The random thoughts of a sceptical activist

Boots the Alternative Chemist

Just two days ago, a fellow Twitterer, Yogzototmentioned a rumour that Boots had removed their homeopathic potions from their shelves.

I emailed Boots, seeking confirmation of this rumour. I got a reply at 09:55 this morning, New Year’s Day!

Thank you for contacting us regarding the rumour that we are going to discontinue selling homeopathic remedies.

Please allow me to dispel this rumour. Currently we have no plans to stop selling homeopathic medicines.

We aim to provide our customers with a wide range and variety of medicines and whilst there continues to be customer demand we will do our uptmost to meet the demand.

I hope this information has been helpful to you and thank you for taking the time to get in touch. If there’s anything else I can do for you, please don’t hesitate to contact me personally on the number below.

So, they haven’t (yet!) decided to do the decent thing and remove the useless products from their shelves. I decided that their answer needed a further response:

Thanks for your prompt reply.

I am disappointed that the rumour is not true.

I sat just a few feet away from your Professional Standards Director, Paul Bennett, when he confessed to the House of Commons Science and Technology Select Sub-committee looking at the evidence for homeopathy that Boots had no evidence that homeopathic potions were efficacious. The video of it all can be found here if you’ve not already seen it. Paul Bennett’s admission is right at the start, but the whole session is well worth watching this as is the second session.

There are several accounts of the session and I can recommend this first-hand account.

His ‘Ratner moment’ (as it’s been described in the press) put Boots in an untenable position: they have admitted that there is no evidence that they work and that they just sell them because they can make a profit from a gullible and unsuspecting public who are less aware or totally unaware of that homeopathy is pseudo scientific quackery.

I’m sure Paul Bennett is well aware now (even if he wasn’t a few months ago) that it’s not just the case that there is no evidence that homeopathy works; it’s also that there is good evidence that homeopathy doesn’t work over placebo. Homeopathy doesn’t need any more testing to find out if it has an effect. The tests have already been done and no good trial has shown any effect over placebo. The fact that there is no plausible mechanism by which it could work is another insurmountable hurdle.

I am well aware that everything that Boots sells is sold to make a profit: that’s what you’re in business to do. But this isn’t shampoo or shavers or hair straighteners we’re talking about. It is far more serious that just conning a gullible public because it has to do with people’s health.

It is clear that Boots does care about people’s health and that they are the most respected and trusted high street brand when it comes to healthcare – respect and trust that’s been handed down through several generations. It is because of this that your attitude to homeopathy is so vitally important.

Selling homeopathic potions alongside conventional medicines misleads the public into thinking it is another form of medicine: different perhaps, but another mode of curing all sorts of medical conditions. They are even marketed as ‘natural’ even though there is nothing natural about them or their manufacture.

Everything about the way they are marketed is designed to make the public believe they are real medicines with real pharmacological effects. Some have MHRA approval (even though proof of efficacy is not required to gain that approval); they have MHRA product licence numbers; they have copycat patient information leaflets; they list hazards and cautions; they list (non-existent) ingredients (even though the only ingredient is sugar); they make claims about what they can treat. They look every bit like a proper medicine.

Look at what you say about one of your homeopathic potions:

“Boots Nux. Vom. 30c Pillules is a homeopathic medicinal product without approved therapeutic indications.”

That is particularly curious wording; but wording that homeopathy proponents managed to get the MHRA to agree to a few years ago. Do you really think that your average customer understands what that really means? The wording was deliberately conjured up to tell customer that it doesn’t work for any conditions, without actually having to say that it doesn’t work for any condition. Do you agree with me that most of your customers will read that and will have no idea what it is supposed to mean? They may even see it as some kind of endorsement. They will simply be swept along by the marketing, the presentation, the packaging and the trust they put in the Boots brand.

Does it really matter? If someone has a cold, then if they want to waste £5 or £10 of their money taking a homeopathic potion, there’s little harm done (but they are still being conned and misled). But it will have no effect whatsoever on the progress of their infection. There is no ‘alternative’ medicine, just medicine that works.

