Boots the Chemists have proved themselves dishonest before, over their promotion of homeopathy and of B Vitamins “for vitality”
In a press release dated 12 March 2008, they have hit a new low in ethical standards
|Boots help boost the nation’s energy levels in just one week
“Health and beauty expert Boots has launched an exclusive energising vitamin supplement that helps boost depleted energy levels and maintain vitality. It is the first time that this exclusive form of CoQ10 has been made available on the high street.”
” . . .supplementation can help to supply higher levels of CoQ10 than are available in the diet. Boots Energy Super Strength CoQ10 containing natural Kaneka CoQ10 is a way of boosting energy levels that can help people who lack energy to see results in a week”
Last year there was an equally misleading press release about CoQ10 from Solgar/Boots Herbal. That one was headed “Need More Energy – Solgar’s Nutri Nano™ Uses Nanotechnology to Deliver Unprecedented Bioavailability of CoQ10”. Not only is the word ‘energy’ misused but notice that the trendy term ‘nanotechnology’ is worked in for extra sciencey effect. It turns out that all this means is that the preparation contains micelles. So nothing new there either. Micelles have been known for almost 100 years.
In contrast, the Boots online store is noticeably more restrained. Could that be because the Advertising Standards People can’t touch press releases, just as they can’t control what Boots Expert Team tell you face to face in the shop?
Boots PR contact is given as: Carrie Eames, PR Manager, Boots The Chemists, D90W WG14, Thane Road, Nottingham NG90 1BS. I’m not sure how Ms Eames sleeps at night. Perhaps you should write to her and let her know what you think.
You might point out to her Boots (anti) Social Corporate (ir)Responsibility Page. It says
|“So it’s part of our heritage to treat our customers fairly and act with integrity in everything we do, rather than seizing on the quickest and easiest way to turn a profit.”|
CoQ10 and “energy”
Coenzyme Q10 (also known as ubiquinone) is a relatively small molecule. It cooperates with cytochrome enzymes (big proteins) to synthesize a molecule called ATP. This is a chemical form of energy that can be used to do work, such as making a muscle fibre contract.
The word “energy ” here is used in the sense that a physicist would use it. It is measured in joules or in calories. The meaning of the word ‘energy‘ is described nicely in the Wikipedia entry. For example, when an electric current passes through a resistor (like a kettle) the electrical energy is converted to heat energy, and the energy used is potential difference (volts) X current (amps) X time. In other words energy is power (in watts) times time. So another unit for energy is kilowatt-hours (one kilowatt-hour is about 3.6 megajoules).
Energy in this sense has nothing whatsoever to do with the everyday use of ‘energy’ to indicate your vitality, or how lively you feel.
Furthermore there is not the slightest empirical reason to think that CoQ10 makes you feel more lively. None. The press release cites a sciencey-sounding reference (Ernster L, Dallner G. Biochemical, physiological and medical aspects of ubiquinone function. Biochim Biophys Acta. 1995 May 24;1271(1):195-204.). But this paper is just a review of the biochemistry, nothing whatsoever to do with feeling good.
CoQ10 and the supplement business
There is nothing new in this big push by Boots. CoQ10 has been a staple of supplement business for a long time now. All sorts of medical claims have been made for it. Everything from migraine, to Parkinson’s disease to cancer has been raised as possible benefits of the magic drug, oops, I mean ‘supplement’. This is quite improper of course, since it is being sold as a food not as a medicine, but it is standard practice among supplement hucksters, and so far they have been allowed to get away with it.
What’s interesting though is that until Boots PR machine swung into action, one thing that hadn’t been claimed much is that it made you feel more lively. That’s one they just invented.
CoQ10 and the press
It’s standard technique to get free advertising by hoping that journalists will dash off an article on the basis of a press release, with the hope that they will be in too much hurry to check the spin. Too often it works.
The Daily Mail has big coverage of the press release, under the title “Can a 60p pill from the chemist really add years to your life?“. This was written by Anna Hodgekiss and it’s not bad. It starts with a nice note of scepticism
“Forget vitamins C, E or even B12. The real wonder supplement is Coenzyme Q10 or CoQ10. That’s what Boots would have you believe, anyway. ”
“So should we all be taking this supplement?
Not according to David Colquhoun, professor of pharmacology at University College London, who says Boots’ claims are “deliberately misleading customers”.
“Yes, CoQ10 helps the body convert glucose into energy, but it’s not the psychological get-up-and-go energy you feel day to day.
“The type of energy it does produce powers our muscles and cells – physical energy. They have confused the two here to promote a product that I’m not convinced would make any difference to how you actually feel at all.”
The article goes on
Among the other sceptics is Scott Marsden, a senior dietician at The London Clinic.
“There haven’t been enough trials to warrant us all taking CoQ10,” he says.
“It sounds boring, but if you are healthy and eating a balanced diet, you will get all the nutrients you need and shouldn’t have to take supplements.
“Not only could you be spending money unnecessarily, you could also be putting your health at risk. Buy some wholesome food instead.” “
Dr Clare Gerada, vice chairman of the Royal College of General Practitioners, is more forthright.
“While there is some evidence to suggest CoQ10 supplements may help patients with heart failure or severe respiratory disorders, more work is needed,” she says.
“This is just another example of normal health being medicalised, and it’s an issue that worries me.
“The human body is an amazing machine, and we have never been in better health. The fact that more people are living well into their 80s and 90s is proof.
“People need to stop looking for a wonder pill in their quest to live for ever.”
But guess who comes out fighting for Boots? None other than my old friend Dr Ann Walker. Little wonder then that my Nutriprofile result recommended a co Q10 supplement, because she is involved in that too.
