# DC's Improbable Science

## Lactium: more rubbish from Boots the Chemists. And a more serious problem

#### November 26th, 2009 · 31 Comments

We have listed many reasons hear why you should never trust Boots.  Here are the previous ones.

This post is about a "functional food".  That is about something a bit more serious than homeopathy, though I’ll return to that standing joke in the follow-up, because of Boots’ latest shocking admission..

Alternative medicine advocates love to blame Big Pharma for every criticism of magic medicine.  In contrast, people like me, Ben Goldacre and a host of others have often pointed out that the differences seem to get ever smaller between the huge Alternative industry (about $60 billion per year), and the even huger regular pharmaceutical industry (around$600 billion per year),

Boots are as good an example as any.  While representing themselves as ethical pharmacists, they seem to have no compunction at all in highly deceptive advertising of medicines and supplements which are utterly useless rip-offs.

The easiest way to make money is to sell something that is alleged to cure a common, but ill-defined problem, that has a lot of spontaneous variability.. Like stress, for example.

The Times carried a piece Is Boots’s new Lactium pill the solution to stress?. Needless to say the question wasn’t answered.  It was more like an infomercial than serious journalism.  Here is what Boots say.

 What does it do? This product contains Lactium, a unique ingredient which is proven to help with the stresses of every day life, helping you through a stressful day. Also contains B vitamins, magnesium and vitamin C, which help to support a healthy immune system and energy levels. Why is it different? This one a day supplement contains the patented ingredient Lactium. All Boots vitamins and suppliers are checked to ensure they meet our high quality and safety standards.

So what is this "unique ingredient", Lactium?  It is a produced by digestion of cow’s milk with trypsin. It was patented in 1995 by the French company, Ingredia, It is now distributed in the USA and Canada by Pharmachem. which describes itself as “a leader in the nutraceutical industry.”  Drink a glass of milk and your digestive system will make it for you.  Free.  Boots charge you £4.99 for only seven capsules.

### What’s the evidence?

The search doesn’t start well. A search of the medical literature with Pubmed for "lactium" produces no results at all. Search for "casein hydrolysate" gives quite a lot, but "casein hydrolysate AND stress" gives only seven, of which only one looks at effects in man, Messaoudi M, Lefranc-Millot C, Desor D, Demagny B, Bourdon L. Eur J Nutr. 2005.

There is a list of nineteen "studies" on the Pharmachem web site That is where Boots sent me when I asked about evidence, so let’s take a look.

Of the nineteen studies, most are just advertising slide shows or unpublished stuff. Two appear to be duplicated. There are only two proper published papers worth looking at, and one of these is in
rats not man.  The human paper first.

Paper 1  Effects of a Bovine Alpha S1-Casein Tryptic Hydrolysate (CTH) on Sleep Disorder in Japanese General Population, Zara de Saint-Hilaire, Michaël Messaoudi, Didier Desor and Toshinori Kobayashi [reprint here]   The authors come from France, Switzerland and Japan.

This paper was published in The Open Sleep Journal, 2009, 2, 26-32, one of 200 or so open access journals published by Bentham Science Publishers.

It has to be one of the worst clinical trials that I’ve encountered.  It was conducted on 32 subjects, healthy Japanese men and women aged 25-40 and had reported sleeping disorders.  It was double blind and placebo controlled, so apart from the fact that only 12 of the 32 subjects were in the control group, what went wrong?

The results were assessed as subjective sleep quality using the Japanese Pittsburg Sleep Quality Index (PSQI-J).  This gave a total .score and seven component scores: sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.

In the results section we read, for total PSQI score

"As shown in Table 2, the Mann-Whitney U-test did not show significant differences between CTH [casein tryptic hydrolysate] and Placebo groups in PSQI-J total scores at D0 (U=85; NS), D14 (U=86.5; NS), D28 (U=98.5; NS) and D35 (U=99.5; NS)."

Then we read exactly similar statements for the seven component scores.  For example,. for Sleep Quality

As shown in Table 3, the Mann-Whitney U-test did not show significant differences between the sleep quality scores of CTH and Placebo groups at D0 (U=110.5; NS), D14 (U=108.5; NS), D28 (U=110; NS) and D35 (U=108.5; NS).

