Today’s Letters to the Editor in Fairfax’s The Age offer ample criticism and no praise for the Blackmores scam (see PDF below) outlined here recently. Pharmacist and health store proprietor, Ian Collins writes;

AS A pharmacist and health store proprietor, I find the guild’s action of linking with one company a most naive and money-grubbing action. To be forced to recommend one company bringing out a new range of products, whose composition has not been widely discussed and has no track record, is beyond belief. To attempt to give all people with blood-pressure problems, no matter what the cause, one formula, ignoring all other health factors, is incomprehensible.

There are so many other products from different brands that may be more effective, products with a history of being useful; why pick this small range of untried products? Maybe the answer is that complementary medicine is basically ignored in pharmacy degrees and very few pharmacists have the knowledge to discuss or ask the relevant questions regarding complementary products.
How embarrassing for pharmacists to be caught with their hand in the till.

Prominent Mornington skeptic Graeme Hannigan writes;

I AM a health consumer and am disgusted at this agreement. If it wasn’t enough that pharmacies credulously offer such quackery as ear candles and the good old magic water of homeopathy, the agreement with Big Quacka means that any lingering vestiges of trust in pharmacies has vanished. Pharmacies are putting financial objectives well ahead of the ethical treatment of customers.
All guild pharmacies should come with a health warning and advice to customers to wash off the snake oil after visiting their pharmacy. I trust the guild will also make available the results of the peer-reviewed randomised double-blinded clinical trials of Blackmores Companion preparations so customers can make informed choices.

In a comprehensive Opinion article, Dr. Ken Harvey digs for some evidence to back this caper, finding little more than a business deal. He writes in part;

So what is the evidence to support the use of Blackmores Companions products?

Its Biotic Companion contains the probiotic strain Lactobacillus reuteri, which is claimed to reduce antibiotic-associated bloating, flatulence and diarrhoea. The risk of suffering these side-effects is relatively low. There is some evidence certain probiotics may reduce the incidence of antibiotic-associated diarrhoea in some populations, but routine use is not recommended by medical authorities. In immune-compromised patients, occasional cases have been reported where probiotic organisms have caused serious blood-stream infection.

Anti-HT Companion contains zinc gluconate to complement use of antihypertensive therapy. There are occasional reports that such therapy may lower zinc levels, but I am unaware of any independent medical authority that recommends routine zinc supplements with antihypertensive drugs.

Stat Companion contains coenzyme Q10 and vitamin D3 allegedly to support statin use. Muscle pain occurs in about one to two patients in 1000 receiving statins, especially if a high dose is used. The evidence that coenzyme Q10 and vitamin D3 can relieve statin-associated muscle pain is not clear-cut and the evidence that taking these ingredients together with statins prevents muscle symptoms is even less clear. As a result, the routine use of CoQ10 and vitamin D in statin-treated patients is not recommended.

PPI Companion contains magnesium to aid use of proton pump inhibitors. There are only occasional reports of clinically significant magnesium deficiency occurring in the many patients receiving PPI therapy. If this rare problem is diagnosed, the recommended management is to stop the PPI. Routine supplementation with magnesium for all patients on PPIs is not recommended.
The fine print of the material Blackmores provides about its products states that if a nutritional deficiency is suspected, pharmacists should refer customers to their GPs for further investigations. I agree.

When the rare person develops a nutrient deficiency on a prescription drug, the evidence-based approach is to confirm the diagnosis objectively with a blood test, case by case, and then treat accordingly. Sometimes that might mean prescribing a supplement. There is some evidence to support that.

But what the Pharmacy Guild-Blackmores arrangement implies is supplementation en masse, in the hope nutrient depletion will be prevented. I am unaware of any good evidence to support that. More importantly, this deal unnecessarily adds to the ”medication burden” and financial cost that many elderly patients already struggle with when taking multiple drugs.

Debate over the lack of evidence to justify the move as patient, not profit oriented, was also reported in Pharmacy News. CEO of APESMA, Chris Walton observed;

We are deeply concerned that pharmacists are increasingly being asked to put their expertise and professional ethics aside by pharmacy owners more interested in making money than doing what is in the best interests of their patients

Blackmores promotional material