However, it is more serious than that. I suspect many who buy OTC homeopathic remedies do so once or occasionally, but there will be some who start to think that they really do work. There are lots of well-established reasons why this might happen and this is not the place to go into them. However, some of your customers will be misled into believing that there is a sound evidence or scientific basis for homeopathy and will start to think they can rely on homeopathy for many or all medical conditions. It only takes a few moments of looking at the Internet to find examples of utterly bizarre anti-scientific and scientifically ignorant pro-homeopathy websites that build on the ignorance and gullibility of the public.

Homeopathy is dangerous and homeopathy kills. Granted, the sugar pills themselves are not dangerous (unless you have an acute sensitivity to sucrose and assuming a reasonable care in their manufacture), but there are many examples of real harm being caused by the belief in homeopathy. For instance, see the examples given here. People die because of their misplaced belief in homeopathy.

I’m sure you’ll say that that has nothing to do with Boots. You are probably right in some respects, but that takes us back to what I said earlier about the trust people have in the Boots brand.

I note your website says:

Our customers are at the heart of our business. We’re committed to providing exceptional customer and patient care, be the first choice for pharmacy and healthcare, offer innovative products ‘only at Boots’, with great value our customers love. Source.

Boots does have a responsibility to its customers to provide them not necessarily with choice per se, but to provide them with products that are sound and to stop offering product that Boots knows do not work. And ‘innovative products’ should not extend to ones that don’t work.

There can be no value other than profit in selling to customers products that have been proven not to work. Would you sell a hairdryer that had no heater or motor in it? This ‘alternative’ product may have several advantages over ‘conventional’ hair dryers: it looks like the real thing; it is lighter; lower power, certainly; it doesn’t have to be rigorously tested; it is cheaper to produce and it offers the customer that (over-used) ‘choice’. The difference here is that it will be immediately obvious to a customer who bought one of these ‘alternative’ hairdryers that it doesn’t work. But it’s not the same with homeopathic potions and health. Many conditions are self-limiting and cyclical, and people are easily fooled by their own beliefs and senses and they are rarely in a position to make an unbiased judgement. See Why Bogus Therapies Often Seem to Work by Dr Barry Beyerstein and Why do ineffective treatments seem helpful? A brief review for further details of this phenomenon.

All this gives Boots another problem: what does your qualified pharmacist say to a customer when asked about a homeopathic product (as you encourage them to do)? The awkward position you have put them in is well illustrated by this account about overdosing (an utterly bizarre concept). They well know that homeopathy is sheer pseudo scientific nonsense, yet what do they say to customers who ask them for advice on the most suitable homeopathic potion for their condition or what the side-effects are?

Homeopathic potions are marketed as if they were proper medicines. It is clear that they are not and Boots is knowingly misleading their customers and continuing this deception.

I urge you to reconsider and to withdraw all homeopathic products as soon as possible.

If you require any further information, please do not hesitate to contact me.

I look forward to receiving your response.

Best regards.

I’ll let you know what reply I get.

Update: 02 January 2010

A brief reply from Boots:

Thank you for contacting us again.

I have passed a copy of your email to our pharmacy team, so they can read your comments and discuss this feedback at their next review.

It’s interesting that they are sending it to their pharmacy team, not some other marketing team.

Update: 15 January 2010

Not sure if their last reply meant they were trying to put an end to me bothering them, I prompted them yesterday, asking:

Can you tell me if there has been any progress on this? When is your pharmacy team’s next review?

I got a response this afternoon:

Unfortunately, we do not receive direct feedback from our Pharmacy Team of the outcomes of their review meetings and so unfortunately, we will be unable to share this with you. Anything that has been discussed will be considered commercially sensitive information and any public information will be released in due course. I do apologise for any inconvenience that this may cause you.

Thank you for contacting us about this. If you have any other queries, please do not hesitate to contact us again.

I didn’t hesitate:

Thank you for your reply. I find it unsatisfactory, however.

I raised some important questions in my email and I am disappointed that I have had no answers to any of them. I would be grateful if you could tell me how I can take this matter forward and get those answers so that I can understand Boots’ position on this important topic.

Bated breath, and all that.

Update: 20 January 2010

After prompting this morning, I got the following response from a Boots’ Senior Customer Manager:

I have been passed your recent emails regarding Homeopathic products.

