Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Trust Boots
Boots the Chemists (now Alliance Boots) is a very big business in the UK. There have 1,450 pharmacies in the UK and employ over 100,000 people.
I posted the item below a while ago, on the old Improbable Science page. I thought it deserved a bit more publicity, for the following reason. The quackometer has posted about Boots too,
I mentioned it during the debate with Felicity Lee at the British Pharmaceutical Conference (2007) (Ben Goldacre’s interview with Felicity Lee is a gem). After the talk I was approached by two heavies. Well, two men in dark suits anyway. It turned out that one was from Boots and the other from Alliance Pharmacies, now merged to form Boots Alliance. They seemed rather bothered by the fact that I’d criticised Boots, but were not entirely unreasonable. They claimed to be on the scientific side and said they’d investigate the matter. I wrote to the Boots man on 10 September, but got no reply, After a reminder on 29 October, I got this.
| Dear David Thank you for your email and reminder. We have investigated the points you raised in your blog. I was informed that it was an old leaflet and has not been reprinted (to my knowledge). However on a point of principle, I have raised the wider issue of clinical validity in my department. This will take its course through to the commercial/buying team. |
| Dear David Thank you for pointing this out. I’ve had a quick look and it is an educational website looking at all aspects of medicine and therapy, including alternative medicine. It is not a direct sales message to the public. I hope this helps |
Corporate Social Responsibility
Boots web site makes a big point about Corporate Social Responsibility (CSR)
“TRUST BOOTS
As you may have noticed, that’s the tagline which in 2005 we adopted as the sign-off to all our advertising. But it’s much more than just a slogan. It’s a concise statement of our entire corporate strategy. Our aim is to make Boots the world’s best health and beauty retailer, and we’re 100% clear that the unique trust in which we are held provides the key to achieving this. Which means, of course, that those two words are also the rationale for all our CSR activities. Everything we do that builds trust is good for our business; anything which could compromise it, a risk we can’t afford to take.”
Trust Boots to provide straight answers.
At one time. Boots were sufficiently ethical not to deal in homeopathy. But no longer.
When asked for evidence that the things they sell actually work, the Boots help desk is astonishingly coy, as related here (thanks to ebm-first.com for giving publicity to this report).
When Boots were asked about their ‘Alternatives Hayfever Relief Tablets’, the answer came, after some delay, “This is a homeopathic product, further information on homeopathic products is available from the Nelson company who make this
particular product for Boots. ” This company has been making homeopathic products for many years and
may well be able to help you further. You may also find general
information about homeopathic medicines in reference books in the public
library”. The email address that they gave me for Nelson’s did not work, and writing to another Nelson’s address produced no reply at all. Clearly any letter that contains the word “evidence” arouses suspicion and is simply deflected.
Dangerous advice from Boots: a small sting.
I have been into several Boots stores, sought out the most senior pharmacist that I can find, and asked them the following question. “I have a 5 year old son who has had diarrhoea for three days now. Please can you recommend a natural remedy”. The response was interesting. In every case but one, the pharmacist reached for a copy of the Boots pamphlet on homeopathy, and thumbed through it, while desperately, but unsuccessfuly, trying to retain an air of professional authority. Then one or another homeopathic treatment from the booklet was recommended. In only one case out of six did the pharmacist even mention the right answer (GP and rehydration). One pharmacist, who turned out to have qualified in Germany, was very insistent that homeopathic treatment was inappropriate and that I should should start rehydration and take the child to the GP. The other five, including one who had an impressive-looking badge saying “consultant pharmacist”, did not even mention rehydration.
Conclusion The education of the pharmacists was clearly insufficient for them to give reliable advice. On the contrary, their advice was downright dangerous.
Miseducation by Boots the chemists
Boots also run an “educational” web site for children, the ‘Boots learning store’. Click on the section for ‘pupils’, and then ’16+’ and you find their education about alternative medicine (do their pharmacists do this course, I wonder?). The slide show that follows is an insult to human intelligence,
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Then follows a totally misleading slide about enzymes.
There is nothing wrong with the enzyme bit, but the analogy with homeopathy is baseless and misleading. Enzymes don’t work when there are no molecules present.
But in the next slide, enzymes and catalysts are forgotten anyway, This is how it works.
This meaningless mediaeval gobbledygook about ‘vital forces’ is being peddled as ‘education’ by the biggest retail pharmacy chain in the UK. What hope is there for kids?
