One can be forgiven for wondering exactly how pharmacist members of The Pharmacy Guild of Australia, will keep a straight face when giving advice about medication.

Not that they don’t have the training to do so. Far from it. Which is what makes the money spinning deal to push Blackmores’ “companion products” to certain medications particularly galling. By it’s very nature this “Coke and fries” (to use Blackmores term) deal is predicated on pharmacists pre-empting doctors and making on the run diagnoses. Diagnoses that they aren’t equipped to make and that may also prove deleterious.

The scam works like this. Blackmores have identified key prescription medicines and isolated potential “nutritional consequences”. They’ve proposed a “companion product” to the prescription with scant regard to the fact that no standing recommendations exist. More so, research into this approach to supplements is both ambiguous and has revealed negative effects.

The four areas you should be terrified about are:

• Proton pump inhibitors and magnesium deficiency with muscle cramps, vertigo, hyper-irritability, excitability and the inevitable poor concentration. But if you can remember where you’re going for long enough you can limp to the chemist, stagger from wall to wall and unleash your hyper-rage upon stock to ensure a swift diagnosis.
• Antibiotic treatment, upset GI microflora and the need for probiotics helped along by icky stories of bloating, farting and diarrhoea. Fear not you gaseous, smelly, splattering assault upon polite society, for they have just the probiotic for you.
• Anti-hypertensives and zinc deficiency along with poor immunity, poor appetite, impaired sense of taste and smell. Topped off with poor skin health (delayed wound healing), GI tract issues with the inevitable diarrhoea which compounds zinc deficiency. Can’t eat, can’t heal, can’t taste, can’t smell and you’re stuck in the toilet. There’s a plus in there somewhere but no doubt you need a zinc supplement.
• Statins (cholesterol lowering drugs) and myalgia plus (get this) “muscle soreness”. Along with cramping, weakness and fatigue, you clearly need Coenzyme Q 10 and vitamin D3. What a pity you’re already too shattered to get out of bed.

Of course dealing with the nutritional consequences, may have… er, consequences. For example Blackmores go on to tell consumers, CoQ10 may:

• Have hypotensive effects in patients with hypertension and may have additive effects on antihypertensive medications

• Interfere with some types of chemotherapeutic agents. Use with caution

• Decrease the anticoagulant effect of warfarin

• Decrease blood glucose levels in people on hypoglycaemic therapy

Vitamin D3 may theoretically cause hypercalcaemia if taken with thiazide diuretics. Caution is advised in those with hyperparathyroidism, malignancies that increase serum calcium levels or other risk factors for hypercalcaemia. Zinc may decrease absorption and blood levels of tetracycline and quinolone antibiotics unless doses are separated by at least 2 hours.

Magnesium may decrease the absorption and efficacy of tetracycline and quinolone antibiotics, bisphosphonates and chlorpromazine unless doses are separated by at least 2 hours. If using [Blackmores’ probiotic] with antibiotics to which [Blackmores’ probiotic] is sensitive, separate doses by at least two hours.

This is enough to make you pause and think about chatting at length with your doctor. There’s a few other useless spooky observations that the (s)CAM industry simply rock at pulling off. Such as vitamin D deficiency being widespread and associated with poor CV health. Magnesium contributes to healthy teeth, bones, muscle/nerve function, electrolyte balance and normal energy metabolism. Myalgia is one of the most common reported adverse effect of statin use.

Many patients – particularly older ones – may already have poor nutrient intake… 1/3 of Aussies over 18 don’t get the RDI of magnesium. My favourite is the veiled suggestion GP’s aren’t capable of doing their job: “…the TGA have advised prescribers to be alert to hypomagnesaemia in people taking PPIs”. To which I can easily imagine Professor Farnsworth from Futurama saying, “Why yes… which is exactly why cowboy’s like you should stay the hell away from grown up science”.

With the help of Dr. Ken Harvey, who we know here from the SensaSlim saga, we can pin down the extent of frivolity being advanced by this joint venture. The statin claims are particularly bold, given side effects. Also, noting Wyman et al;

Some small clinical trials seem to show that coenzyme Q10 supplements can be used to lower blood pressure and to treat or prevent myalgia caused by hydroxymethylglutaryl coenzyme A reductase inhibitors (statins). However, larger trials are needed to determine if they are truly effective for these purposes.

On the topic of probiotics, The March 2011 issue of Therapeutic Guidelines Antibiotic, states;

There is some evidence that prophylactic probiotics reduce the incidence of antibiotic-associated diarrhoea but the appropriate combination of agents has not been established, so probiotics cannot be recommended for routine use. In immune-compromised patients, occasional cases of probiotic-associated bacteraemia have occurred

Regarding zinc and magnesium supplementation there is no standing recommendation for use with anti-hypertensive therapy and PPI use respectively. As Farnsworth just reminded us, being on the lookout for symptoms is for trained health professionals. Blackmores’ hijacking of professional guidelines is just another trick for selling for the sake of it.

Consumers Health Forum of Australia chief Carol Bennett claims in Fairfax that the entire caper is unethical and urges consumers to demand evidence and report pharmacists who lean on fears. Geraldine Moses, who is a drug safety researcher reminds us of the folic acid related seizures epileptics sustained after taking a supplement to combat the reduction in folate specific to epilepsy medication.

Today The Age reported;

PHARMACISTS have been accused of putting money ahead of patients’ interests after striking a controversial deal to market dietary supplements with prescription medicines.

The Pharmacy Guild of Australia, which represents 94 per cent of Australia’s 5200 pharmacies, has agreed to start recommending a range of Blackmores products to patients when they pick up prescriptions for anti-biotics, blood pressure drugs, cholesterol medicine and proton pump inhibitors.

Last week, Blackmores chief executive Christine Holgate told Pharmacy News the deal meant they could provide ”the Coke and fries” with prescription drugs while providing pharmacies with ”a new and important revenue stream”.

Her comments prompted sharp criticism from doctors and consumer advocates who said it risked turning pharmacies into McDonald’s-like businesses that push products onto patients who do not need them. Under the deal, when a prescription is filled, a prompt in the pharmacist’s computer system will remind them to discuss a particular Blackmores product that has been designed to offset possible side-effects of their prescription drug.

[……]

Australian Medical Association president Steve Hambleton said the move was outrageous and smacked of commercial interest rather than clinical need.

He said he did not know of any solid evidence backing the combination of dietary supplements with the prescriptions included in the deal. ”I think the evidence for Coke and fries is about the same as the evidence for these products,” he said. Dr Hambleton said the recommendations had the potential to confuse patients, who should trust their doctors to prescribe them what they need without any conflicts of interest.

Geraldine Moses, a drug safety researcher and pharmacist based at Brisbane’s Mater Hospital, said she was concerned about the deal because of good evidence that the more drugs a person took, the more likely they were to have adverse reactions and interactions. She said while Blackmores may have evidence showing that prescription drugs reduce particular nutrient levels and that their supplements increase those nutrient levels, it was incorrect to presume that replenishing those levels was the right thing to do.

Outrageous, unethical and potentially dangerous according to experts. This is undoubtedly a grab for money targetting a demographic that is unable to afford trumped up scams with potential risks. Given the appalling performance of the alternative product industry in the recent Auditor General’s Report and concerns raised about regulation of same in the TGA Transparency Review in July, the Pharmacy Guild should be ashamed of itself.

I wish Professor Farnsworth could get a piece of them.