Ann Walker’s colleague on the Nutriprofile project, Dr Sarah Brewer comments on CoQ10 on the Healthspan site, thus.
“As CoQ10 is vital for energy production in muscle cells, lack of CoQ10 is linked with lack of energy, physical fatigues, muscle aches and pains . . .”
It seems that she also can’t distinguish between energy in joules and energy as vitality,
Female First and Marie Claire also carry a story “Boots Sell ‘Life Extending’ Pill”
“A new pill that claims to add years to our lives is due to hit shelves in Boots stores this week but scientists say the drug is misleading.”
“Despite these claims Professor David Colquhoun told Marie Clare that he believes the drug is ‘deliberately misleading customers’: “Yes, CoQ10 helps the body convert glucose into energy, but it’s not the psychological get-up-and-go energy you feel day to day,” he said.”
(Funny, I never consciously spoke to Marie Claire but the quotation is OK.)
The Times, in contrast, carries an appalling column by their Dr Thomas Stuttaford, “A natural solution to tiredness“. There isn’t even a question mark in the title, and the content is totally uncritical. Private Eye has nicknamed the author ‘Dr Thomas Utterfraud’. How very cruel.
See also, excellent articles on CoQ10 by Ben Goldacre in the Guardian, and at badscience.net, and at Holfordwatch and Dr Aust’s Spleen
Aha Boots have repeated their mendacious claims in newspaper advertisements
This appeared in the Guardian on 18 March, and I’m told it was in the Mail too.
The small print says
“The new Boots Energy supplement contains Kaneka Q10 to help boost your energy levels throughout the day”
Here is what I just sent to the Advertising Standard Authority, or email firstname.lastname@example.org . Why not have a go yourself?
|“The words “boost your energy levels” and “still lacking energy” constitute a (presumably deliberate) confusion beteen ‘energy’ measured in joules and the everyday use of the word ‘energy’ to mean vitality. The former usage would be justified in viewof the role of Coenzyme Q10 in ATP production. There is neither theoretical justification nor any empirical evidence that CoQ10 helps your vitality or ‘energy’ in the latter sense.”|
A full size graphic to attach to your complaint can be downloaded here.
Yes. “NutriNano”… good grief.
The urge to pen a Dr Utterfraud-alike article after the fashion of Private Eye is almost irresistible:
NanoNutriLipoBalls – A Doctor Writes:
As a national newspaper doctor I am frequently asked by the nice chaps and chap-ettes on the “Nutrition and Health“ pages: “can we have a quick 300 words to pad out this press release, sorry, story about some expensive supplement?”
My answer is always “Only if it will help tackle my low financial energy levels, sunshine”. And aren’t low energy levels something we all increasingly suffer from in today’s non-stop energy-sapping 24-hr world?
It is amazing these days how often my patients seem to wish they had more energy.
I don’t know how many times I have heard a patient say to me “I feel worn out, doctor”. To which I usually respond: “That sounds very much like what we doctors call an “Energy Deficiency” – fifty pounds, thank you, pay the receptionist on your way out. Next!”
Twenty thousand or so years ago, a quick sabre-toothed tiger hunt would have left primitive man with a huge appetite, but after a haunch of roast mammoth and 12 hrs solid sleep he would have been ready for anything. However, nowadays we work so much we hardly have time to eat, or to sleep more than five hrs a night – and when we do eat it’s more likely to be a hurried prawn sandwich than mammoth supreme.
Faced with that, who couldn’t do with a bit of a pick-me-up? And new NanoNutriiLipoBalls are formulated with EnergyNano’s patented Fast Liposome Intra-Mitochondrial Formula Liquid-energy AntioxidantMax technology, or “FLIM FLAM” for short, to get extra-fast to the parts other Energy supplements cannot reach.
So how were the results? Well, within a few days of first encountering NanoNutriLipoBalls, things were certainly looking up. Having banked a pleasingly large cheque, I found that my energy levels had been dramatically improved. A spring had returned to my step, a twinkle to my eye, and a satisfying bulge to my wallet.
(Is that enough?)
Stutterford says people are just finding it gives them more energy, although he doesnt state source for this.
I wonder if the pills have caffeine in!
– if not, it is just posisble this could be a drug that people are finding gives them some pep, even if science does not at the moment explain why? (a bit like what happened with Viagra?)
It isn’t that science can’t explain, but that there is no reason to think their is any effect (beyond placebo) in the first place . Stutterford just relates anecdotes, more like a supplement huckster than a doctor.
Interesting that the Boots press release says, “It is the first time that this exclusive form of CoQ10 has been made available on the high street”. One of the ‘exclusive’ features is, I understand, that the supplement ‘contains natural Kaneka CoQ10’, iimplying to me that this is unique to the new Boots version. So I thought I would check this claim.
Having found another make of CoQ10, Vertese, I looked at the claims made for it. As well as all the usual gubbins, the promo stuff on the website says, ‘……Contains Kaneka Coenzyme Q10. Suitable for adults and children 12 years and over. Dosage: Swallow one capsule a day, preferably with a meal’.
Next question, is it available ‘in the high street’? I first phoned Boots, and the kind man told me it was very good for boosting my energy levels but they only sold their own brand. Then I phoned a pills and potions shop (sorry ‘healthfoods’) and although they don’t stock it they could get me some Vertese by Monday.
So is the Boots claim to uniqueness valid? Wouldn’t their version have to be substantially different for their claim to be valid? Whilst this doesn’t have direct relevance to the pseudo-science of the stuff, it seems important in being yet another exaggeration which could lead people to favour their local Boots rather than going elsewhere. All part of the ‘anything goes as long as it helps the profits’ ethos.