I would again like to assure you that at Boots we take our responsibilities as the leading Pharmacy-led Health & Beauty retailer in the UK very seriously and as part of this we are committed to providing our customers with a wide range of healthcare products to suit their individual needs.  We know that many people believe in the benefits of complementary medicines and we aim to offer the products we know our customers want. All our products in this range are labelled in accordance with MHRA guidance.

Our Pharmacists are trained healthcare professionals and are on hand to offer advice on the safe use of complementary medicines. The Royal Pharmaceutical Society of Great Britain issues guidance to pharmacists on the correct selling of homoeopathy, which our pharmacists adhere to. We would support the call for scientific research and evidence gathering on the efficacy of homoeopathic medicines as this would help our patients and customers make informed choices about using homoeopathic medicines

We take the concerns of all of our customers very seriously and we thank you for the time you have taken to give us this feedback.

I will be responding…

Update: 21 January 2010

My response to Boots:

Thank you for taking the time to respond.

I still don’t think my concerns and questions have yet been answered or even taken seriously.

However, I would like to respond to some of your comments you raised.

You say you are: “committed to providing our customers with a wide range of healthcare products to suit their individual needs.” How can a homeopathic product ‘suit their individual needs’ when they have no effect over placebo (as admitted by your Professional Standards Director, Paul Bennett). What need does that satisfy? It cannot even be considered a ‘healthcare product’ if there is no healthcare benefit!

There is also the problem that homeopaths tout homeopathy as ‘individualised’. The supplier of your products (including the Boots own brand) is Nelsons and on their website, they say: “The whole person must be taken into consideration when choosing a remedy.” How can this seemingly fundamental principle of homeopathy be followed if members of the public are able to select whatever homeopathic product they want with a consultation with a homeopath?

“We know that many people believe in the benefits of complementary medicines…”

Perhaps there are many, but this does not alter the fact that there is no scientific evidence for the efficacy of any homeopathic product.

“…and we aim to offer the products we know our customers want.”

I’m sure you must realise that this is taking advantage of your customers: selling them products that will not affect their medical condition. Some would call this unethical.

“All our products in this range are labelled in accordance with MHRA guidance.”

Perhaps, but as I’m sure you’re aware, neither the National Rules Scheme nor the Simplified Registration Scheme are in the slightest bit concerned with efficacy, just that they are dilute enough not to harm anyone. In fact, you no not sell Nelson’s Arnicare range, the only product to have been granted approval under the National Rules Scheme. All the products you do sell are registered under the Simplified Registration Scheme. I note particularly that the MHRA do not allow any therapeutic claims to be made for these products. Do you agree with the MHRA that therapeutic claims should not be made for these products?

“Our Pharmacists are trained healthcare professionals and are on hand to offer advice on the safe use of complementary medicines.”

Since homeopathic products do not have any pharmacological effect (other than a very small chance of problems caused by lactose or sucrose intolerance), what advice could your Pharmacists possibly give for its safe use? I would be intrigued to know.

“The Royal Pharmaceutical Society of Great Britain issues guidance to pharmacists on the correct selling of homoeopathy, which our pharmacists adhere to.”

I am aware that the Royal Pharmacists Society of Great Britain have not followed the evidence and equivocate on this issue, but that has nothing to do with the evidence for the efficacy of homeopathic products nor the ethics of selling products labelled as medicines when they have no pharmacological effect.

“We would support the call for scientific research and evidence gathering on the efficacy of homoeopathic medicines as this would help our patients and customers make informed choices about using homoeopathic medicines”

There has been a lot of scientific research on homeopathy and some would argue there is no need to spend any more money: it has been proven to have no effect over placebo. However, the question that arises from that is what is Boots doing to gather that evidence? It seems that Paul Bennet had not even asked Robert Wilson of the British Association of Homeopathic Manufacturers for the evidence, but are you actively pursuing this evidence that you would like to see?

However, I’m glad to see that you support your customers making informed choices. Can you tell me how your customers can make an informed choice when they are not presented with the facts about the homeopathic products you are selling them as ‘medicines’?

I would urge you to respond to my earlier concerns as well as these and I look forward to receiving your reply.

Best regards.

Update: 22 January 2010

A response from Boots from the same Senior Customer Manager:

I am sorry that you remain unhappy with our position on this matter. I would like to reassure you that your comments and feedback have been fully understood and of course I will ensure these are passed onto our pharmacy and healthcare teams.

