Last month I questioned a Boots pharmacist over the instructions on some Arnica 30C pills they were selling. I was simply following the instructions on the packaging that suggested in case of an overdose I should contact a pharmacist or doctor, his response was somewhat confused and far short of the advice I would expect from a trained pharmacist.
The full story can be seen here:
http://skepticbarista.wordpress.com/2009/12/14/how-much-sugar-is-too-much-sugar/
So not really satisfied with the response I’d been given, I figured the only thing to do was to go directly to Boots Customer Services and Nelsons (the manufacturer). They’d be able to give me clear answers to my questions!
Both Boots & Nelsons were asked the following questions:
1. What dosage would constitute an overdose ?
2. What would be the effects of an overdose ?
3. What actions should be taken in the event of an accidental overdose ?
Simple enough questions, the packaging gives a recommended dose of “Take 2 pills every 2 hours for the first 6 doses and then 4 times daily“, and it does say seek advice from a doctor or pharmacist, however there are no details of the effects of taking too many of these pills.
The ingredients listed on the packaging are 30C Arnica Montana, Lactose & Sucrose. 
In any homeopathic remedy with a 30C dilution the chances of even a single molecule of the active ingredient still being present in a pill is so unlikely it isn’t even worth considering.
How they can actually get away with listing Arnica on the ingredients is beyond me …. let alone list it as an ‘active’ ingredient!
That just leaves us with Lactose & Sucrose ……… or to put it another way SUGAR !
After a few days an email response came back from Nelsons:
In answer to your questions:-
1. What dosage would constitute an overdose ?
Taking more than the directions specify
2. What would be the effects of an overdose ?
See attached document (PDF HERE: Arnica 30c pillules SPC )
3. What actions should be taken in the event of an accidental overdose ?
Speak to a medically qualified doctor or visit A&E
We do hope the above information will be of some help.
So, I have an answer to Question One (how much) …. taking more than 2 pills every 2 hours would constitute an overdose ! I’m not really sure what I’d be overdosing on, but never mind they’ve sent me a document to answer Question Two, so at least I’ll know what symptoms to expect!
Reading through the supplied document, it soon became clear I may have been expecting too much!
Section 4.8 Undesirable effects: None known
Section 4.9 :Overdose (Ah-ha, at last) None known (Oh bugger!)
So that leaves the answer to Question Three – WHAT !!! ……. They suggest that I visit A&E !
They’ve just told me that there are no undesirable effects and no known effects of an overdose, yet they say I should speak to a medically qualified Doctor or run down to the A&E. I will just point out that this is different advice to that given on the product label.
Thankfully my visits to A&E units are fairly few and far between, but on the occasions that I have needed to attend, the (often overworked) doctors & nurses all seem rather busy dealing with all manner injuries, I suspect all of them are of a more serious nature than somebody who has ingested less than a spoonful of sugar.
Oh well, I don’t suppose I could expect too much from a company who produce homeopathic pills …… Boots will give me some sensible answers! So I waited for their response, then Christmas arrived, then New Year arrived, and I waited a few days longer. Then after a small prompt, Boots replied:
Thank you for your patience in awaiting this response. First of all, I must apologise for the delay in being able to respond to your original comments.
I’m sorry to hear of the problems that you encountered when speaking to a pharmacist in our Loughborough store about the Nelsons Arnica 30c product.
With regard to your specific questions, I can only say that an overdose would be to take more tablets than the manufacturers recommend. It is also possibly unlikely that any action would need to be taken as a result of taking more than the recommended dose, unless the person taking the tablets was sensitive to lactose.
We would normally expect our pharmacists to deal with a query about an actual overdose as appropriate. However, for someone asking in advance about a possible overdose, then it would be reasonable to suggest speaking to a homeopathic prescriber for further guidance.
For any information relating to the advice provided on a non-Boots product, we would always recommend speaking directly to the manufacturers
As you can see, the response from one of the UK’s largest high street pharmacies wasn’t particularly helpful, actually less so than Nelsons.
Their advice on how many pills constitute an overdose agrees with that given by Nelsons ….. basically anything more than the 2 Arnica pills in 2 hours. And their comment of “possibly unlikely that any action would need to be taken” would also seem to confirm that there would be no effect of taking an overdose, but seems to disagree with Nelsons advice to run off to the nearest A&E and make myself look like a complete arse!