Mayo Clinic did a review of CoQ10 recently, summarising conditions claimed to benefit and assessing the evidence for each. In most cases, ‘C’ grade given, “Unclear scientific evidence for this use”.
Thanks Claire -good summary at the Mayo clinic. And ‘lack of vitality’ doesn’t even get on the list of the many conditons for which there is “Unclear scientific evidence for this use”..
What I find hilarious is how CoQ10 is STILL being touted around as “NEW miracle supplement!” when it has been around for donkeys’ years.
Lurking in my files I turned up a dissertation a bright young first year medical student wrote for me back 1999 (sic) on:
“Coenzyme Q10: snake oil or medicine”
A sample quotation:
“While some adverts for CoQ10 make use of anecdotal evidence from individuals testifying to “the miracle of Q10”, others make weightier-sounding allusions to scientific studies. But to what extent are claims made by the supplement industry upheld by scientific studies?”
– A question Dr Stuttaford, Ann Walker, Sarah Brewer, Boots “expert team” and sundry “health” journos all seem to have forgotten how to formulate.
The answer, by the way, is “not very much, if at all”, as the Mayo Clinic’s summary emphasises once again.
Relying on memory here, but: Knut Flytlie was involved in a book (or books) about CoQ10 some years ago. I seem to recall that it had chapters on CoQ10 in relation to just about everything – cancer, heart disease, energy. Lots of anecdote – pictures of elderly chaps playing guitar having recovered from a stroke etc… There was also something about bioavailability and how oil-based capsules were better. I can’t recall if any particular brand was mentioned, but the whole thing read like a testimonial.
Sorry – just spotted this on Q10:
“Pharma Nord (UK) sends free to people who reply to its advertisements a book called ‘Q1O – Body Fuel’ by Dr Knut T Flytlie and Torben Dhalvad.
Claims in the book include: ‘Ubiquinone has also proved to be effective in the treatment of periodontal disease, high blood pressure, diabetes, myopathy, and immunological problems.'”
The book I read in the 90s was (I think) this one: Q10 by Dr Knut T. Flytlie and Bjorn F. Madsen. It was definitely Flytlie and Madsen.
[…] been getting some attention lately, off the back of a Boots marketing campaign. David Colquhoun has described Boots’ marketing of these pills as “as bad a bit of nutribollocks as I’ve ever […]
Stutterford often relates drug company PR mailings virtually word-for-word. Often I read a drug company promotional mailing only to see a breathless retelling of it, as solid fact, the next day in Dr S’s column in The Times. He’s a buffoon
Mr Hunnybun. Thanks for providing such a clear translation of my rather obtuse prose. And I do like your recent comments on dyslexia. Yet more medicalisation,
A quick check with the KEGG database confirms that human beings synthesize their own CoQ. The overall message from Boots seems to be that if you aren’t getting enough CoQ in your diet, then you need a fancy supplement, whereas one might expect that any shortfall could easily be made up by one’s own biosynthetic pathways.
Yes, your cells make their own Q10. The biosynthetic pathway is “shared” (part of it) with cholesterol biosynthesis. Hence the claim by some “Q10 boosters” that if you take statins (which partially inhibit a key enzyme in the pathway) you “need” to supplement your Q10.
This is one of the two most scientifically plausible scenarios for taking Q10 – the other being rare inborn (genetic) disorders of mitochondrial metabolism. HOWEVER, there is no convincing trial evidence for CoQ10 supplementation even when people are taking statins and even in the subgroup of people with “suspicions” of statin side effects (Coracle has written about this). So if Q10 were to be marketed as a medicine for this statin setting there would not be nearly enough evidence to approve it. This points up – again – the difference between the efficacy standards for drugs (there are some) and supplements (there aren’t any).
Of course, if there isn’t convincing evidence that Q10 makes a difference even in a situation where using it might be biochemically “plausible” , you can bet your mortgage there is bugger all reason for for normal people to take it. Apart from making Boots and similar peddlers considerably richer.
been lurking for a bit but at last have something useful to add to a post!
“In contrast, the Boots online store is noticeably more restrained. Could that be because the Advertising Standards People can’t touch press releases, just as they can’t control what Boots Expert Team tell you face to face in the shop?”
They have placed it as an ad in yesterday’s Mail on Sunday You magazine page 36. The ad says ” A spring in your step or your money back. The new Boots Energy supplement contains Kaneka Q10 to help boost your energy levels throughout the day. And if after a week you are still lacking energy, we’ll give you your money back”.
Yes. had heard about the money back offer. Boots are clearly great believers in the power of the placebo… and wishful thinking,
It’s against my principles to buy the stuff, but how much money could we make them lose if we all went and bought some and went back a week later saying it did nothing for us. I’m not suggesting we take it. I’ll probably flush mine down the loo. Seems the best place for it.
[…] doesn’t seem to be getting a great reception! Here is what Ive found on my virtual travels. Dcscience reports “In a press release dated 12 March 2008, they have hit a new low in ethical […]
[…] is more important than your health – except their profits. Here is what David had to say about Boots Energy Super Strength CoQ10 . Here is what Boots have to say in their mission statement and in their code of business ethics […]
No surprises here then. I popped into my local Boots to get hayfever medication the other day and decided to ask them about a new treatment which I’d read contains an extract of grass pollen designed to stimulate an immune response. I’m a little hazy on the details, but there’s more info via their website – http://www.grazax.com.
