldacre for sure, who has some relevant comments about the use of commercial research organisations, is also a proponent of homeopathy.
The draft NHMRC report has outlined its inclusion and exclusion criteria in detail in a publicly available document. The evidence is that the inclusion/exclusion criteria were methodological, not ideological. There have been public warnings issued about the ineffectiveness of so-called homoeoprophylaxis as it cannot and does not induce immunity, and should not be recommended as a method of “immunising children against potentially serious infectious diseases”. (Ms Lecari??)
Ms. Lecari is correct to say that I support immunising children against potentially serious infectious diseases – using either vaccination or homoeoprophylaxis – but that doesn’t in any way change the fact that the NH&MRC were ideologically selective in the way in which they constructed their report to achieve a pre-determined outcome (arising from their published 2012 anti-homeopathy position). It was non-science.
JennyH has embarked on a common argument from the proponents of homeopathy – one looks for evidence of effect and doesn;t find it, but, instead of concluding that the substance is ineffective, claims that ”we just haven’t found it yet”, or “science is not advanced enough to demonstrate it”. In fact, very advanced science has looked for evidence of anything in highly dilute solutions that could possibly have a physiological effect – there isn;t anything. Both Hahnemann’s speculations – treating ”like with like” and ”the more dilute, the more potent” have been disproven as mechanisms now that we have sophisticated ways of directly measuring and visualising physiological processes. The other commenter, I Golden, is a proponent of ”homeoprophylaxis”, otherwise known as ”homeopathic vaccination” – which is is most certainly non-science.
If the drugs sold in pharmacies were exposed to the type of examination undertaken by the NH&MRC then many would, according to Ian’s test, be inappropriate for sale in pharmacies. Furthe, the NH&MRC excluded by definition most positive studies supporting the effectiveness of homeopathy (including high qualitiy studies), it excluded by definition evidence showing that appropriate homeopathic treatment increased health and wellbeing, it excluded by definition evidence relaing to disease prevention, it did not consider the evidence showing the cost-effectivenes of homeopathy, and it did not look at safety and quality issues. It ignored the fact that homeopathy is currently used by 500 million people worldwide, prescribed by hundreds of thousands of medically trained practitioners, and forms part of national health-care systems. The NH&MRC report was non-science
The conclusions do not say what the review itself says often: that it did not find the evidence it wanted. The review does not prove that homeopathy is ineffective. What it proves is that it did not find the evidence it wanted to disprove the null hypothesis.
Care must be taken with a null hypothesis: Failing to find evidence that something is effective does not prove the opposite. What it proves is that more evidence is needed to come to a conclusion either way.
Perhaps this review will be the catalyst for NHMRC to fund research into homeopathic treatments, and so get the specific kind of research they and the Australian people want?
JennyH claims to have the ”uncomfotable feelng that the conlusions did not fit the evidence in the body of the review”. That’s not what I found. JennyH – could you outline precisely what you mean? What evidence was presented that was not reflected in the body of the review?
The assertion that “only 1% of the articles in medical journals are scientifically sound” may reflect poorly on the publication of sub-standard research, but it doesn’t mean that only 1% of medical care is based on the clinical sciences – on the contrary. Many of us have published papers as part of training, or as part of an academic role, that didn’t add a huge amount to world medical knowledge – but they did help us become critical readers of the medical literature. We are still in vigorous debate about thrombolysis in stroke, knee arthroscopy, the precise role of the statins, and many other areas where data is rapidly evolving. Medical science is, however, based on the physical and clinical sciences, as opposed to homeopathy, which breaches most of what we know from physics and chemistry to physiology and pharmacology. Medical science may not be perfect, but that does not give homeopathy any credibility. “Two quoque” describes the logical error of criticising the opponent rather than defending one’s own argument.
I have had a good look at what the NHMRC has published about their review of homeopathy and been amazed. Not just the draft information paper but the rest too. It left me ith the uncomfotable feelng that the conlusions did not fit the evidence in the body of the review. Has anyone else looked past the Working Committee interpretation?
It would not be a good outcome for Australian science if it condems an alternative therapy that does have the high level evidence brought to light in the body of the review. What do you say, Ian?