The discussion states

"The comparisons between the two groups with the test of Mann-Whitney did not show significant differences, probably because of the control product’s placebo effect. Despite everything, the paired comparisons with the test of Wilcoxon show interesting effects of CTH on sleep disorders of the treated subjects. "

Aha, so those pesky controls are to blame! But despite this negative result the abstract of the paper says

"CTH significantly improves the PSQI total score of the treated subjects. It particularly improves the sleep quality after two weeks of treatment, decreases the sleep latency and the daytime dysfunction after four weeks of treatment.

Given the antistress properties of CTH, it seems possible to relate the detected improvement of sleep aspects to a reduction of stress following its’ chronic administration."

So there seems to be a direct contradiction between the actual results and the announced outcome of the trial. How could this happen?  The way that the results are presented make it hard to
tell.  As far as I can tell, the answer is that, having failed to find evidence of real differences between CTH and placebo, the authors gave up on the placebo control and looked simply at the change
from the day 0 basleine values within the CTH group and, separately, within the placebo group.  Some of these differences did pass statistical significance but if you analyse it
that way. there is no point in having a control group at all.

How on earth did such a poor paper get published in a peer-reviewed journal?  One answer is that there are now so many peer-reviewed journals, that just about any paper, however poor, can get published
in some journal that describes itself as ‘peer-reviewed’.  At the lower end of the status hierarchy, the system is simply broken.

Bentham Science Publishers are the publishers of the The Open Sleep Journal. (pity they saw fit to hijack the name of UCL’s spiritual founder, Jeremy Bentham). They publish 92 online and print journals, 200 plus open access journals, and related print/online book series. This publsher has a less than perfect reputation.  There can be no scientist of any age or reputation who hasn’t had dozens of emails begging them to become editors of one or other of their journals or to write something for them. They have been described as a "pyramid scheme” for open access.  It seems that every Tom, Dick and Harry has been asked.  They have been described under the heading Black sheep among Open Access Journals and Publishers.  More background can be found at Open Access News..

Most telling of all, a spoof paper was sent to a Bentham journal, The Open Information Science Journal.  . There is a good account of the episode the New Scientist, under the title “CRAP paper accepted by journal”.  It was the initiative if a graduate student at Cornell University. After getting emails from Bentham, he said “”It really painted a picture of vanity publishing”. The spoof paper was computer-generated rubbish, but it was accepted anyway, without comment.  Not only did it appear that is was never reviewed but the editors even failed to notice that the authors said the paper came from the "Center for Research in Applied Phrenology", or CRAP.  .The publication fee was \$800, to be sent to a PO Box in the United Arab Emirates. Having made the point, the authors withdrew the paper.

Paper 5 in the list of nineteen stidies is also worth a look.  It’s about rats not humans but it is in a respectable journal The FASEB Journal Express Article doi:10.1096/fj.00-0685fje (Published online June 8, 2001) [reprint here].
Characterization of α-casozepine, a tryptic peptide from bovine αs1-casein with benzodiazepine-like activity. Laurent Miclo et al.

This paper provides the basis for the claim that digested milk has an action like the benzodiazepine class of drugs, which includes diazepam (Valium).  The milk hydrolysate, lactium was tested in rats and found to have some activity in tests that are alleged to measure effects on anxiety (I haven’t looked closely at the data, since the claims relate to humans)..  The milk protein, bovine αS1 casein contains 214 amino acids.  One of the many products of its digestion is a 10-amino-acid fragment (residues 91 -100) known as α-casozepine and this is the only product that was found to have an affinity for the γ-amino-butyric acid (GABA) type A receptors, which is where benzodiazepines are thought to act.  There are a few snags with this idea.

• The affinity of α-casozepine peptide had 10,000-fold lower affinity for the benzodiazepine site of the GABAA than did diazepam, whereas allegedly the peptide was 10-fold more potent than diazepam in one of the rat tests.
• The is no statement anywhere of how much of the α-casozepine peptide is present in the stuff sold my Boots, or whether it can be absorbed
• And if digested milk did act like diazepam, it should clearly be callled a drug not a food.

### What’s the conclusion about lactium?

Here is what I make of it.

Does it relieve stress?  The evidence that it works any better than drinking a glass of milk is negligible. Tha advertising is grossly misleading and the price is extortionate.

Corruption of science.  There is a more interesting aspect than that though.  The case of lactium isn’t quite like the regular sort of alternative medicine scam.  It isn’t inherently absurd, like homeopathy.  The science isn’t the sort of ridiculous pseudo-scientific ramblings of magic medicine advocates who pretend it is all quantum theory The papers cited here are real papers, using real instruments and published in real journals,

What is interesting about that is that they show very clearly the corruption of real science that occurs at its fringes,  This is science in the service of the dairy industry and in the service of the vast supplements industry.  These are people who want to sell you a supplement for everything.