To my non-surprise, the Boots employee suggested I try homeopathy instead. I explained that homeopathy was not for me, and after some persistence the “expert” appeared from behind the pharmacy area, clutching a copy of the BNF, and proceeded to tell me that Grazax was basically homeopathy anyway (it isn’t, as far as I can make out) so I’d be better off not trying it.
My response went something along the lines of “I’m not convinced by bullshit, sorry”. Still, there’s one born every minute I guess…
Sub-lingual immunotherapy (essentially trying to desensitize you to the allergens you are allergic to, in this case by sticking a daily controlled dose of allergen extract under your tongue) is a real therapy… there is even a Cochrane review here.
Given that this is a real treatment with real effects, both wanted and unwanted, I would be astonished if Boots (or anyone else) were allowed to sell it over the counter. I would think you would need to be prescribed it by a specialist NHS allergy clinic and to be taking it under their monitoring. Given the potentially serious nature of severe allergic reactions, it’s not the sort of thing you would want to do unsupervised, or at the behest of anyone other than a real specialist doctor.
There is a BBC article from a while back with some contact details for the MRC Asthma and Allergy Centre at Imperial College, who are doing long-term trials of this stuff, so you could try contacting them on the numbers given in the article. There may be other trials elsewhere in the country.
Cynically one might suspect your Boots “expert” either didn’t know the stuff, or knew that they weren’t allowed to sell it to you, and instead tried to flog you something they ARE allowed to sell freely to anybody – good old 100% active ingredient-free homeopathy, sole effect relieving you of your cash.
To say “it’s basically the same” betrays a good deal of ignorance. Partly it suggests your Boots expert can’t tell the difference between “herbal” and “homeopathic”. Plus, although the Grazax stuff is “herbal” to the extent that it is a plant-derived substance (grass pollen extract), it is not being given as a “herbal medicine” but rather as a “mild allergen challenge”. The mechanism is a particular immune one and not related to the way most herbal medicines are supposed to work. The unwanted effects the stuff produces mainly relate to the fact that you are exposing yourself to something you are known to be allergic to. Given the commonness of the unwanted effects they list in their literature I suspect this is only ever going to be used on people who find they can’t get relief with the standard therapies like antihistamines, nasal steroid sprays and eyedrops (which are well tried and relatively free from unwanted effects).
Yes, quite so, thanks for that. Just to make it clear, I wasn’t expecting to be able to get it without a prescription; all I wanted was some information. Admittedly I was testing the waters a bit to see if the information Boots gave was going to be useful or, as one might suspect, a load of cobblers.
Having looked at the patient information on Grazax I don’t think my pollen allergy is severe enough to warrant using it. However, my allergy to bullshit certainly seems to be getting worse.
“To my non-surprise, the Boots employee suggested I try homeopathy instead. I explained that homeopathy was not for me, and after some persistence the “expert” appeared from behind the pharmacy area, clutching a copy of the BNF, and proceeded to tell me that Grazax was basically homeopathy anyway (it isn’t, as far as I can make out) so I’d be better off not trying it…”
Please, please don’t tell me that this person was a pharmacist.
Steven Novella posted a piece debunking homeopathy’s claims to be analogous to allergen immunotherapy (the subcutaneous version, given by injection rather than drops under the tongue, but still relevant, I think).
You might like to give it to that Boots ‘expert’ – http://www.theness.com/neurologicablog/index.php?p=206
Sorry if I was lecturing, CTurner. Occupational hazard for academics!
Claire, you are right, the sublingual immuno-is basically trying to do the same as the subcutaneous (injection) immunotherapy, essentially desensitize the allergic response by limited controlled exposure. The sublingual approach is being investigated as it won’t have the “barriers to widespread use” that needing to get regular injections poses.
Personally I would take a lot of persuading to use anything other than the tried and tested steroid nasal spray and antihistamines. I suffer from pollen and (especially) housedust allergies, but since the 24 hr non-drowsy antihistamines appeared they have been rather easier to manage.
Re. your other comment, Claire – if it was a real pharmacist telling CTurner that then they should get the sack.
Agreed Dr Aust, I don’t think either kind of allergen immunotherapy could be seen as the ‘standard of care’ esp. where symptoms are well controlled by easily available, safe medications. It is hard to access in the UK, but where it is available it is usually recommended for the more severe cases which don’t respond well to drug therapy and where avoiding the allergen is difficult. There is interesting research ongoing into allergen immunotherapy possibly having a role in preventing onset of asthma in children with allergic rhinitis e.g. here: http://doctor.medscape.com/viewarticle/473936_1 – registration needed, then it’s free.
Like you, with allergies relatively easily controlled by widely available and safe medications I would be hesitant about allergen immunotherapy. But I think if I developed a life-threatening insect-venom allergy, I might be more willing to consider it.
Claire, I’m afraid the “expert” probably was the pharmacist . Perhaps they need to go back to school (or try another career!).
Dr Aust, no need to apologise – I appreciate the information.
I might have found immunotherapy more useful when I was a kid; my hayfever was worse back then. Summer meant either staying indoors or walking around like a runny-nosed zombie in sunglasses, stupefied by antihistamines. I’d agree that nasal spray, eyedrops and non-drowsy antihistamines do the job perfectly well for the majority of adults though.
Claire, I’m afraid they probably were a pharmacist. Perhaps they need to go back to school (or get another job!). Thanks for the link to Novella’s piece though, I may well show it to them next time I go there.
Dr Aust, no need to apologise. I appreciate the information.
I hope you do pass on that piece to the Boots pharmacist. It really is unacceptable for somebody in that position to be misinforming people so badly – particularly when the store in question is selling the homeopathic products you were being advised to try, which reliable evidence suggests are no better than placebo.
