Whilst out in Loughborough today I took a short cut through Boots Pharmacy. On the way I couldn’t resist having a look at the range of Homeopathic remedies on sale.
I picked up a small box of Nelson’s 30C Arnica homeopathic remedy. I began reading the wording on the box and became curious at the instructions explaining what to do if you take an overdose! The advice given was to seek advice from a doctor or pharmacist, taking the label with you.
Arnica 30C - How much is too much?
I wondered what advice I would be given if I had accidentally (or deliberately) taken too many of these innocent looking sugar pills. At a 30C dilution there is no active ingredient in the pill. Homeopathic remedies are often sold as ‘safe’ and yet here were clear instructions telling me an overdose was possible and to seek professional advice.
Well just next to me was a counter, behind which were two members of staff, both wearing a badge saying ‘Pharmacist’ …. This seemed like the perfect opportunity to seek some professional advice on the products they were selling.
I asked one of the pharmacists how much of this particular product I would need to take in order for it to be classed as an overdose and what action should I take if I had accidentally taken that much Arnica 30C.
At this point the pharmacist started to read me the instructions on the box and starts looking very lost “Erm ….. It says take 2 every 2 hours … Erm… anything more than that…. Erm”
The instructions on the box say: Take 2 pills every 2 hours for the first 6 doses and then 4 times daily until symptoms improve for a maximum of 7 days.
I told him that I’d heard the recent reports in the media that there are no active ingredients in a 30C homeopathic remedy and if that were so why would there be overdose instructions. I asked him how many sugar pills is too many and what course of action should be taken if it happened.
The second pharmacist had been listening to this and trying to hide her obvious amusement, however the suggestion of overdosing on sugar pills is too much and she walks away covering her face, leaving the remaining pharmacist struggling with how to reply ( Not very helpful! )
The response was ” You erm ……. use these following instructions of a homeopathic prescriber“
So I pointed out that it says seek advice from a doctor or pharmacist, he is a pharmacist and he’s the one selling the product and I’m seeking his advice, what would he suggest.
At this point he gives in and simply says that he’ll have to look further into it and probably give the company (Nelson’s) a call and see what they suggest. He then states that although they sell the products they only have ‘fingertip’ knowledge of them. I take that to mean they simply take the cash and hand you the box!
Once home I decided to check the Nelson’s website and see what advice is on offer for their Arnica 30C:
http://www.nelsonshomeopathy.com/shop-online/Arnica-30c_prod1736.aspx (WordPress is playing up at the moment – will correct this link later)
It mentions nothing about overdosing, what it does say is:
Instructions: Always read the label. Keep all medicines out of reach of children.
I did, and sought advise as detailed on the label!
Ingredients: n/a
Now why am I not shocked … however it doesn’t even mention lactose!
Dosage: Always read the label.
I did and just for good measure the pharmacist also read it out to me!
Potency: n/a
Are they admitting that a 30C dilution has no potency at all. I thought they claimed all that dilution made it more potent!
So having found a product in Boots sought the advice of a pharmacist, I still have no idea how much is too much, however I’m not too worried as neither does the pharmacist. I think the only thing I can do now is drop a quick line to both Boots and Nelson’s seeking their advice.
zeno
December 14, 2009
Brilliant!
You will remember to blog the responses you get, won’t you?
Simon Perry
December 14, 2009
Hilarious!
twaza
December 14, 2009
You must have had fun with your survey!
Lactose is a problem for people, including children, who are lactose intolerant.
Lactose is a serious problem for children with congenital lactase deficiency. See http://en.wikipedia.org/wiki/Lactose_intolerance#Congenital_lactase_deficiency
skepticbarista
December 14, 2009
Yeah I’ll add any responses that come back.
@jobrodie
December 14, 2009
Brilliant
Apart from James Randi’s downing a bottle of something during a lecture (I think it was a remedy for sleep or something) have there been many instances of homeopathic overdoses? Vaguely recall something about a planned ‘overdose flashmob’ to deliberately hoover up some sugar pills in public.
William Satire
December 14, 2009
You can severly overdose if you forget to take it. I thought that was obvious!
SP
December 14, 2009
I am a 4th year pharmacy student. We are taught nothing about homeopathy in our course. There is a general sort of understanding that it is crap and not worth talking about, but I would say a good percentage of my classmates and a few of my lecturers do not know the difference between homeopathic and herbal remedies.