Medical claims are made for supplements, yet loopholes in the law are exploited to maintain that they are foods not drugs.  The law and the companies that exploit it are deeply dishonest.  That’s bad enough. but the real tragedy is when science itself is corrupted in the service of sales.

Big Pharma and the alternative industry. Nowhere is the slose alliance between Big Pharma and the alternative medicine industry more obvious than in the supplement and nutriceutical markets. Often the same companies run both. Their aim is to sell you thinks that you don’t need, for conditions that you may well not have, and to lighten your wallet in the process. Don’t believe for a moment that the dark-suited executives give a bugger about your health. You are a market to be exploited.

If you doubt that, look from time to time at one of the nutraceutical industry web sites, like nutraingredients.com. They even have a bit to say about lactium.  They are particularly amusing at the moment because the European Food Safety Authority (EFSA) has had the temerity to demand that when health claims are made for foods, there is actually some small element of truth in the claims.  The level of righteous indignation caused in the young food industry executives at the thought that they might have to tell the truth is everywhere to see. For example, try Life in a European health claims wasteland.  Or, more relevant to Lactium, Opportunity remains in dairy bioactives despite departures. Here’s
a quotation from that one.

“Tage Affertsholt, managing partner at 3A Business Consulting, told NutraIngredients.com that the feedback from industry is that the very restrictive approach to health claims adopted by the European Food Safety Authority (EFSA) will hamper growth potential.”

“Affertsholt said: “Some companies are giving up and leaving the game to concentrate on more traditional dairy ingredients.”

### Science and government policy

It may not have escaped your notice that the sort of low grade, corrupted, fringe science described here, is precisely the sort that is being encouraged by government policies. You are expected to get lots of publications, so never mind the details, just churn ‘em out;  The hundreds of new journals that have been created will allow you to get as meny peer-reviwed publications as you want without too much fuss, and you can very easily put an editorship of one of them on your CV when you fill in that bit about indicators of esteem.  The box tickers in HR will never know that it’s a mickey mouse journal.

### Follow-up

Boots own up to selling crap

Although this post was nothing to do with joke subjects like homeopathy, it isn’t possible to write about Boots without mentioning the performance of their  professional standards director, Paul Bennett, when he appeared before the Parliamentary Select Committee for Science and Technology..  This committee was holding an “evidence check” session on homeopathy (it’s nothing short of surreal that this should be happening in 2009, uh?).  The video can be seen here, and an uncorrected transcript.   It is quite fun in places.  You can also read the written evidence that was submitted.

Even the Daily Mail didn’t misss this one. Fioana Macrae wrote Boots boss admits they sell homeopathic remedies ‘because they’re popular, not because they work’

“It could go down as a Boot in Mouth moment.

Yesterday, the company that boasts shelf upon shelf of arnica, St John’s wort, flower remedies and calendula cream admitted that homeopathy doesn’t necessarily work.

But it does sell. Which according to Paul Bennett, the man from Boots, is why the pharmacy chain stocks such products in the first place.

Mr Bennett, professional standards director for Boots, told a committee of MPs that there was no medical evidence that homeopathic pills and potions work.

‘There is certainly a consumer demand for these products,’ he said. ‘I have no evidence to suggest they are efficacious.

‘It is about consumer choice for us and a large number of our customers believe they are efficacious.’

His declaration recalls Gerald Ratner’s infamous admission in 1991 that one of the gifts sold by his chain of jewellers was ‘total crap’.”

The Times noticed too, with Boots ‘labels homeopathy as effective despite lack of evidence‘.

Now you know that you can’t trust Boots. You heard it from the mouth of their professional standards director.

A commentary on the meeting by a clinical scientist summed up Bennett’s contribution thus

"Paul Bennett from Boots had to admit that there was no evidence, but regaled the committee with the mealy-mouthed flannel about customer choice that we have come to expect from his amoral employer."

Well said

The third session of the Scitech evidence check can be seen here, and the uncorrected transcript is here.  It is, in a grim way, pure comedy gold, More of that later.

### 31 responses so far ↓

• 1 zeno // Nov 26, 2009 at 22:56

What’s that at the bottom left of the packet of Equilibrium?

“Effective formulations by Boots nutritionists”

Sounds like a claim of medical efficacy to me. Trading Standards anyone?