Your story is especially worrying given that patients are at present being encouraged to view pharmacies as the ‘NHS front door’, the first port of call for people seeking reliable information especially about more minor, chronic conditions e.g.
I trust the pharmacists involved in this scheme are better informed that your Boots homeopathy promoter.
Hear hear, Claire.
There is actually a ton of information about Grazax on the net, including a bunch of NHS assessments, and it would take less than 5 min with an internet connection to find out exactly what it is and what it tries to do, and under what circumstances a person could get prescribed it. So zero excuse for trotting out lame bollocks like “it’s basically sort of homoeopathy”
[…] writing the recent post Boots reaches new level of dishonesty with CoQ10 promotion, I sent a complaint about the dishonesty of the advertisements to the Advertising Standards […]
I have had discussions with various Boots pharmacists over the years about homoeopathic “medicines”. They will not admit outright that the stuff is useless, but if I say I think it is they generally shrug and smile in a way I take to be a tacit agreement.
Given the nature of their professional training, they have to know it’s junk.
They have a job to do , so there’s a limit to how much of their time I’m going to take up. I do wonder though what constraints on what they say, if any, are actually put on them by Boots.
Any organisation selling things will coach it’s staff in how to stress the positive and suppress the negative aspects of their mechandise- caveat emptor – but surely a pharmacist has a responsibility not to mislead by either omission or comission?
Given the recent tightening of the advertising regulations, I wonder if we can expect more direct honesty in future?
Only once have I asked directly if the company had told them what to say, and it was denied, I’m nit sure to be glad or sorry if that is the case. If it is, then we have not only a dishonest company, but also a lot of individually dishonest individual pharmacists too.
As Boots know very well, what you are told in the shop isn’t covered by rules about false advertising (“come in and tak to our expert team”). It is an easy way to cheat the public.
This becomes even more disturbing when you realise that Boots is trying to get heavily involved in primary care by setting up pharmacies in general practices.
Add to this the fact that in its NHS ‘reforms’ the government is pushing for pharmacists to take over some of the work of general practitioners, and it seems to me you have a recipe for quackery getting into the NHS through the back door.
“…a recipe for quackery getting into the NHS through the back door.” [Lindy]
or even throught the front door:
Click to access pr070913.pdf
“Pharmacies – The NHS front door”
RSPGB press release, 13/09/07 (pdf)
DC wrote, “As Boots know very well, what you are told in the shop isn’t covered by rules about false advertising”
Might be covered by The Consumer Protection from Unfair Trading Regulations 2008 though:
“A commercial practice is unfair if—
(a) it is a misleading action under the provisions of regulation 5;
(b) it is a misleading omission under the provisions of regulation 6;”
Commercial practices which are in all circumstances considered unfair
17. Falsely claiming that a product is able to cure illnesses, dysfunction or malformations.”
“…Another document warns GPs are too expensive to be employed for monitoring patients with chronic conditions, warning: ‘Unit costs for GPs of providing these additional services would be significantly higher than for pharmacies.’
Under proposals in the pharmacy white paper, pharmacists would run chronic disease clinics, cardiovascular screening and public health programmes…”
It gives me pause to think that CTurner’s ‘expert’ on allergen immunotherapy might well end up running an allergy clinic.
“If it is, then we have not only a dishonest company, but also a lot of individually dishonest individual pharmacists too.”
Is it possible to be honest while working in a dishonest company or a dishonest industry? I think it is possible, but not easy. If you are employed by a company then you have a duty to them and you owe it to them to do the job to the best of your ability. This can go further than it should – people generally wish to please their employers and if they think their employers would like them to be less-than-scrupulously-honest then they will probably be tempted to act in that manner. They should resist that temptation, but it must be an easy trap to fall into.
Here in France, no pharmacist will ever tell you that something they have on their shelf doesn’t work. Since they choose what they stock, it would make them look silly.
My family pharmacy expert tells me that an honest pharmacist won’t go any further than saying “People are happy with it” (code for: it’s useless, but hey, I’ve got a job to do) when selling obvious snake-oils.
Unscrupulous pharmacists might say “Be careful not to take more than the prescribed dose – it’s really powerful” to give the product an aura of efficacy, without actually saying that it works.
What she used to say was “Ce medicament n’a absolumment aucun effet …….. secondaire”. As you might expect, she didn’t shift many units with that patter.
[…] words don’t seem to accord with Boots’ mendacious advertisements for CoQ10 (which were condemned by the […]
I see the branch of Boots in a town I used to live in has got roped into homeopathy awareness week:
“…a form of treatment strongly backed by Prince Charles.” Way to appeal to inappropriate authority, guys.
And here’s another branch of Boots that’s got roped in to homeopathy awareness week:
By the way, that one includes a claim that homoeopathy is effective in “everything from coughs and skin conditions to heart disease, diabetes, depression and more.”
If that is so, then their claim is fraudulent, and therefore illegal.
Who is going to sue them?
Good question. The Advertising Standards Authority is OK but toothless, and doesn’t deal with the web. The Office of Fair Trading should be able to sue them but won’t. To label something “arnica” that contains no arnica is obvious fraud, but some legal loophole allows it to be done.
Homeopathy Awareness Week event at Boots, Exeter.
This is particularly irritating:
“…Homeopathy particularly helps people with allergies and is popular with many high profile people and celebrities including Prince Charles…”
That link provides even more insights, Claire.
The Express & Echo reports that,
‘Ms Schwartz will explain how homeopathy can help with everyday health issues between 2pm and 5pm’.
So not only do the remedies contain nothiing but they only work at certain times of day.