Memorably, our lecturer was telling us about how often patients don’t immediately think of things like otc painkillers, indigestion meds, contraceptives or herbal remedies as drug history if you ask them for potential interactions. One of my classmates asked whether homeopathic remedies could interact with their drugs as well. Unbelievably, the lecturer answered with a seriously unsure sounding “you would encourage the patient to tell you and their doctor about anything like that, herbal or homeopathic..”
Long story short, this sort of misunderstanding and non-committal attitude towards these products is spread far, and not being addressed in current teaching.
skepticbarista
December 14, 2009
SP:
Thanks for you comment – interesting.
I think one of the big problems with homeopathy (apart from the fact that there is no evidence it works) is that it is sold in pharmacies alongside conventional medications. This leads people to believe that it is as effective as other medications, it’s as if by being available on the shelves of a pharmacy, homeopathy gains some sort of credibility by association.
I think you are better placed than most to comment on the levels of knowledge pharmacists have on these products, today it was perfectly clear to me that the pharmacist had, at best, very little understanding of the homeopathic products Boots were selling. His comment that they only had ‘fingertip knowledge’ of the products would seem to confirm this.
I do think it’s unreasonable to expect pharmacists to be fully trained in all forms of alternative medicines, they’ve already got enough to learn. Although some understanding of the potential interactions with conventional medications should be taught – Sugar pills are unlikely to cause too many problems with interactions, however herbal remedies like St John’s Wort could have far more impact!
Perhaps your classmates & lecturers need to read ‘Trick or Treatment’, they may find the ‘Herbal Medicine’ chapter particularly informative.
http://www.trickortreatment.com/references_5.html
Adam
December 14, 2009
Given that the patient may say “homeopathic” when they mean “herbal” too, asking them for details might not be the worst idea ever.
Anthony
December 15, 2009
The pharmacists’ professional body itself publishes good books on herbal interactions:
Stockley's Herbal Medicines Interactions
I think you are quite wrong about alternative meds and pharmacists. It’s essential they have an understanding of them (and I mean a scientific evidence-based understanding of them).
Jon d
December 14, 2009
I thought of the same point as Adam. Might be an interesting bit of research, finding out if the public know the difference, iirc Boots keep homeo shelved next to the herbal, the retailers and manufacturers are deliberately trying to keep it all as vague as possible.
Possibly it has benefit as a suicide preventative – depressed people necking bottles of sugar pills in the hope of having a fatal ‘overdose’
Andy Wilson
December 14, 2009
Hah
Very nice Skeptic Barista
Very nice indeed
Andy
Anthony
December 15, 2009
Was the first person a registered pharmacist? Most pharmacies do not employ two pharmacists, so you may have been talking to a non-scientifically trained shop-worker rather than a pharmacist.
I teach pharmacy students about homeopathy and other alternative meds at a school of pharmacy. I would hope that after one of my lectures no student would be left in any doubt about the lack of an evidence or plausible mechanisms for homeopathy. I even show them examples of pharmacists involved in the sale of homeopathy and dubious nutritional supplements, and ask them to think about the professional ethics of such sales.
So it isn’t all bad in pharmacy, but just like the medical profession we have people who buy into this nonsense.
zeno
December 15, 2009
Anthony
As SkepticBarista says in his post: “two members of staff, both wearing a badge saying ‘Pharmacist’”. I suspect that perhaps because of long opening hours and size, Boots may well employ two pharmacists.
Congratulations on what you teach your students!
skepticbarista
December 15, 2009
Anthony,
I identify the person I spoke to as a pharmacist simply through the badge he was wearing ‘Pharmacist’. To the very best of my knowledge he was a fully trained, fully qualified pharmacist.
If in fact he is not a fully qualified pharmacist then I think that is a different and quite serious issue !
The pharmacist I spoke with at not time endorsed the homeopathic product, nor did he actually attempt to sell it to me. I would not really expect (or want) my pharmacist to be a trained homeopath or herbalist, but think they should be aware of any potential dangers (overdose) or interactions that may be caused by products they sell, particularly if that product masquarades as an effective ‘medicine’.
I would not have even approaced the pharmacist if it was not for the overdose advice on the product label. I do not really have an issue with the individual pharmacist in this case …. more with Boots policy of selling non effective products alongside conventional medicines without really making a distinction between the two.