But there is more. Now for the exam. If you click on the ‘teacher’ section you can download the students’ notes and the test. The ‘Student Notes’ include the following direct claim that homeopathy can cure diseases.
Now take the test, Here is question 1, and the answer.
I suppose that if the educators at Boots classify Hahnemann’s provings as a ‘clinical trial’ it goes a long way to explain the quality of their learning store, and the quality of the advice given by their pharmacists.
Boots Alternatives also sells a “snoring remedy”
The evidence for effectiveness of this herbal product is very dodgy, as described here earlier. This was an interesting saga that involved bad statistics, inappropriate controls and concealed financial interests. It eventually appeared on the BBC Radio 4 programme, You and Yours.
Postcript: “Nurses and pharmacists are to be given greater powers to prescribe drugs”
The foregoing history does not give one much confidence in the government’s latest money-saving wheeze. [BBC]
“The latest measures mean nurses and pharmacists will be able to prescribe treatments for more serious conditions such as heart disease and diabetes – traditionally the domain of GPs.
Health Secretary Patricia Hewitt said: “Nurse and pharmacist independent prescribing is a huge step forward in improving patient accessibility to medicines from highly skilled and well trained staff.”
And Chief Pharmaceutical Officer Dr Keith Ridge added: “For pharmacists, this is the dawn of a new era. It will help transform the public’s perception of pharmacy and the services they deliver to patients.”
This item was first posted on the original IMPROBABLE SCIENCE page.
30 Responses to Mis-education at Boots the Chemist
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I’ve seen the figure of £1.6 billion annual spend on CAM in the UK and this (free full text) article by Ernst et al claims that homeopathy is one of the most popular forms: http://www.mayoclinicproceedings.com/inside.asp?AID=4251&UID= . Is it possible to find out how much Boots make from sales of homoepathic remedies? I’ve also been wondering lately about the demographics of support for CAM and homeopathy. There are some reports indicating that it is a predominantly female, middle class demographic. If this is a group with increasing purchasing power, perhaps it’s not surprising that suppliers are responding to a business opportunity.
Claire you might be interested in this Mintel report which is reported to put the homeopathy market at ~£30m in the UK.
Thanks. Looks like the Mintel report would answer my questions – pity about the £1500 price tag!
Well, I’m amazed by the “Vital Force” page. All they need is to add something about a Midicurian count, give a reference to Obi-wan Kenobi saying that The Force is within us and around us……. but no! Then they’d have to pay royalties to George Lucas, obviously.
Was alerted to this by Ben Goldacre’s miniblog: http://www.smh.com.au/news/national/homeopaths-baby-died-of-infections/2007/11/05/1194117926205.html
A quote from another Boots educational leaflet ‘Vitamins and Supplements ..check it out’ may throw some light on the pharmacists’ natural approach to a baby with diarrhoea,
‘At Boots, we want to help you stay on top of your health by giving you easy ways to learn about your body, keep in peak condition and avoid unnecessary visits to the doctor.’
Strikes me that you don’t know if it’s an unnecessary visit until you’ve see the doctor…
One of the nutrition ‘experts’ cited in this leaflet is Dr Ann Walker…..mentioned before on this site?
Thanks Sarah. That’s an interesting one. I can’t find that on Boots web site, but there is some fine boloney about vitamins and supplements. How about this one?
Notice how it carefully manages to say nothing at all about whether it actually works (it almost certainly doesn’t), while implying that if you take it you’ll be able to stroll up mountains. It is a thoroughly dishonest advertisement.