But it is alarming that the P of W and his FIH are insidiously creeping in everywhere, with the danger that the FIH will become increasingly mainstream and accepted.
” ‘Ms Schwartz will explain how homeopathy can help with everyday health issues between 2pm and 5pm’
So not only do the remedies contain nothiing but they only work at certain times of day.” [Lindy]
Maybe that’s why the trials are failing to find any effect above placebo – they were doing it at the wrong time! [/bad joke]
That statement about ‘people with allergies’ is a bit sweeping. I know some people with life-threatening allergies but curiously they seem happier to stick with proper medical diagnosis, avoidance and the prescribed rescue medication. Though I suspect she is talking about the more minor end of the spectrum, hayfever etc. But even here, the evidence is not compelling, e.g. in this summary from a p gaylard, http://apgaylard.wordpress.com/2007/11/19/the-evidence-for-homeopathy/
ARIA update: I – systematic review of complementary and alternative medicine for rhinitis and asthma
Passalacqua G, et al. ARIA update: I – systematic review of complementary and alternative medicine for rhinitis and asthma. Journal of Allergy and Clinical Immunology 2006;117:1054-62.
“… Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis …”
The CAM library also adds this ‘bottom-line’ conclusion: “Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.”
I discovered today that Boots has friends in high places. Former Health Secretary Patricia Hewitt is now a
‘Special consultant, Alliance Boots Ltd. (£45,001-£50,000)’ for a few days a year. Maybe she’d like to suggest that Boots’ pharmacists give proper scientific advice and stop giving out nonsense about fairy-tale remedies.
Perhaps not directly relevant to this posting, but none-the-less giving interesting insights into how distorted isthe system is the knowledge that she is also a ‘Senor Adviser, Cinven. (£55,001-£60,000)’, a company which provides healthcare (and more), with
‘Opportunities for private equity investment within this sector [Health] exist across many Western European geographies. Key areas include:
Growing efficient, focused private companies which offer medical services at cheaper rates than the fully costed equivalent within the public sector, thereby reducing government reimbursement; ….’
Before becoming an MP she was Director of Research for Andersen Consulting (now Accenture). Accenture is of course the huge consulting firm which was involved in the NHS database and then got out of it, or was sacked, I’m not sure which. It seems she does not always remember her more enlightened days when she was General Secretary of what is now Liberty.
Cinven sounds like exactly the sort of outfit that would be looking forward to owning the sort of subsidiaries that would bidding for Polyclinic franchises… which would be entirely in keeping with Patsy Hewitt’s record as Sec of State for Health. And I suppose companies like Boots might be in the polyclinic market too… as the main source of profit in polyclinics seem likely to be:
(i) getting people to take health advice from people who cost less than doctors, like nurses, pharmacists and even health advisers
(ii) using the “all on one nice new site” thing to flog add-ons which have a better profit mark-up than consultations with trained medics (or even nurses or pharmacists)… such as [insert name of favourite alternative therapy]
[…] Try the page that compares 10 brands of CoQ10 (that is the stuff I wrote about recently, in “Boots reaches new level of dishonesty with CoQ10 promotion” – their advertising was deemed improper by the ASA ). It isn’t a recommended […]
[…] And then. of course, there is the deeply dishonest promotion by Boots the Chemists of homeopathic miseducation, of vitamins and of CoQ10 supplements. […]
[…] to cure cancer is illegal. Of course that isn’t done in public, just in private (a bit like Boots’ advice on useless supplements)). The BBC did some secret […]
[…] She even gets a brief mention at Boots reaches new level of dishonesty with CoQ10 promotion […]
[…] – this energetic feeling probably has nothing to do with “energy” in the sense that a physicist would use it. While vitamin B1 is involved in carbohydrate metabolism, which provides energy to the body’s […]
[…] This claim has already been addressed by David Colquhoun at dcscience.net: Boots hit a new low in ethical standards. Colquhoun actually went as far as to say that the claims that CoQ10 could boost energy levels were […]
[…] Can you trust Boots? Don’t Trust Boots Boots reaches new level of dishonesty with CoQ10 promotion […]
[…] March 2008, Boots did it again, with a big promotion written up as Boots reaches new level of dishonesty with CoQ10 promotion. The strategy seems clear by now. Launch an enormous publicity effort, and rely on journalists to […]
I am compelled to buck the trend here!
I am someone who has benefited greatly from Co Q10. Years of propranolol and bendrofluazide to treat hypertension and a brief encounter with statins had me heading towards congestive heart failure! My heart was enlarged, I could barely walk and then I learned about Co Q10. Within days of taking the stuff and stopping the three prescription drugs mentioned, I found I had more energy and I mean the stuff that had me able to climb stairs, go walking and swimming!
Within 3 months my blood pressure was normal. I’d lost weight, my blood glucose level had dropped dramatically, my cholesterol ratio had improved and I generally felt I’d reclaimed my life!
Friends and family were so impressed by the change in me that they too now take Co Q10 and feel that they have more energy…yes ordinary energy to do things. I struggle to understand why you wouldn’t feel energised if every cell in your body is fueled up. My husband recently developed sepsis following a hospital procedure and despite being gravely ill he was back at work after 3 weeks. I believe CoQ10 played a major part in his speedy recovery. There’s published research that shows survival rates in sepsis are improved by CoQ10. I have a friend who’s critically ill in intensive care following an episode of sepsis and her lungs have been damaged by being on a ventilator yet her doctors refuse to allow her to have CoQ10.