• 2 twaza // Nov 26, 2009 at 22:57

Paul Bennett should get some kudos and support for being honest. It is an astonishingly rare quality. His employer is probably punishing him more than sufficiently for spilling the beans.

• 3 neoconnell // Nov 27, 2009 at 08:55

Poor Paul Bennett! In comparison to the appalling performances of other pro-ho advocates on the panel he was at least relatively transparent.

What was fascinating from some of the others was seeing how possible it is to hold 5 contradictory positions at one time in order to defend the indefensible.

Watching Ernst politely smirking in the background of the first half made my evening!

It struck me though that without a background in the sciences how do the panel separate the truth from the bull? At least we have Dr Harris MP

• 4 Margaret // Nov 27, 2009 at 10:25

I stay out of Boots these days. People assume Boots can be trusted and if they are selling something then it must be good/helpful.

Most of the non-scientists I’ve ever worked with don’t need any publications to substantiate their beliefs. Their evidence seems to come from ‘promotions’ in shops and elsewhere. Science is not in nice gold-lettered wrappings so the public give science no credit.

Those papers are there for the few who want the evidence but don’t have the time to follow-up. Like most of us.

neoconnell makes a good point. The majority of politicians don’t understand science, just like the public they represent.

• 5 David Colquhoun // Nov 27, 2009 at 11:16

I agree, Paul Bennett was relatively honest and it would be fascinating to know if he gets into trouble for that.

It wasn’t the main point of this post though. While I’m 100 percent in favour of open access to the results of research, it hadn’t occurred to me before that the ‘author pays’ system is open to serious corruption. It provides a direct incentive to the publisher to publish any old rubbish and could be thought of as a form of vanity publishing.

It seems to me that peer review is badly broken, at least at the bottom end of the quality spectrum. It is worse than useless because “peer-reviewed” is used to give credence to rubbish.

I don’t know quite how it will work, but I can see little option but to go for self-publication in the future, with all data on-line. Let the reader be the referee, and save a great deal of money. Any system that puts Elsevier and Bentham out of business has to be an improvement.

• 6 Claire // Nov 27, 2009 at 12:02

With ostensibly ‘peer reviewed’ research validating dubious health products which are then offered for sale in trusted entities such as pharmacies, is it any wonder lay people are bamboozled by health claims and confusion reigns under the banner of consumer choice? People are being encouraged to see pharmacists as their first point of contact for the NHS and there are plans for them to deliver services such as vascular checks in the community – http://www.medicalnewstoday.com/articles/139825.php – so the public is being encouraged to trust in their clinical knowledge and status as health professionals. I find this difficult to reconcile with the arrays of homeopathic products and questionable food supplements on display in every pharmacy I have visited.

• 7 Mojo // Nov 27, 2009 at 12:26

Re the Times headline (“Is Boots’s new Lactium pill the solution to stress?”).

I think it’s a fundamental law of journalism that if a headline is in the form of a question, the answer is almost invariably “no”.

• 8 lactium // Nov 27, 2009 at 16:18

WOW YOU PEOPLE REALLY DO NOT KNOW WHAT YOU ARE TALKING ABOUT AT ALL.

May I suggest you contact me to clarify the product Lactium – which has several clinical studies to prove it efficacy. You can NOT compare it to milk – this comment shows your total lack of knowledge about this product hence you should not be so critical, at least till you have more facts.
Look forward to hearing from you.

• 9 Dr Aust // Nov 27, 2009 at 17:11

“What was fascinating from some of the others [in the HoC Ctte h'pathy debate] was seeing how possible it is to hold 5 contradictory positions at one time in order to defend the indefensible….”

Hmm. Are you talking about Dr Peter Fisher? I have often thought that his powers of Doublethink must be of 9th Dan / Sensei proportions (if I may mix my metaphors).

• 10 BadlyShavedMonkey // Nov 27, 2009 at 23:33

We vets have been on the receiving end of a fairly hefty promotional push for a product called Zylkene;

which seems to exist in that same evidence void.

The particularly troubling thing for me is the way this has been promoted as if it is a medicine by a company that produces licensed medicines, so you have to have your wits about you to spot that this is actually a nutraceutical that neatly sidesteps any requirement to demonstrate efficacy.

• 11 David Colquhoun // Nov 27, 2009 at 23:52

@lactium

Thanks for telling me (in capital letters) that I don’t know what I’m talking about. It’s a pity that your complaint wasn’t a bit more specific.

