Australasian Science Magazine

By Peter Bowditch

The engagement of pharmacy and pseudoscience was broken before they could get to the altar, but it would have been a one-sided marriage anyway.

Many years ago I did some stage acting, and one of the plays we performed was Rhinoceros by Eugene Ionesco. It 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 when I read about an agreement between the Pharmacy Guild of Australia (the professional body for retail pharmacists) and Blackmores (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” Blackmores 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 are filled.

I shouldn’t have been surprised, because The Pharmacy Guild has form. In 2005 it 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 selling rubbish in a manner that 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 Blackmores agreement has them recommending one of four specific Blackmores products whenever a prescription is 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 to 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 terms of the number of prescriptions filled, with antibiotics taking a lowly sixth place.

Blackmores said that the research supporting the Companion Products would be made available on its web site, but this took some time. Before Blackmores 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 Blackmores published information on its web site supporting the 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.”

The term “listed products” refers to a class of medical devices or preparations that 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”, while real medicines are usually “registered” because this 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 had already issued a statement saying that none of the Blackmores 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: “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.