I believe that the denial of the value of CoQ10 and all the published research about it is driven by ignorance and Pharmaceutical companies who wish to protect their profits. The body’s ability to produce CoQ10 diminishes with age. As a 60 year old it makes a great deal of sense to me to maintain my CoQ10 level. After paying for the supplement for over 2 years I am delighted to now be getting it on prescription!! Much better value to the NHS than all the other drugs that had proved harmful to my health! Scoff if you wish, but I know, from personal experience, the tremendous improvement it has made to my life.
I am glad that you recovered from your debilitating symptoms.
“Within days of taking the stuff and stopping the three prescription drugs mentioned, I found I had more energy………………”
How do you know that it wasn’t the fact that you stopped taking the three prescription drugs that was responsible for your recovery? If you make two changes to your regimen you cannot possibly tell which of them, if either, was the causative factor.
Perhaps you would kindly give the references that show such positive results of good trials of CoQ10.
The fact remains, I had hypertension, an enlarging heart and I do believe those conditions required to be treated. I do not accept that stopping the medication alone would have brought about the improvements I experienced. I believe the published research that proves Co Q10 to be useful in treating heart failure.
There is a great deal of information available if you do a simple internet search. Names like K Folkers, Peter Langsjoen, Stephen Sinatra and the International Co Q10 Association would all lead you to the references you seek.
As a non-scientist, I am still confused about this. I do gymnastics (which I am a bit old for really). I want something to get the most out of my muscles, given the sad fact that despite the amount of training I do and the correct diet I eat, building muscle is harder for oldies like me (female, over 40) – or is that not true?. I’m happy to feel washed out all day, but I’d like to spring a bit higher in a handspring in the evening!! Might this supplement be any good for this?
Since you have obviously read some of the good references to which you refer, I would really be grateful if you could let us have the spcifics. Most people responding on this site do give full references when asked.
The last time I looked up the evidence on CoQ10 and heart failure, it was a long way from being convincing. The general verdict tends to be, at best: “Large, well-designed studies on this topic are lacking”. Furthermore, the people reporting positive results all tend to be folk whose life’s work is being evangelical about the benefits of CoQ10, like Dr Langsjoen.
There is some more discussion of CoQ10, and anecdotal evidence, over at my blog in the comments thread here
You might care to look at the movie, Integrative baloney @ Yale, http://www.youtube.com/watch?v=X2WF8ovmyfg&feature=related
There you will see a quack descibing how he did a controlled trial of CoQ10, The result was that it was ineffective, but living in the parallel universe of alternative medicine, he did not accept his own result but asked for a “more fluid concept of evidence”.
DC and those of us who criticise CAM, the use of nutritional supplements etc. and who demand proper evidence for their efficacy are frequently and wrongly accused of being paid by pharmaceutical companies. In fact there is a very strong tendency to be, rightly in my view, equally critical of the behaviour of ‘big pharma’ and its conflicts of interests..
So, @ZHENA51, perhaps you would care to examine the website of
International Co Q10 Association
http://www.icqa.org/ICQA/about_us.html and take just a cursory glance at its ‘Supporting members’. I wonder how impartial sucha group of companies would be.
The following piece of research, albeit a small study, indicates a link between CoQ10 deficiency and levels of fatigue in people with CFS/ME and suggests that supplementation would be beneficial (but does not test the hypothesis). Anyway, I just thought it might be of interest …
Neuro Endocrinol Lett. 2009;30(4):470-6.
Coenzyme Q10 deficiency in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is related to fatigue, autonomic and neurocognitive symptoms and is another risk factor explaining the early mortality in ME/CFS due to cardiovascular disorder.
Maes M, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E.
Maes Clinics, Antwerp, Belgium. email@example.com
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a medical illness characterized by disorders in inflammatory and oxidative and nitrosative (IO&NS) pathways.
This paper examines the role of Coenzyme Q10 (CoQ10), a mitochondrial nutrient which acts as an essential cofactor for the production of ATP in mitochondria and which displays significant antioxidant activities. Plasma CoQ10 has been assayed in 58 patients with ME/CFS and in 22 normal controls; the relationships between CoQ10 and the severity of ME/CFS as measured by means of the FibroFatigue (FF) scale were measured.
Plasma CoQ10 was significantly (p=0.00001) lower in ME/CFS patients than in normal controls. Up to 44.8% of patients with ME/CFS had values beneath the lowest plasmaCoQ10 value detected in the normal controls, i.e. 490 microg/L. In ME/CFS, there were significant and inverse relationships between CoQ10 and the total score on the FF scale, fatigue and autonomic symptoms. Patients with very low CoQ10 (<390 microg/L) suffered significantly more from concentration and memory disturbances.
The results show that lowered levels of CoQ10 play a role in the pathophysiology of ME/CFS and that symptoms, such as fatigue, and autonomic and neurocognitive symptoms may be caused by CoQ10 depletion. Our results suggest that patients with ME/CFS would benefit from CoQ10 supplementation in order to normalize the low CoQ10 syndrome and the IO&NS disorders. The findings that lower CoQ10 is an independent predictor of chronic heart failure (CHF) and mortality due to CHF may explain previous reports that the mean age of ME/CFS patients dying from CHF is 25 years younger than the age of those dying from CHF in the general population. Since statins significantly decrease plasma CoQ10, ME/CFS should be regarded as a relative contraindication for treatment with statins without CoQ10 supplementation.
PMID: 20010505 [PubMed – indexed for MEDLINE]
Thanks very much. This paper is an example of the surrogate endpoint. As you point out, it proposes a hypothesis but does NOT test it.
The claims made by Boots, and those made by Dr Maes, would be justifiable only AFTER a test had been done to see if CoQ10 had a beneficial effect on human patients with ME/CFS. That has not been done, and until it is, the claims made by Boots (and Maes) can’t be taken seriously.