Are you disagreeing with my interpretation of the published evidence, or have you got new evidence?

If fhe latter, I’m always ready to listen to new evidence so please tell me about it

• 12 David Colquhoun // Nov 28, 2009 at 16:11

No response from Lactium?

I guess that, unlike academics, employees of supplement companies don’t work at weekends

• 13 Margaret // Nov 29, 2009 at 08:03

I’d prefer to see far less publishing – quality not quantity!

I had a wonderful genetics prof. His mantra for both life and genes is very much the same:

You get what you selected for. The problem is, you don’t really know what you are selecting for until you have the data and you look at it.

Selecting researchers on the number of publications may have to led to lots of guff papers!

May I suggest the equivalent of a viva prior to proceeding to sending off a manuscript for publication. Yes, and every author should attend.

• 14 David Colquhoun // Nov 29, 2009 at 09:24

@Margaret
You are right, of course. Far too much is published.

Academics come under constant pressure from bone-headed bean counters to show that they are “productive” and that they are having “impact”. Their promotion, and sometimes their jobs, are dependent on acquiescence to these silly and counter-productive demands.

The blame lies largely with these managers who are usually more-or-less failed scientists themselves, or, still worse, HR people with no knowledge of science at all.

They have corrupted a noble enterprise, and most scientists are too afraid that their career prospects will be harmed if they stand up and say so. It’s easy to blame them for being so pusillanimous, but they have mortgages to pay and children to bring up, I guess their passive acquiescence in the system is understandable.

Luckily, just as there has been a revolt against pseudo-science in recent years, I see signs of a revolt against the sorts of managerialism that have brought us to this situation.

The financial crunch could even be helpful if it results in firing of the legions of hangers-on that now populate universities. On the other hand, given the abysmal quality of most vice-chancellors, it could be that they’ll just fire all those pesky scientists who insist on using their brains, and just let HR run the whole show.

• 15 Dr Aust // Nov 29, 2009 at 13:21

I would place a large bet that the redundancies in UK Univs will overwhelmingly be academic ones, DC. Managers look at the fraction of the total wage bill that goes on different grades / roles. What they see is that the biggest chunk of Univ wage bills is for lecturers/senior lecturers over 40 years of age (i.e. broadly at or near top of the relevant pay scales). There are a lot of these people, so a large total wage bill for them – ergo they are the ones to thin out. Plus as there are so many of them, plenty of others in the same grades to cover the workload.

Can’t “thin out” senior Professors, far too important to Univ reputation. (And they are more likely to be involved in deciding who to target for redundancy)

Can’t thin out administrators, far too important as are all either carrying out “important statutory roles” (as we were told by one important administrator recently), or doing scut work for someone doing same. or busy deciding where the axe should fall.

Re academic job losses, the managerial logic goes that if you cut the “least productive” (in perceived research terms, see last two comments), nothing will change but the student:staff ratio, see e.g. numerous recent articles in the Times Higher.. And a popular idea in the managerial echelons is that this can be “spun away” by claiming that traditional student-staff contact is “outmoded” in the “internet age”. Expect to see many Vice-Chancellors in the next few months making ringing statements about “personalising the student experience” through “enhanced on-line learning”.

• 16 Margaret // Nov 30, 2009 at 08:52

I’m an ex-scientist; I stood up, hung up my lab coat and and walked when I realised I just couldn’t stomach the management games (I didn’t have a mortgage, but I’d still invested so much).

Just what is ‘productive’. How can you measure it in terms of science? And should it even be measured? All that intellect and yet we can’t find a way of organising academia!

Imagine a police officer being given a three year contract and then being given renewal on the basis of arrests or crimes solved. You get what you select for! We wouldn’t allow it in so many other spheres yet in science that is what happens – then promote them, give them research grants, let them hire postdocs, and supervise graduate students!

Why be surprised at the appearance of “corruption of real science that occurs at its fringes”? That is one of the things selected for, albeit unintentionally.

Dr Aust,

I agree that the redundancies will be academic ones on the whole. The drums have been telling me one or two uni’s are already clearing out researchers this year. Most of my postdoc friends still in academia are frightened, miserable and entirely let down. Their passion has gone, pulped out of them.

And as for online learning. I’m so glad I went to Uni where I did and when I did. To have online learning would have been robbery, robbery of everything an inspiring education should be. Just watch. There will be more ‘training’ rather than education too.