Boots then go on to say that they would expect their pharmacists to deal with an actual overdose as appropriate – But they’ve just told me that it’s “possibly unlikely” I’d need to do anything! So would that pharmacist just tell me to go away ….. maybe an opportunity to find out will present itself!
The pharmacist and Boots customer care have both advised me to seek guidance from a “homeopathic prescriber“. I’m sorry Boots, that’s just a cop out. You sell these products, you provide a set of cards for customers to look up symptoms and see which homeopathic remedy they should purchase. In other words, by making them available in your pharmacies and providing your customers with a method of choosing the right remedy – - – You are the homeopathic prescriber!
Boots need to seriously look at the damage homeopathy does to their reputation, a quick Google search just using the words ‘Boots homeopathy‘, should make them hang their heads in shame. Boots Professional Standards Director Paul Bennett has openly admitted that they have no evidence to show that homeopathic remedies work, they sell them simply because people are willing to buy them.
Part of the reason that people still buy these remedies, is that seeing them on the shelves of retailers like Boots implies some level of effectiveness. Boots know these are just sugar pills, yet they’ll still sell them at £5 a bottle! Paul Bennett should either change his job title to avoid the use of the term ‘Professional Standards‘, or even better, he should actually live up to his job title and remove these products from sale.
A few items of interest:
The MHRA’s document on Nelsons Arnicare Arnica 30C: MHRA ARNICA Document
(External links)
Hampshire Skeptics Society – So What Wouldn’t Boots Sell?
1023 Campaign – Open Letter To Boots:
Quackometer: Storm in a Tea Cup
Leicester Mercury: Boots, homeopathy and a question of trust.
Jane Smith
January 11, 2010
I am gobsmacked that Boots would suggest a spoonful of sugar requires a trip to A&E. But if they didn’t, they’d be admitting that they’re selling sugar-pills masquerading as a medical treatment.
I do hope that Ben Goldacre reads this article. I shall tweet him a link just to make sure.
skepticbarista
January 11, 2010
Hi,
Just to be clear …. It was Nelsons who suggest a visit to A&E. Boots advice is the simply “possibly unlikely that any action would need to be taken”.
I’d love to hear comments from people who actually work in A&E (or NHS Direct) on exactly what they’d say if I turned up having tried to overdose on a handful of tiny sugar pills.
Hmmm …….. Maybe Tic-Tacs should carry overdose instructions!
skepticat
January 11, 2010
Excellent work.
I noticed when I was in there the other day that most of the homeopathetic remedies Boots says has no information whatsoever either inside or outside of the packets, nor on any separate leaflets, on what the remedy is supposedly for. That’s rather unusual for a supposedly medicinal product, I would have thought.
skepticat
January 11, 2010
Correction: that should be “most of the homeopathetic remedies Boots *sells* has no information”. Apologies
Jones
January 11, 2010
Nice article. Can’t help but wonder if you’ll go nuts before Boots gives in, though – I think I would
jamesc
January 11, 2010
skepticat: Aren’t they forced by Advertising standards policy to *not* make any medicinal claims on products which they can’t reasonably suggest are worthwhile for that medical complaint? I.e. If I give you a pill and advertise that it cures arthritis, you can sue me if it doesn’t. If I give you a pill and say that it “is a possible factor in keeping joints healthy” or something vague like that (as they do with glucosamine), then you can’t sue me for false advertising when it doesn’t work. If they give you a sugar-pill and claim it will do anything other than help you get cavities or generally raise your sugar level…then you could sue them for false advertising. (or at least get them to remove the adverts…which then costs them money…)
-JamesC
Tetenterre
January 11, 2010
“The ingredients listed on the packaging are 30C Arnica Montana, Lactose & Sucrose. ”
Aren’t they meant to list the ingredients in decreasing order of mass?
skepticbarista
January 11, 2010
I think you’re right under normal circumstances, but in this case I think they get away with it as they are listing Arnica as the ‘active’ ingredient first and then the lactose and sucrose as excipients, the inactive ingredients used as a ‘carrier’. Strange though how both Boots & Nelsons make comment about possible sensitivity to lactose (one of the inactive ingredients) as the only possible side effect of these pills. It seems the potential for any problems would come from one of the inactive ingredients!