Thanks for your comment, I’m pleased and encouraged that pharmacists are being taught about the lack of evidence. However earlier comments suggest that not all student pharmacists are being given that level of training.
Dr. F. Grogan
December 15, 2009
“have there been many instances of homeopathic overdoses?”
Yeah. It’s called “drowning”.
amoebic vodka
December 15, 2009
Water intoxication?
I assume that at the label mentioned it contains sugar, even though the website didn’t. Does a diabetic having too many sugar pills count as an overdose?
skepticbarista
December 15, 2009
The packaging did state that it contains sugar. There was no diabetic warning, however given the size of the pills and the suggested dose, I doubt there is enough sugar per dose to make any difference.
sideshowjim
December 15, 2009
Well, it could ruin your teeth for a start…
Jo Brodie
December 15, 2009
People who treat their diabetes with insulin are generally recommended to carry glucose tablets in case they experience a hypo (hypoglycaemia = low blood glucose levels). I don’t know how much glucose or sucrose is in a homeopathy tablet but as the tablets are teeny probably not very much. I expect they’d be a but useless in reversing a hypo.
Probably should stress at this point that I am not trained (IANAM?)…
Anyway the issue of overdose is a bit tricky. If you took a lot of glucose then yes, blood glucose levels will rise and the person might feel a bit I’ll – but to be a major problem I think they’d have to omit insulin (or in some cases a combination with alcohol can cause problems too). Diabetic ketoacidosis is a medical emergency arising from a high glucose, low insulin situation and it can lead to the build up of ketones – it can be fatal.
I’m beginning to wish I hadn’t started typing this from my iPhone – I might come back to it later
There’s more about DKA, insulin or alcohol on Diabetes UK’s website http://www.diabetes.org.Uk
Disclaimer: I work there but these are my views
Zeno
January 14, 2010
Jo
Last night, I was working out (for a forthcoming blog post!) just how much sugar is a useless homeopathic pill. I estimate there’s about 0.28 g in each, so in a bottle of 84 (a usual number), there is 23.52 g (a bit short of an ounce in old money). This is the equivalent to the sugar contained in about 20 Malteesers, so it may well have an effect on someone having a hypo. They may well need more sugar, but it might buy you some time.
Idris Hughes
December 15, 2009
I can endorse what Anthony is saying (as a fellow pharmacist) and confirm that in our experience the vast majority of pharmacists will have nothing to do with homeopathy – they are trained as scientists and can see for themselves that there is nothing beyond a placebo affect in homeopathy. I’m very surprised to learn that Boots are promoting this in the way your contributors (and yourself) indicate. Any Boots pharmacists out there care to comment? How do they reconcile this practice with their training?
Idris
zeno
December 16, 2009
After what their Professional Standards Director said to the House of Commons Science and Technology Select Sub-committee, I would expect the first item on Boots’ next board meeting to be homeopathy and how they get out of the mess they’re in.
skepticbarista
December 16, 2009
Had a quick message from Boots Customer Care team today saying my query is being dealt will be answered as soon as possible.
Have asked them:
> What dosage of Arnica 30C pills constitutes an overdose ?
> What would the effects of an overdose be ?
> What action should be taken in the event of an overdose ?
Given that the only ingredients listed were sugar, I’ll be interested to see exactly what they come back with!
I’ve not had any response from Nelsons (asked them the same questions), I wouldn’t be at all surprised if Boots & Nelsons gave the same reply.
I did actually wonder if you are allowed to label/sell something as ‘Arnica’ if it doesn’t actually contain even a single molecule of the Arnica!
mikewhit
December 16, 2009
Hey, why don’t they use a 30C dilution of methadone for treating drug addiction ?
symball
December 18, 2009
I have already asked trading standards about selling something as arnica when it doesn’t contain any- they just referred me to the MHRA.
Chadders
December 27, 2009
Oops, perhaps you need to change your pharmacy!!!
I find it a bit concerning that Boots have not ensured that their staff have sufficient training on the products on their shop floor, having said that I found the report hilarious!!
zeno
December 27, 2009
I’m not sure what training on homeopathic potions you could give a pharmacist – over and above the training he/she will already have received in proper medicines. They already know they are nonsense.