• 17 Beauty « cbtish // Nov 30, 2009 at 11:21

[...] Another story is about Boots’ mis-selling of a food supplement called Lactium, which they pretend can help to alleviate stress. This is a more important story for patients with mental health problems, because it’s a story about mental health science gone wrong, about bad science being used for commercial gain: Does it relieve stress? The evidence that it works any better than drinking a glass of milk is negligible. Tha advertising is grossly misleading and the price is extortionate. [...]

• 18 Lindy // Nov 30, 2009 at 12:27

@Margaret

The sad -and infuriating – thing is that this applies also to the way the NHS is being treated, in particular primary care. For the past year at least GPs have been under attack from the Dept of Health. The latest, concerning staff cuts and tellling medics that they must be ‘more productive’ is seen here:

http://www.healthcarerepublic.com/news/bulletin/DAILY_NEWS/article/969760/?DCMP=EMC-BreakingnewsfromHealthcareRepublic

And here is a slightly shortened version of my response to that post as I would make the same sort of response to the way academic staff are being treated.

“Sorry, this brings out a rant from me.

“What do they mean by ‘more productive’? Sell more drugs? Make sure there are plenty of interventions, tests, scans so that companies providing these services make more money?

“Much of the work of doctors, especially GPs, cannot be quantified in management-speak or human resources and their rollocks tick-box approach.

“So how about saving money by cutting out all the self-important sounding managers and the management consultants employed by PCTs, stop using private firms as ‘providers’, stop expensive and deceptive PFIs and ‘leadership’ (the latest HR buzzword) programmes. I suggest all these daft NHS interlopers take unpaid holidays for reflection on what medicine is about so that they might just for once listen to the medical profession and learn something. If they still don’t understand, then they could stay away”.

• 19 Margaret // Nov 30, 2009 at 19:50

@Lindy

Hope the rant made you feel better! And you are right.

It’s happening to teachers (my cousin rants) and to the police – my brother can retire next year, and with another 15 years of work left in him, he’s decided to take the pension rather than deal with, wait for it, managers who can’t and won’t use handcuffs! Not the dangers of the job, like criminals with guns, baseball bats and knives, not the constant stream of victims, but incompetent managers who couldn’t organise a game of bingo!

And they can keep their little mittens off my GPs – two of them are the best things since sliced bread.

• 20 Homeopathic Review: Putting the Boot In « God knows what… // Dec 3, 2009 at 08:34

[...] there is evidence that they are effective. On top of those, the ever vigilant Prof. David Colquhoun discussed the admission in a follow up to a post discussing Boots shoddy standards of [...]

• 21 drsquared2b // Dec 3, 2009 at 22:39

Wow! I was really excited to read your article on my lengthy (first capital connect cursed) commute to outer suburbia – though that is another topic entirely. I have become increasingly suspicious of the aforementioned company. How can you be both a reliable chemist and be pushing this rubbish?

Frankly, I regard all this homeopathy/herbal nonsense as an insult to the NHS, and I honestly don’t know what to say to patients when they come in (as they often do in my current location on the muesli belt), demanding it. Short of doing a mini-mental state examination to determine if they’ve taken leave of their senses, I am so stunned by the ludicrous suggestion that anyone would want to take some totally unproven, untested and potentially unsafe substance as opposed to some nice, safe, NICE approved and evidence-based medicine, that I am rendered completely speechless through a total lack of anything polite to say. Perhaps we should all be a lot less polite about it and meet people head on.

While it would be unprofessional to say what I think to a patient, I am evidently free to share my opinion with my parent’s friends – should they ever (with decreasing frequency) mention getting some alternative therapy instead of what their GP recommended. What makes them think they know better? If you explain there is no evidence and no safety data, they just give you (the person with the training) a condescending look indicating that you are both ignorant, and in cahoots with the government/NICE (as if!). I just can’t understand how in this day and age we are busy turning NHS funding over to homeopathy. It is so wrong, and against everything the NHS and evidence-based medicine stands for. I might not be able to be strident with the patients, but I am trying to create a bubble of enlightenment in my vicinity.

• 22 Lindy // Dec 4, 2009 at 11:55

@drsquared2b

Try this from Phil Peverly in ‘Pulse’ for how to deal with woo-seekers in your surgery:

http://www.pulsetoday.co.uk/story.asp?sectioncode=20

• 23 Dr Aust // Dec 4, 2009 at 17:05

Yes, the homeopathy “debate” is going strong over at Pulse. If you type “homeopathy” in their search box you get a bunch of articles. The most recent is one on the Minister of Health’s dismal performance at the House Science & Technology Ctte hearing.