Earlier today I sent an email to Nelsons asking them for some info on the volume (mg) of Arnica, Lactose & Sucrose that somebody would ingest if they took the full 84 pills (average contents) in one go. No response yet, but I have a feeling that half a glass of milk and a handfull of Tic Tac’s would far exceed the level of sugars in these pills. I can only guess what they’ll say about Arnica !
RodneyB
January 11, 2010
Look, you’ve obviously not understood the concept of homeopathy. The greater the dilution, the more powerful the effect. So if you take twice the recommended number of tablets, that’s equivalent to only diluting it by half as much. Which means it would weaken the effect, not increase it. That would not be an overdose, but an underdose. If you swallowed all the pills in one go, that would be like diluting normal medicine in a bucket of water.
Of course, by the same logic, if for example you were to take only 1 pill in four hours instead of 2 in two hours, you would be quadrupling the dose: by taking fewer pills than recommended, you are in effect taking an overdose. If follows that if you forget to take any pills at all for a day, you are in effect subjecting yourself to a massive overingestion of powerful substance that you ought to hurry to A & E immediately and hope you arrive before you die of Arnica poisoning. Or severe cognitive dissonance.
I hope this clears things up.
benji
January 11, 2010
excellent blog post… hope you don’t mind if i reference it in my own…
classic!
Chutzpah
January 11, 2010
Thanks for nearly making me spit my tea out over my laptop when I read the suggestion that you pack yourself off to A&E.
On a more serious note though, you should DEFINITELY follow up on the email from Boots and remind them that as the company selling the products they should not palm you off to a homeopathic therapist. You wouldn’t expect to walk in after an OD of any other of their products and have them tell you to contact the manufacturer.
If they don’t feel comfortable giving advice on the product (which it doesn’t sound like they do) they shouldn’t sell it. Simple.
Michael
January 12, 2010
Sounds like the response of someone caught between a rock and a hard place – a company that probably wishes in retrospect that they never got involved with such absolute nonsense but can’t now say so outright due to a variety of legal reasons and contractual obligations.
“We don’t really want to talk to you about it, so speak to the folks that have us over a barrel with our hands tied behind our backs…”
The dialogue you had with the pharmacist sounds just like that. No wonder he’s confused – he sounds just as though, privately, he’s aware of the situation (as was his colleague) and knows full well that there’s no adequate answer to your question but also knows full well about things like “mystery shoppers”. I’d be interested to hear how his response would change if you asked him that question outside the context of the Boots shop and at the pub or the gym for example.
DocAnon
January 15, 2010
Toxbase, which is the database that Emergency Departments and NHS Direct use when dealing with poisoning and overdose has the following entry for Homeopathic Medicines
Type of Product
Homeopathic drugs.
NB Do not confuse with herbal preparations which may be toxic
Ingredients
The ‘filler’ in homeopathic tablets is usually lactose.
Toxicity
Non-toxic.
NHS Direct /NHS 24/Primary Care
If this product was taken accidentally and is definitely homeopathic and the patient has no symptoms or minor GI symptoms the patient does NOT need to be referred to hospital
Features
Unlikely to arise, except in patients with lactose intolerance.
Management
Not required.
skepticbarista
January 15, 2010
Thanks DocAnon:
I may actually get back to Nelsons with that info and see what they have to say about it. I’ve already asked them for some info on the contents of a pill … how much Arnica, Lactose & Sucrose and they avoided answering the question.
Obviously at 30C there is no Arnica left and I strongly suspect that about half a glass of milk and a handful of Tic Tacs would supply higher levels of lactose & sucrose!
Zeno
January 15, 2010
Excellent DocAnon! Thanks for giving a sane answer to all this nonsense.
agirl
January 15, 2010
I’m a doctor, and have worked in A+E. If someone came in seriously worried about an overdose of these pills, I might well do some tests to check they hadn’t actually taken something more harmful (as I would assume they were a bit ‘simple’, and easily confused). Anybody with an intentional overdose gets offered the chance to speak to somebody from psychiatry as well. That might well be helpful in this scenario.