I wish medical profesisonals would be able to be more critical thinkers and bemoan (and question) the quality and availability of evidence for many treatments on offer. The 1991 article published in 1991 comes to mind – Where is the wisdom…? The poverty of medical evidence BMJ, volume 303, October 1991- which examined the available evidence. The conclusion: “only 1% of the articles in medical journals are scientifically sound” or “Category 1 evidence supported 7 of 50 thoracic surgical treatments ” in: The Annals of Thoracic Surgery Volume 70, Issue 2, August 2000, Pages 429–431 )
“When good evidence is lacking, the best and most dedicated of us do wrong in the utter conviction of being right” (L. Eisenberg 1977, NEJM, 297, 1230-2)
How to explain an implausible finding? One of two ways: either it was a spurious result, or the water and/or alcohol of the ”remedy” produced the change. Spurious results generally go away if the study is replicated with good methodology. If the latter is true, we should have many exceptionally healthy water and alcohol drinkers!
http://www.ncbi.nlm.nih.gov/pubmed/17532732
Wait a minute !!!!! cytokines expression is no laughing matter if homeopathy is a placebo how do you explein the study of Maimi Children Hospital
Stocking Homeopathic medications and other such rubbish in Pharmacies gives them credibility they don’t deserve,
The public places a large amount of trust in the advice of their pharmacist and in pharmacy staff and on the whole I think they do an excellent job. I understand everyone has to make a living but I believe an ethical pahramacist should not stock goods that make health claims that cant be or have not been substantiated.
I would surmise from this article that the if you wish to shop at a discount chain pharmacy then you will get cheap advice which in the end could cost you more.
I had my flu shot this year at a local pharmacy. The shots were given in a small room to one side of the retail floor. While I waited outside the door for my turn, I was concerned by signs on the adjacent room advertising naturopathic and acupuncture services and, of course the shelves filled with the usual homeopathic remedies, herbal products and supplements. It did not increase my confidence in the “evidence-based” services the shop provided and, in my opinion, devalues things like vaccinations.
I’m a firm believer in vaccination and evidence-based medicine but find it difficult to reconcile that commitment with the fact the authorities – government regulators or professional bodies – not only don’t shut down the trade in useless alternatives, but allow it to be boldly promoted. I have to accept the possibility that I’m wrong and that the anti-vaxxers and alt-med-adherents just might be right after all.
In order to have trust in any advice relating to the vaccination I’m receiving at the pharmacy, I either need to believe the pharmacy is fundamentally honest and is therefore also honest about those other things, in which case I’d have to ask myself why I’m having the jab in the first place because homeopathy can prevent or cure anything – without side-effects – or so the story goes. Alternatively, I’d need to accept that the pharmacy is willing to lie about those other things to make a buck, in which case I wonder why I’m having the jab HERE rather than avoiding the place like the plague.
My trust in pharmacists is not nearly as high as it probably should be. They should stick with evidence-based products. If I want faith healing, I’ll join a church.
I agree with Sue about the supplements etc. Truth in labelling laws are easily circumvented by having a bunch of pamphlets sitting in a rack nearby and by pharmacists spruiking the products verbally. Anyone who lines up regularly in pharmacies (as I do) to collect their monthly supply of prescription pills, can’t help but overhear some of the dodgy advice being offered to other customers about what unproven nostrums they should take for this-that-or-the-other ailment.
‘Sociologist’ is wrong in thinking that pharmacists are not trained to provide professional advice about the medications they dispense, but when they start promoting useless remedies they are doing the same thing as many CAM doctors – misleading their customers.
Pharmacists have an ethical obligation to provide sound advice about the safety & efficacy (or lack thereof) of all the products they sell. Sadly, many are not living up to those obligations and are exploiting the position of trust they occupy:
http://www.smh.com.au/business/the-most-trusted–and-the-least-20130502-2iusc.html
http://trends.e-strategyblog.com/2013/12/31/americans-views-on-honesty-ethics-in-professions/16259
Surely the main problem for pharmacists, particularly those who own their own pharmacies, is how to survive if they only stick to evidence based therapies.
From time to time we read that pharmacists want to be able to dispense medical advice. The problem I see is two fold. Firstly look around any pharmacy and you will see, on sale, a profusion of untested remedies and dubious “medical” products. Pharmacies are hardly providing evidence-based products and advice in every case Secondly the pharmacist has a conflict of interest in having a financial incentive to selling products they might advise.. Doctors generally are at ‘arms length’ from the drugs they prescribe. Pharmacy must adopt evidence based practice if it is to be taken seriously and be given greater powers in advice and treatment.
Well George, just explain how homeopathy is the beloved property of the “public”. Are you not a member of the public, too? I regard myself as a member of the public and I’ve never even taken a homeopathic remedy. It’s actually doctors who seem to discuss homeopathy more than almost anyone I’ve ever met.
Surely a product that doesn’t contain the active ingredient is contravening various laws. so why don’t y’all take legal action against a pharmacist or manufacturer who misled you or mislabelled a homeopathic product and fix this problem once and for all?