I used to work as a counter assistant at a pharmacy (not boots) but I never saw the problem with selling homeopathic medicine… After all, what’s the harm in selling placebo?… I see it as no difference to cough mixtures, which don’t work either (except for pholcodeine)… And in my experience none of the pharmacists take it seriously… I dont think your small sting at boots shows much because you specifically asked for a ‘natural tretment’ and it’s biased… I doubt you would have been given the same advice if you had not specifically asked for natural treatment…
As I see it, there are much worse problems with the NHS than homeopathy and vitamins… I now work summarising notes at a GP and I’ve noticed that if you dont go to your GP to get medication then no one will follow it up whereas if you don’t have a vaccination or smear test you’ll get sent 3 reminder letters and will be called numerous times (as practices get paid depeding on smear tests and vaccinations)…
In any case, you should look into the dangerous use of alternative therapies in unlicenced places and not have a go at boots or the royal homeopathic hospital… These places work with western medicine (not against it) and only hopeless cases are referred by GPs such as ‘IBS’ and chronic fatigue syndrome… At worse it’s a waste of money but I think the real problem lies in unlicenced sector… For example, the amount of steroids in chinese herbal medicine and chiropractors… I once met someone who had left sided sciatica and after going to a chiropracter had total left sided foot drop – he couldn’t dorsiflex (move foot up) at all and he could still not walk properly after two orthopaedic surgeries at UCH!…
[…] derive their income from devising treatments for cancer not cancer prevention/ ? any fule know ill children are better off with natural remedies than nasty drugs / MMR causes autism alongside mercury , wheat, dairy and cupcakes / ? anything else, […]
Mac86, you say “what’s the harm in selling placebo”. How about these two reasons. (a) you aren’t (I’d guess) in a position to judge whether there is something that could be done that is more effective than a placebo, and (b) it’s dishonest.
As for my sting, yes of course it was biassed. That was the point of it. The advice I got from all but one of the pharmacists was worse than any decent parent could have given.
With regard to the sting, Mac86, surely the point is that properly trained pharmacists should not have given way to the consumer’s stated preferences in a case where failure to pursue the correct course of action (rehydration, GP) could have had very serious consequences for a young child?
Thinking about this further, the potentially dangerous advice from all but one of the pharmacists makes me worry about the prospects of having a sensible, productive debate on the role of CAM in healthcare. For instance, homeopaths make claims about treating asthma, especially in children e.g. here: http://cambridgenatural.co.uk/_wsn/page12.html . Yet, according to people like Professor Ernst, there is no good evidence for this claim:
“…In another study, Ernst got five homeopaths to examine children with asthma. ‘Children are supposed to respond better than adults to homeopathy, and asthma is said to be particularly responsive to homeopathic treatments,’ he said. ‘However, again we found no evidence that homeopathy worked.’…” http://observer.guardian.co.uk/uk_news/story/0,,1669982,00.html . Other studies have made similar findings, e.g. here: http://www.bmj.com/cgi/content/full/324/7336/520 . So how is a useful debate to proceed?
I am sympathetic to Prof. Ernst’s view that some CAM modalities might have a supportive role in that they promote relaxation and a sense of well being, helping people to cope with symptoms and possibly making them view their medical treatment more positively. And if all CAM therapists restricted themselves to making these kinds of modest claims, that would be fine by me. But many don’t. Returning to asthma, some practitioners of the Buteyko method made extravagant claims, e.g. here: http://www.wellnaturally.co.uk/index3.php?page=book_01 . Now, there is some mildly encouraging but far from complete evidence about this therapy, which is why conventional doctors feel unable at present to make an unequivocal recommendation about it. The response from some therapists is to make insinuations about Big Pharma etc, as here: http://www.asthma999.com/spotlightnews/ . Indeed, it is extremely depressing that no supporter of this method made any comment on dangers of suggesting that asthma medicines are ‘dangerous and useless’ in this alarmingly misleading post:
http://community.wddty.com/blogs/lynnemctaggart/archive/2007/10/09/The-problem-with-asthma-treatments.aspx
A 5 year old with diarrhoea is hardly a medical emergency… As for ‘very serious consquences’ – what a joke… The point is that there is no treatment you can give for a 5 year old with diarrhoea!… None of the normal diarrhoea medications are even licenced for children under 12 and rehydration therapy is not is just saline solution – it is not much better than givng just water… In any case rehydration therapy isn’t licenced for babies under 18 months… And what exactly do you think happens to babies with diarrhoea?… As for going to the GP, I know fully well that a GP would do nothing – I’m a medical student and have seen them do nothing in such cases… There would need to be much more anything serious problems if a GP is going to do anything (weight loss, anaemia, oedema) but such problems take weeks of continuous diarrhoea and would need specialist treatment… but trust me, 99% of the time the GP would do nothing… your argument that homeopathic medicatioin leads to serious consequences is wrong… it is no digfferent to children being given cough mixtures when they hasve a cough when there is no convincing evidence that they work… a proportion of these have chest infection (possible even TB, pneumonia, whoopong cough…etc) and need to have antibiotics asap… alternatively, what about phartmacists given olive oil drops for wax in ear when quite a high proportion have an ear infection and should have been prescribed antibiotics…
My point, that you both seem to have missed, is that the real problem lies outside the medical world… I have seen chiropracters causing permanent disablity… I’ve also seen someone who stopped taking angina medication by a ‘nautralist’ who later had a heart attack 3 weeks after stopping his medication… No doctor or pharmacist would ever tell someone to not take angina medication for homeopathic placebo whereas a lot of ‘alternaive therapists’ would… It are these people that are the main problem – not the pharmacists at boots!…
Well I think it is rather likely that the GP would recommend rehydration with the usual salts if it had been going on for long, as the pharmacists should have done.
