A close run thing at the chemist

Many years ago I did some stage acting, and one of the plays we performed was Rhinocéros by Eugene Ionesco which was part of what was known as "The Theatre of the Absurd", a literary equivalent to surrealist art where what was on stage challenged the senses and the observer's perception of reality. I thought I was in another Ionesco play in September this year when I read about an agreement between the Pharmacy Guild of Australia (the professional body for retail pharmacists) and Blackmore's (the country's leading manufacturer of supplements and "alternative" medicines). The proposal was that when people had prescriptions filled for certain classes of medications the pharmacist would advise them of "complementary" Blackmore's products to counter the side effects of the medications. The specific recommendations would be displayed to the dispensing pharmacists by the Guild software used to record prescriptions as they were filled.

I shouldn't have been surprised, because The Pharmacy Guild has form. In 2005 they joined forces with the Complementary Health Care Council of Australia to run a "Natural Healthcare Expo" in Sydney. In 2008 the retail pharmacists of Australia were awarded The Bent Spoon by Australian Skeptics for the practice of selling rubbish in a manner which legitimised it by association with real, tested, effective medications and medical treatments.

This new proposal went beyond what had happened in the past. Previously, pharmacists carried shelf loads of supplements and nostrums and if asked gave vague recommendations based on what little knowledge they had of the supposed effects of these products. The Blackmore's agreement had them recommending one of four specific Blackmore's products whenever a prescription was filled for one of four drug classes: zinc supplement for antihypertensives, Coenzyme Q10 for statins, lactobacillus probiotics for the diarrhoea associated with antibiotics, and magnesium supplement for proton pump inhibitors.

It is probably no coincidence that these four categories make up a very large proportion of all prescribed medicines. Pharmaceutical Benefits Scheme statistics for the year up June 2010 show that over 72 million prescriptions were filled for the four categories of drugs. Three of the categories occupied the top three positions in the ranking of numbers of prescriptions filled, with antibiotics taking a lowly sixth place.

Blackmore's said that the research supporting the Companion Products would be made available on their web site, but this took some time. Before Blackmore's made the research available, the National Prescribing Service published an analysis of available research and concluded that there was insufficient evidence for the usefulness of any of the Companion Products.

When Blackmore's published information on their web site supporting their four Companion Products it was only made available to "healthcare professionals", although this was rather easily bypassed.

A couple of paragraphs stood out.

"The evidence was compiled in line with the Therapeutic Goods Administration's Levels of Evidence Guidelines for listed products, and demonstrates that some prescription medicines diminish nutrients and that supplementation can improve nutritional status".

"Listed products" refers to a class of medical devices or preparations which do not have to prove efficacy, just that they don't do too much damage when used according to directions. That is, for something to get a "Listed" classification it does not have to be shown to work or even provide any benefit at all. Homeopathic products are "Listed". Real medicines are usually "Registered", because that classification means that evidence has been produced that they do what the promoters say they do.

"In addition, evidence was sourced using two key resources identified by the National Prescribing Service as having the highest quality of information for complementary medicines: The Natural Standard Professional Database and the Natural Medicines Comprehensive Database".

Leaving aside my opinion about databases of magical snake oil preparations, the important message to be taken from this paragraph is that the National Prescribing Service cited had already issued a statement saying that none of the Blackmore's Companion Products actually have any benefit at all. It is standard operating procedure for pseudoscientists to refer to authorities in the almost certain knowledge that the general public will be impressed by the reference and fail to see what the authority really had to say.

In October the Pharmacy Guild announced that the arrangement was not going ahead, although they were hardly apologetic and the media release consisted largely of justifications for the idea, an example being that they said that they were just responding to "some media reporting of the endorsement which was ill-informed and inflammatory".

The release also said that "The last thing the Guild would ever want to do is deplete the credibility of community pharmacists, or damage the trust in which they are held by Australians". Perhaps one day they will realise that partnerships with pseudoscience can't possibly do anything except "deplete the credibility" of members of a scientific profession.

This article was published as the Naked Skeptic column in the January/February 2012 edition of Australasian Science