One of the central issues, as Ian Carr points out, is the separation of pharmacy ownership from the dispensing pharmacist. ALthough there are many pharmacists like the poster above, who work in institutions rather than retail, the vast majority of pharmacists are employed in the retail setting – often just doing shifts or sessions with no control with what is sold on the retail shelves. This is particularly the case in chain-store discount pharmacies, which often also stock groceries and clothing as well as a wide range of pharmacy products and cosmetics. IN my view, the groceries and cosmetics are less problematic as they are generally not being promoted as therapeutic products, in contrast to the placebo ”remedies”.
“Sociologist” you have a very narrow view of pharmacy which belies yout title. I have worked in pharmacy for over 30 years and have never worked in a “retail” pharmacy. Pharmacists are health professionals (as are optometrists). It takes 5 years to become a fully registered pharmacist and there is minimal training in retailing included in pharmacy undergraduate education. Pharmacistss are in fact medication experts. I am paid to provide professional advice. Yes the model of community pharmacy in Australia is based in a retail environment and yes in that environment the pharmacist’s professional input is included in the price of the product. However there will be a growith in pharmacists being remunerated for their esprtise directly. Already there are a number of professional services provided by pharmacists which are remunerated directly by Medicare and this will increase. There are also members of the public who are willing to pay a pharmacist directly for their professional time.
“Ben” medical practice is as much an art as science. I personally do not support homeopathic medications or supplements etc but a lot of medicine cannot be explained by pure science either. I think you will find medical colleagues who also promote the use of complementary medicines. In fact I often have to discourage GPs from prescribing supplements to the frail elderly in my practice in aged care. So be careful what you wish for.
To me there is a strong argument that stocking homeopathic “medicines” in a pharmacy amounts to unsatisfactory professional conduct. Any pharmacist who believes in homeopathy has such fundamental flaws in their understanding of physics, pharmacology and evidence based medicine as to be unfit to practice. Any pharmacist who sells such “medicine” while understanding that their customers are mistaken in their beliefs about the efficacy and mechanisms of action of these “treatments” is involved in a fraud. In many ways this is worse than the lay peddlar of nostrums and snake oil who might conceivably be under the same misapprehension as their customers.
This issue should be dealt with by AHPRA, initially by the issuing of a warning, followed by a desist order, with further sanction if necessary. It is no different than a medical practitioner bleeding patients for the treatment of schizophrenia, or any one of countless other therapies, once widespread, which have been abandoned and would now be considered improper care for a health practitioner.
Support you 100% Ian – my question is whether there is a need for a pharmacy brand which is committed to giving strictly evidence based information to the public and selling only evidence/science based lines. This would definitely be a point of difference. Would this be appreciated by the public or would they be deeply insulted that we are telling them their beloved homeopathy is quackery? Other than s2/s3″s would we have a predominantly empty front of shop? Also do we apply the science based approach to our cosmetic range as well? What about products like Glucosamine, which have been proven not to work and have a great public support thanks to the placebo effect?
When the fudamental laws of physics need to be breached for a healthcare product to have efficacy, and this then needs an enquiry, its a sad day for science. (ie 30C is greater than Avogadros number) The human condition is afflicted with superstition and much has been written on why the human brain believes such twaddle as homeopathy. Much of our brain seeks easy answers, so we can run our lives without being overwhelmed thinking about unimportant things (to the individual that is); sadly what were once niche ares of lunacy, now with modern marketing (and legal system), can be spread far and wide. I dont think this is a solvable problem through reasoned debate, as the “opposition” dont use reason in the first place. Only compulsion (ie removal of medicare (or should that be mediocre) payments to health funds that allow drivel based healthcare) is ikely to lead to change. Given the standard of health care beaureacrat/politician now, there little chance of this.
Pharmacists are essentially commercial retailers – with additional qualifications which gives them a unique position in retail. The same applies to optometrists.
They are not like doctors, lawyers, accountants who provide professional opinion and sell their time only – in other words their product is their professional time. The pharmacists are not trained to fulfill any of those roles and should not stray from their retail base.
There is no harm if pharmacies sell other products which may or may may not be efficacious – following the argument of the article they shouldn’t stock beauty products.
there is no harm stocking and selling multiple products – if they won’t someone else will. Coles/Woolworths come to mind.
Thanks for the article, Ian, and for your stance against pseudo-medicine. The other example currently filling pharmacy shelves is the ”supplements” aisle – from vitamins to protein powders. Many stores have their branded vitamin fridges much like the Coke fridge or branded icecream freezer in every corner store. Homeopathy is a particular issue – not only is it useless (other than as placebo) but there is a real ”truth in advertising” problem when one cannot detect any of what is on the label. How would one know whether that particular little bottle or pillule no longer contains Nat. mur. or no longer contains Rhus. tox?