• 24 Dangerous Conventional // Dec 5, 2009 at 15:42

I dare say that products like Lactium have a poor evidence base and homeopathy is little more than a placebo but please can we have a serious debate about conventional OTC products which are actually harmful or even down right dangerous. Take effervescent co-codamol. Eight tablets have the same amount of sodium as 8g of salt. I wonder how much hypertension/heart failure is induced by this manure (OTC and prescribed) He, 2003.The codeine 8mg is insufficient to provide analgesia but causes constipation.I could go on about cough medicines and decongestants but what’s the point.I think the folks on this site are too blinkered in bashing natural medicines to look at their own practices.
He, F. J. and MacGregor G.A. (2003) How far should salt intake be reduced? Hypertension 42:1093-1099.

• 25 Allo V Psycho // Dec 8, 2009 at 12:28

I know I shouldn’t, but:

Dangerous Conventional.

Yes, OTC and prescription medications can be dangerous. Since the Universe was not designed for human benefit, a bioactive substance which has a beneficial effect on one problem is likely to have side effects on others. Frequently, the ‘side effect’ is an unintended consequence of the main effect. Rational medicine is about making risk/benefit calculations. Five years of demanding study as a student, followed by two years of supervised practice as a junior doctor is required as a minimum starting point for the very brightest of our young people, and even then, errors still happen, and risks still exist. A good OTC example is paracetamol: effective as an analgesic, safe in normal use, lethal in overdose. This is the subject matter of pharmacology research and pharmacy practice. It does not require routine comment in this blog, because Professor Colquhoun has spent a highly successful lifetime in pharmacological research and teaching, where these issues are central. He chooses to devote this particular blog to ‘Improbable Science’, of which alternative medicine is a major, but not the sole, source. He does also excoriate poor practices in the pharmaceutical industry and healthcare arenas, rather more effectively than you do.

Compare rational medicine with alternative medicine, where, after less demanding selection procedures, practitioners at best spend three years in courses of laughable rigour and sometimes dangerous content, as evidenced by Professor Colquhoun. Herbal preparations can be bioactive, but with ingredients of unknown provenance or dose, which are therefore dangerous in themselves: homoeopathic preparations contain nothing, so do not pose dangers of use, but rather dangers of misdiagnosis, or delay or abandonment of evidence based treatment. Indeed alternative practitioners of all kinds are completely unqualified to make diagnoses of pathologies, and therefore all offer risks of misdiagnosis.

I think if you actually read and reflected on this site, you would see that it does not take a narrow view. Do you agree that the same standards of evidence of efficacy and safety should be required of all medical preparations and claims?

• 26 Mass placebocide attempt. The 10:23 campaign // Feb 4, 2010 at 22:32

[...] Boots is deeply involved too in the great ‘detox’ scam, as recounted, for example, in “Detox”: nonsense for the gullible, along with the Prince of Wales.  And, most recently, Lactium: more rubbish from Boots the Chemists. And a more serious problem. [...]

• 27 smcg1983 // Feb 15, 2010 at 23:54

Why are you so judgemental against all pharmacists? I have been reading this site for about an hour and have read nothing but insults againsts pharmacists, mainly directed at boots pharmacists but either way! I am in my final year studying pharmacy and although I do not personally like boots as a company I think that their pharmacists are well educated individuals. I agree that homeopathy is a load of quackery and I personally will not be recommending it to anybody when I finish. I am a scientist before I studied pharmacy and know that homeopathy defies all of the laws of physics etc so therefore would feel it is unethical for me to ever advise such a preparation. However, should I be unlucky enough to ever end up working for a big company like boots I would not have much choice as to whether it is on the shelf or not and if people want to but it that is their problem. Pharmacists are not homeopaths or experts in alternative medicines but they are very educated professionals in conventional medicines and I do not think the way you are speaking about them here is fair at all. Fair enough attack the multi- corporations, they are the ones putting them on the shelves but I can assure you I do not know any pharmacist who would go out of their way to recommend an alternative treatment.

Dont tar us all with the one brush and open your eyes and realise it is not the pharmacists at boots fault it is the stake-holders who are raking in the profits (you should know boots are the worst payers of pharmacists in the UK also…). Not the point but realistically most boots pharmacists are unhappy in their jobs with boots! Bring back the independent pharmacies and I guarantee you things would be different.