I imagine that you can’t really be defending the pictures shown above as “education”.
I’d really love to believe that all the fault lay entirely with alternative crackpots, and that physicians, academics and pharmacists (and even medical students) were faultless. Unfortunately the evidence shows this is not the case (for two extreme cases, just look at these).
Evidently I must have had the GP in the 1% as I clearly remember, when I asked health visitors or our GP about diarrhoea in children, being told that if it lasted 3 days or more, to see a doctor. I had to do this just once with my younger child (then aged 3), GP recommended rehydration salts and gave me a list of signs to watch for which would warrant further medical attention.
For me, the wider point is that if an organisation like Boots, strongly associated in the public mind with dispensing prescribed medicines, is promoting homeopathic medications, this risks creates the impression that they have some kind of official imprimatur. If they wish to sell such things, fine, they’re a business. But if they are, as it appears, also undertaking to educate the public, then they should point out that there is no good evidence these medications work better than placebo.
I agree Mac86, that there is a problem regarding the proper role of CAM in healthcare. My family experience is of asthma and allergy, for which CAM enthusiastically promotes itself.
But, thinking further about the fact that all but one of the pharmacists in the ‘sting’ failed to give the correct, safe advice to a parent with a self-declared preference for ‘natural’ care actually makes me a bit pessimistic about the realistic prospect of having a productive debate on the proper place of CAM in healthcare, if trained professionals are not giving the correct advice. For instance, homeopaths make claims regarding treatment of chronic disease, particularly asthma, e.g. here http://cambridgenatural.co.uk/_wsn/page12.html even though there is no good evidence of efficacy. See for instance, this: http://www.bmj.com/cgi/content/full/324/7336/520 or these comments by Professor Ernst: http://observer.guardian.co.uk/uk_news/story/0,,1669982,00.html . So given these two fairly unreconcilable positions, I can’t see how a productive debate is to be had.
I do in fact sympathise with the view that some CAM modalities might have a place in supporting medical care by promoting relaxation and helping patients to cope with their symptoms and their medication requirements. If practitioners restricted themselves to making these kinds of modest claims, that would go a way to appeasing me. But many don’t, e.g. this person, who adds for good measure the tired insinuation that the medical profession and the drug industry are suppressing a miracle cure for asthma: http://www.wellnaturally.co.uk/index3.php?page=book_01 . Now, there is some mildly encouraging evidence for the Buteyko method but it is far from compelling, which is why conventional medicine at present is unable to make an unequivocal recommendation. And, I note, none of the enthusiasts who commented on this alarmingly misleading post (http://community.wddty.com/blogs/lynnemctaggart/archive/2007/10/09/The-problem-with-asthma-treatments.aspx ) made any reference to the dangers of suggesting to asthmatics that their conventional treatments are ‘dangerous’ or ‘useless’.
I take the point… I know there is a lot of rubbish about homeopathic medication on the boots website… You’re quite right to question that…
However, I don’t understand why you don’t agree with pharmacies selling placebos… They are placebos there that aren’t homeopathic and still claim to ‘treat’ disorders…
look…
http://www.rescueremedy.co.uk/about_whatisrescue.htm
http://www.kalmsstress.com/kalms.htm
But then in a world where we have millions who are on benzos for anxiety or anti-depressants – some for very trivial reasons – you can’t deny that people don’t benefis from taking placebo meds… Incidentally, the diagnostic questionnaire produced to ‘diagnose’ anxiety is sponcered by Pfizer (talk about blatant conflict of interest!!)
http://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9/questionnaire/
look at the bottom of the page!
“PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a trademark of Pfizer Inc.” !!