I would like to conclude by confirming that Boots support the call for scientific research and evidence gathering on the efficacy of homeopathic medicines as this would help our customers make better informed choices about using homeopathic medicines

…and my reply:

You said: “Boots support the call for scientific research and evidence gathering on the efficacy of homeopathic medicines as this would help our customers make better informed choices about using homeopathic medicines.”

What is it about the existing evidence that you think is inadequate to be able to come to an informed view of the efficacy of homeopathy? Why do you think more research is required?

Since there already has been a lot of research and the best of that indicates that homeopathy does not work, do you not think you have a responsibility to tell your customers so they can make that informed choice you say you want?

If evidence for efficacy does turn up in the future, you can make sure your customers are informed of this at that time.

Meanwhile, your customers are being mislead into thinking homeopathic products are proper medicines, just like the many real medicines you sell. By selling these disproven products, you are misleading your customers and the brand image and integrity of Boots suffers. Does this not concern you?

Thanks.

21 Responses to Boots the Alternative Chemist

  • Thanks for taking the time to persist with this!

    I like Boots – lots of useful things on sale and I pop in there every now and again for things.

    The fact that they’re failing to ‘disambiguate’ herbal from homeopathic does concern me a bit. It seems like cloaking homeopathic products by hiding them next to something that does have some active ingredient in it. I’m not sure if this is by accident or design.

    I think you have a very nice analogy against the misuse, in this instance, of patient choice.

    Can’t help wondering though, if the products were removed, would this be exploited as being ‘because they’re super-effective (secretly) and big pharma is scared of them’ ;-)

    I’d rather Boots had a section within its ‘alternative medicine’ for ‘unproven remedies’ with big signs saying “buyer beware” everywhere. Maybe more effective to relegate homeopathy to comic status rather than remove it?

  • Great letter. I hope it gets the desired response. To be honest I can’t see how Boots can persist with their current untenable position. :-)

  • I agree in principle that Boots shouldn’t be conning people.

    However, I think the critical statement in the above letter is “there is good evidence that homeopathy doesn’t work over placebo”, in other words homeopathy often *does* work, in the same way that a placebo does.

    If a placebo works, why not use it? The problem being that if you call it a placebo, it definitely won’t work.

    So in effect, homeopathy is just a means of delivering placebos – it gives them a legitimacy and a high enough price to make most people think they should work, as a result of which they may well actually do some good. But to make them work, Boots has to be dishonest.

    A dilemma indeed.

  • A friend of mine insists that tobacco calms his nerves. He suffers from acute anxiety attacks and self-medicates with cigarettes (and alcohol) so as to “avoid taking drugs” :)

    I wonder though, do Boots stock cigarettes given that there is an obvious demand for them and that they are seen, by some, as an alternative to science-based medicine?

  • Atheist:

    have you for but a moment considered that you have adopted a position against 98% of the human race, both past and present?

    do you think you are RIGHT and they are all WRONG?

    WRONG

    now listen to this arrogant puffed up son of a bitch….

    http://www.youtube.com/watch?v=ilWM7jIEN_k

    little scientist geek who would try to usurp God Himself!!!

    Looks like your website is under attack from supernatural forces…

    http://isgodimaginary.com/forum/index.php/topic,40909.0.html

    you really need to add comment moderation to your blasphemy…

  • zeno btw

    we are going to put you to DEATH ….

  • @atheismisdead “comment moderation”, like foolish threats, has no place in the open exchange of ideas…

    Sure, your position is intellectually bankrupt and you’d need to filter replies to maintain any illusion that it had merit, but that’s not Zeno’s problem.

    idiot.

  • “If a placebo works, why not use it? The problem being that if you call it a placebo, it definitely won’t work.”

    Two points here: one is that Lee Crandall Park tried an open trial of placebo and found that patients reported improvement despite being told they were taking a placebo (link). The other is that a placebo will only “work” if you are measuring (subjective) patient-reported continuous outcomes, especially pain. Even then, the effect of placebo “could not be clearly distinguished from reporting bias and other biases.”

    This is something I wrote about here: The Powerful Placebo.