Dr Maes’ web site is interesting. He seems to have a large number of theories about depression etc but rather little tendency to admit that things aren’t known, and a distinct tendency to espouse theories for which the evidence is thin.
There is definitely something good for me in these pills. They have increased my energy, but more importantly for my job – my mental acuity which I thought was gone forever. I have been recovering from some strange neuro symptoms I’ve had since last year and these have definitely given me a much needed boost. I guess if anything they can market this as a tonic for those recovering from illness.
There is no panacea. Different combinations of diet, exercise, lifestyle and supplements if necessary will help different people. I’ve not yet found a conventional medicine that does not make me feel worse, yet they are tested and apparently trusted by all. All I can say is that at this time I’m glad this supplement is available. If it sells then it must be working for some people.
The medical world is too hung up on the results of studies. This limits imagination and takes emphasis away from concentrating on treating the individual as a whole. No study is perfect.
I’m glad you got better, but how on earth can you be sure that you would not have improved equally quickly without the coQ10?
I’m puzzled by your assertion that no conventional medicine helped you, because there are, as far as I know, no conventional medicines that are recommended for problems like yours.
I must disagree strongly when you say “The medical world is too hung up on the results of studies”. How else do you find the truth about something other than by studying it? To resort to guesswork and superstition, as you seem to recommend, is a recipe for promoting deception and charlatans (like Boots).
Matts paper will probably never be tested as no patent would be granted, so why would anyone waste their money for no return. (capitalist model) Maybe Boots did say things that perhaps they should not have but did they kill anyone? compare and contrast Vioxx from Merck, did everything right, spent the millions doing the trials to get approval, get FDA approval, all very scientific and conventional and look how that ended up. FDA analysts estimated that Vioxx caused between 88,000 and 139,000 heart attacks, 30 to 40 percent of which were probably fatal, in the five years the drug was on the market, oh dear, In the year before withdrawal, Merck had sales revenue of US$2.5 billion from Vioxx. Oh dear again. Just who can we trust out there…Not the FDA not NICE, not big Pharma,not small Pharma and certainly not Politicians, we are on our own, as even God appears to have taken his eye off our ball. All we can do is follow our nose, so to speak…… Interesting forum, my 1st visit.
“I’m glad you got better, but how on earth can you be sure that you would not have improved equally quickly without the coQ10?”
because it was a pretty sudden improvement after a long period of malaise which appeared to result in a better complexion (a healthy colour in my cheeks, that “glow” of health), I haven’t experienced that for a long time. General increase in fitness without exercise, low fatigue even though I am extremely busy and would normally be bushed by such activity. Improved mental acuity. All of which as been consistent since I’ve been taking the pills. I went to a class and felt really groggy (after a gap when I first started the pills), about an hour after taking the pill I started to perk up. There is a clear connection. I simply feel more like “normal” used to feel before I had my weird illness. It’s like taking a really good tonic, but in my case I have always had side effects and this has none.
“I’m puzzled by your assertion that no conventional medicine helped you, because there are, as far as I know, no conventional medicines that are recommended for problems like yours.”
that’s because conventional medicines treat the body like a car at a mechanics for maintenance, looking at just the parts that need attention rather than at the whole human. My experience of anaphylaxis (I have had severe allergic reactions that do not have a straightforward cause in the past), has given me a good insight into how backward our conventional knowledge on physical problems is. What is considered to be in the “unknown” box is considered untreatable rather than being a bit imaginative and looking at alternatives. Thousands of years of knowledge being thrown away because we think we know it all now.
“I must disagree strongly when you say “The medical world is too hung up on the results of studies”. How else do you find the truth about something other than by studying it? To resort to guesswork and superstition, as you seem to recommend, is a recipe for promoting deception and charlatans (like Boots”
Medical studies start at a point of reference. That point of reference is the accumulated history of studies to date. They are therefore limited by the imagination of those who have gone before. they are limited to a sample which is then extrapolated to the global population. Samples by their very nature are flawed, miniscule samples applied to the complex variables that form the mix of humanity are simply short sighted. Conventional studies on small national samples are limited in their usefulness, but as long as they have been carried out to specified conditions are held up as credible. I am simply saying we don’t know as much as we think we know based on scientific studies. Many of the most revolutionary discoveries are made by chance.
Urrgh. This again.
Ubiqvoice (Oct 17th) raises the usual line about
“CoQ10 will never be tested properly as it couldn’t be patented and thus could earn drug companies money”.
Wrong. You can patent a ‘delivery formulation’, i.e. the particular biological form of something that is used as a medicine, and there is an enormous amount of ‘formulation science’ done by Pharma for exactly this reason. It is also worth mentioning that:
(i) There is a lot of debate about whether the CoQ10 that enthusiasts chomp in the standard supplements is ‘bio-available’, i.e. ever gets into the body. There is more debate about whether what doesgets absorbed into the body actually makes it into particular cell types that the AltMed enthusiasts claim are targetted.
(ii) Certain formulations of CoQ10 HAVE been patented, and even given what is called ‘orphan drug’ status.
The point is that, if CoQ10 REALLY showed the tremendous promise of miraculous effects that its advocates claim, Big Pharma would be all over it, making and patenting different forms of it, pills/gels/patches etc, combining it with other agents etc. All of this would be perfectly patentable and potentially revenue-generating.
So what, then, do we conclude from the fact that this isn’t happening? The obvious answer is that the evidence for real biological effects is simply not good enough to make anyone think it is worth the time, effort and money to develop it. Just like drugs that don’t make it through Phase 1 and/or Phase 2 clinical trials, in fact.
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