Anyway, the placebo effect is very strong and in my experience half the people who go to pharmacies don’t have all that much wrong… And considering the dramatcally increasing number of people who take medicines when they aren’t even physically ill… I think there is a place for selling placebos to people if they want it…
Yes of course there are lots of other placebos. I did a little investigation of a herbal quite recently that turned out quite interesting.
I’m not sure why you are so critical, because we are both saying much the same thing. That it it is undesirable to sell things as effective remedies when they are not. It makes no difference whatsoever whether they come from homeopaths, herbalists or big pharma.
The question of using placebos intentionally when nothing else can be done is one that raises some difficult dilemmas. They deserve some serious though that has not yet happened.
Lastly, although it is quite clear that placebos can produce physical effects, it is still not really known how much of the apparent effectiveness of useless pills arises from placebo effects, and how much comes from the fact that you’d have got better anyway. It is the old story. Echinacea cures your cold in 7 days when otherwise it would have taken a week. No placebo effect is needed.
Ok, I agree with that…
Keep up the good work :D…
I came across this article recently, which I found slightly disturbing as the conclusion seemed to me to be positioning things like homeopathy as part of ‘self-care’ for asthma: http://www.biomedcentral.com/1472-6963/6/76 . ‘Self-care’ in chronic conditions is a popular concept and there is no doubt mileage in it, but I’m not sure what contribution can be made by homeopathy. From experience, I can identify with the reports from parents and patients in the article who found that not enough information about triggers was given in their NHS care. But…the methods used in homeopathy to diagnose and treat allergies and asthma have been proven not to work by many reputable investigators. Unfortunately, at present accessing clinical specialist allergy care is often not that easy in the UK. Something those promoting unproven therapies seem to have noticed.
Given the Alliance/Boots angle, I wonder how long it will be before we see denunciations of ‘Big CAM’. For obvious reasons, it sets my teeth on edge to see the sugar pills etc right next to the allergy medications in my local branch. I find this recently updated roundup of unorthodox treatments and diagnostic methods useful:
http://www.allergy.org.au/pospapers/unorthodox.htm
Saw a report recently that a spritz spray for delicate skin, which had all sorts of labels, such as “hypoallergenic” etc. but eventually turned out to contain nothing but water and was selling for something like two pounds.
Hoboy.
[…] This advertisement has to be one of the sneakiest bits of spin that I’ve seen in a while. It appeared in today’s Guardian. And a lot more people will see it than will look at the homeopathic nonsense on the Boots ‘education’ site. […]
[…] This item was first posted on the original IMPROBABLE SCIENCE page. It can now be found a, wirh some new stuff, on this blog. […]
[…] Or their bad advice on childhood diarrhoea. […]
[…] then. of course, there is the deeply dishonest promotion by Boots the Chemists of homeopathic miseducation, of vitamins and of CoQ10 […]
[…] Can you trust Boots? Don’t Trust Boots Boots reaches new level of dishonesty with CoQ10 promotion […]
[…] been criticising Boots for years now, starting with Mis-education at Boots the Chemist in May 2006. was largely about homeopathy, but Boots’ quackery is not restricted to […]
[…] What can be done about homeopathy insidiously creeping into our lives? If you have a problem, if no one else can help, and if you can find them, maybe you can hire the A-Team. So without further ado, I will introduce Face http://shpalman.livejournal.com/tag/homeopathy, Murdoch http://gimpyblog.wordpress.com/, Mr T http://dcscience.net/?cat=13 and Hannibal http://www.badscience.net/?cat=35. Fuck. There’s only four people in the A-Team. It’s not enough. Here’s why it’s not enough: apart from Le Canard Noir on the Quackometer blog http://www.quackometer.net/blog/labels/homeopathy.html, there’s also the young, hip bloggers from the Bad Science forum – http://badscienceblogs.net/. The Bad Science bloggers include Hawk Handsaw, who can be found here: http://hawk-handsaw.blogspot.com/search/label/homeopathy and Ithika (here: http://brokenhut.livejournal.com/tag/homeopathy). Apologies to anyone who has written awesome posts on homeopathy and yet not been listed here. The reason is that I was too damn lazy to go through all the blogs on the badscienceblogs index. Sorry. DC Science has a new post highlighting homeopathy in Boots here: http://dcscience.net/?p=191. […]
[…] down on a prescription pad. Anyway, sugar pills are just a common delivery mechanism as found in Boots or Holland and Barrett. That ultimately eccentric and bizarre homeopath, Rudolf Steiner, came up […]