  • @James Cole: thanks for the links – most interesting. If there is little evidence that placebos actually do any good, then I withdraw my previous comments and agree completely with the original article. Boots should not be peddling homeopathic products without at least making it very clear that there is no clinical evidence that they work.

  • Great letter Zeno. I wonder what Boots pharmacists will do with it.

    Re atheismisdead – if you put Zeno to death, I will sue you. You will find that your resulting legal bills will be far worse than being put to death ;-)

  • Jack of Kent, that is priceless. Thank you for making my evening.

    Zeno, well done.

    Atheismisdead, your comments are obnoxious and silly. You appear to be a twit.

  • Lifelinking

    I’m scared to say anything – JoK may consider he has given me advice and send me a bill!

  • @atheismisdead

    Spoken like a true Christian.

  • Just a thought, but maybe instead of stopping Boots selling overpriced water – perhaps we should encourage them to increase the price?

    Given that research indicates that a more expensive placebo is more effective than a cheaper one – imagine all of the good that could be done by doubling the price!?! In fact, why stop there. Increase the price by a factor of 30 – imagine how incredibly effective that could be!

  • Paul is right If one considers the dilution of a product before it is a homeopathic remedy it is difficult to understand how there is any scientific evidence for this to work as thers is unlikely to be many molecules (if any) of the original product in the final product Where is the scientific evidence

  • They may well have been trying to stop you bothering them. The last response I got from them said “In response to your final comments” – How do they know it’s my ‘final’ comment!

    Actually I have further questions for them that will be on their way at the weekend.

  • Maybe the thing to do would be for someone with a cold/dodgy leg/misaligned chachra to buy a homeopathic remedy and follow the course. When it doesn’t work, to contact Boots and demand redress.

    Boots will, naturally, hide behind the fact that they don’t *guarantee* any of their medicines work, conventional or otherwise. If it were a coventional drug, there would be supporting information they could use to defend their decision to stock it. But since there won’t be for this, you demand to know the reason why they have sold you a drug that they know doesn’t work. Can we then do them under trades description, given their position as a chemist and our reasonable expectation that they wouldn’t sell something that they knew didn’t work? A hypothetical argument is one thing, but might it not have more power if it was an actual upset customer demanding action, going to local trading standards, maybe also appearing on local news?

    Yes I know you wouldn’t atually have to take the potion, though it you did and documented it, then it might be useful supporting evidence.

  • Since homeopaths emphasise that their remedies contain powerful, potentised “water memory”, how do they refute allegations that a proportion of this does not pass right through the patient and enter the water supply/food chain?

    Statistically, the chances that the “right” patient will then be drinking the “right” potentised water (further diluted and strengthened by succussion in its journey through the pipes belonging to Southwest Water or whomever) at some point in the future are surely fairly high?

    Maybe you could include a question about “active ingredients” in your next missive ;-)

  • Isn’t what they’re doing Fraud?

    I went and had a look at the Fraud Act 2006. IANAL, but

    ” Section 2 makes it an offence to commit fraud by false representation. Subsection (1)(a) makes clear that the representation must be made dishonestly. This test applies also to sections 3 and 4. The current definition of dishonesty was established in R v Ghosh [1982] Q.B.1053. That judgment sets a two-stage test. The first question is whether a defendant’s behaviour would be regarded as dishonest by the ordinary standards of reasonable and honest people. If answered positively, the second question is whether the defendant was aware that his conduct was dishonest and would be regarded as dishonest by reasonable and honest people.

    11. Subsection (1)(b) requires that the person must make the representation with the intention of making a gain or causing loss or risk of loss to another. The gain or loss does not actually have to take place. The same requirement applies to conduct criminalised by sections 3 and 4.

    12. Subsection (2) defines the meaning of “false” in this context and subsection (3) defines the meaning of “representation”. A representation is defined as false if it is untrue or misleading and the person making it knows that it is, or might be, untrue or misleading.

    13. Subsection (3) provides that a representation means any representation as to fact or law, including a representation as to a person’s state of mind.

    14. Subsection (4) provides that a representation may be express or implied. It can be stated in words or communicated by conduct. There is no limitation on the way in which the representation must be expressed. So it could be written or spoken or posted on a website. ”

    Seems to me there might be a case…

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