Anyway just wanted to point out that I dont think anybody stupid can get a degree in pharmacy like you are making out here. Everybody know about rehydration salts so I dont know what you were implying by that. Maybe you should take a look at your own profession, or lack of, before you start critisising others…..

• 28 David Colquhoun // Feb 16, 2010 at 00:15

@smcg1983
Hang on a moment, I didn’t say anything about all pharmacists. I’d love to know how many pharmacists would react like those that I asked, but I have no idea. All I say is that in my own, very limited, experience, the pharmacists that I encountered were not up to your standards. It looks to me like a prima facie case for further investigation.

What I can say with considerable certainty though, is that Boots’ advertising campaigns for Lactium, coQ10 and vitamins are deceptive and, in my view dishonest, The fact that Boots sell homeopathic pills while admitting there is no reason to think that they work is also disgraceful. The highly ambiguous guidance given by RPSGB is equally shocking.

These things make life very difficult for an idealistic and well-educated young pharmacist such as you. You are being let down badly by your elders. I can understand the difficulties that a pharmacist is in if asked for advice about something that has been advertised heavily by your employer. It can’t be easy to tell a customer that the company’s advertising campaign is deceptive and that they should save their money.

• 29 Rondog // May 10, 2010 at 16:33

This product is also marketed for pets, under the name Zylkene, and is going to be included in a range of pet foods. Zylkene is marketed in the UK by Schering-Plough, and it is getting a lot of support by vets who seem incapable of understanding that it is unsupported by proper evidence. There are two published trials in animals, both of which are flawed.

Apart from a lack of efficacy, there should also be concerns about safety, and whether these drugs should be classes as “foodstuffs”. There is basic toxicology data, but nothing about immune modulation effects that could have longer term health consequences.
Also, whilst this drug is a natural product of milk digestion, this is only substantially true in infants, and no comparative work has been done to check how the human tryptic breakdown products of casein compare with those from cows milk. How can this product be considered safe or natural, when it is clearly neither. There seems an absolute unwillingness of governments to regulate this area properly.

• 30 henry354654 // Jan 21, 2013 at 05:40

*I had been a pot smoker for 25 years, couldn’t find anything that replaced the feeling in any other drug.  Tried everything, even RC’s for last 2 years, Research Chemicals, legal here in New Zealand, such as MAM-220, JWH-018, dozens of them.  Sometimes up to 4grams a day sprayed on Damiana leaf sold as Pot alternatives in the local brewing shop. Bitter orange extract and other stuff included from talking to people in the manufacturing (no ingredient lists!) revved me up to much, as it is like meth in effect, lost weight etc, not my mind though, am a computer analyst, and still am. My point is this Lactium saved me from wasting my money and health as soon as the first dose.  I took 2 caps a day – 140mg Latium (alpha Casoepine enriched, how much, who knows) also including Zizyphus 4.5grams, sold as a product here in NZ at the supermarket. NEVER makes me sleepy, just knocks the anxiety on the head and buzzes me out for up to 5 hours at a time.  Makes me feel like I had a big weed session the day before and am still gliding. I now don’t drink, smoke or even feel the need for coffee!  No kidding, this stuff rocks. I get high on it if I also have 200mg of Korean Panax Ginseng extract 1/2 to 1 hour AFTER the Lactium.  I can’t believe this has the effect it does, no tolerance, no come-down, no brain fog.  I feel happy and productive and can focus like never before, and I was a real hard worker before this too on weed.  Bicycled 10km a day before it and still do. Research or not, if you have an ‘A’ type personality, and need ‘stuff’ to wind down on, then try this. No I don’t work for Boots, it’s not here in NZ, or the company that sells it.  Apparently it (certain product) is the biggest selling sedative, err, sleep aid, in Australia. My doctor would not put me on any drug, nor have I ever been prescribed mental illness tablets of any kind ever. I did ask, but wasn’t a candidate, as I had/have never suffered from any mental illness, just liked getting real high all the time. And now I still can if I want, thanks to Lactium and Panax Ginseng, just have a bigger dose! I’m happy to be quizzed on this if anyone would like to, just ask.

• 31 henry354654 // Jan 21, 2013 at 05:47

*What I am trying to say is that I am no longer a Drug abuser, at all, because of Lactium, and supporting extracts mentioned, period. I now only have 1 cap (75mg) every 4 days or so and use Panax for a rev up if weight training or cycling every 2-3 days.