What FX? CBC’s Marketplace looks at Cold-fX

I’ve been blogging for over three years and Cold-fX, a popular Canadian ginseng supplement, was one of the first topics I tackled. The omnipresent Canadian advertising, huge pharmacy presence, and impressive-sounding efficacy claims made it an ideal case study. Perhaps not surprisingly, when I reviewed the data, the results didn’t hold up:  I concluded that in a best case scenario, you’d need to take Cold-fX for four cold seasons (about 16 months) to prevent a single cold. And while the manufacturer claimed that Cold-fX could actually stop colds once they’d started, I noted that there was no published evidence to back up that claim. I concluded there was was little rationale to justify supplementing with Cold-fX. The published clinical evidence wasn’t persuasive, and the supplement is not inexpensive. The smarter strategy? Washing your hands regularly is clinically proven, and it’s a lot less expensive.

Since my review, the popularity of Cold-fX has continued unabated. And the manufacturer has branched out into all kinds of supplements: Cell -fX (shark cartilage), Cold Sore fX (bee propolis), Remember-fX (also ginseng), Memory-fX (more ginseng), and Immunity-fX (ginseng again, but with with reishi mushroom). Skeptical yet? So was CBC’s Marketplace, which scrutinized Cold-FX in a episode broadcast earlier this month. (I can’t embed the video, so you’ll need to watch the video at the CBC’s site.) For those of you that haven’t seen Marketplace, it’s a consumer affairs/consumer advocacy show that takes on medical topics from time-to-time. Last year it did an excellent investigation of the elaborate placebo system known as homeopathy. The producers are clearly science and consumer advocates, making natural health products low-hanging fruit. So Cold-fX was a fitting topic. Their investigation focused on several issues:

Super Cold-Treatment Reference Spectacular!

I was recently the guest of Desiree Schell on Skeptically Speaking, where we spent an hour discussing the prevention and treatment of the common cold. Here are some of the references and sources I cited or referred to during the discussion. So read along as you listen to the podcast.

The Red Flags of Quackery

This compilation made me laugh out loud:

Click to Embiggen

From the website Sci-ənce. Nicely done.

Anything missing?

Third year anniversary!

I recently asked a colleague for search advice on a topic I was researching. When I told her it was for a blog post, she was intrigued. “How much do you get paid to blog?” she asked. When I told her that blogging didn’t provide any revenue, she was dumfounded. “Even writing for [big pharmacy trade magazine] will pay you a few hundred dollars per article! Why would you write something, and then just give it away?” I told her I wasn’t interested in writing 5000 words on someone else’s topic, waiting months to see it in print, and then wondering if anyone even read it. “Blogging provides immediate gratification,” I replied, “That model seems hopelessly outdated. If there’s a therapeutic controversy, or pharmacy practice issue, I want to discuss it now – not in six months, or a year.” And blogging provides a level of feedback that’s unheralded compared to traditional publication models. Sure, you may be called a Nazi, a Communist, or a Big Pharma Shill, but that comes with the territory when you criticize quackery and call out pseudoscience.

New Year’s Resolutions

Heh. From Cyanide and Happiness.

(Email recipients may need to click the links to view.)

via Yoni Freedhoff

Generic Drugs: Are they Equivalent?

With healthcare costs continuing to rise, generic drugs are looking more attractive than ever. The prospect of getting the same drug at a lower cost is tempting to anyone with a large drug bill — patient or insurer alike. The savings are massive: Lipitor lost patent protection in the USA last month — it was a $10 billion drug worldwide, and the generic versions are priced at a fraction of the original cost. In 2012, Plavix and Seroquel, two other blockbusters, will lose patent protection too — that’s another $10 billion in drug costs that will shrink. This “patent cliff” will shrivel about $255 billion in worldwide patented drug sales over the next five years. If you’re taking a prescription drug and not already on a generic, you probably will be soon. And depending on where you live, you may be automatically switched to a generic version of your prescription drug as soon as it’s available.

Pharmacists are responsible for most of the switches from brand to generic drugs. National, state, or provincial regulations may specify which drugs and brands may be automatically substituted — that is, without patient or prescriber consent. Consequently, pharmacists do spend time speaking with patients about generic drugs. Misconceptions are common, ranging from manufacturing standards (“they’re weaker!”) to efficacy (“the drugs don’t work!”). Pharmacists, with exposure to pharmacokinetics and drug design in pharmacy school, generally understand the science of how generics are approved. Patients, consumers, and other health professionals, however, may not understand why pharmacists are so confident substituting between brands.  So today’s post is directed at anyone interested in how generic drugs are evaluated and approved for sale. Specifically, I want to review the concept of bioequivalence, the confirmation of which assures us of the interchangeability of different drugs — that is, one can be substituted for another.

Why Dr. Oz will not save pharmacy practice

Retail pharmacy is a competitive business, and these are tough economic times. And as I’ve pointed out before, retail pharmacies are increasingly selling ethically questionable products like homeopathy, positioning them as alternatives to real medicine. So I guess I should not have been surprised when a blog reader, (who is also a very prominent Canadian pharmacy leader) passed on the following to me from Pharmacy Development Services – a program to profile and promote products recommended by Dr. Oz:

Season’s Greetings to pharmacies that sell homeopathy

From the  Nightingale Collaboration, a UK-based group that is challenging misleading claims in healthcare advertising:

We know from what our supporters tell us that there are more than a few pharmacists up and down the country who still either aren’t sure what homeopathy is and even recommend it to some of their customers in the mistaken belief that it is a proven, efficacious alternative medicine.  We thought we’d seize the opportunity of this time of year to try to raise awareness among high street pharmacists and their staff about homeopathy. We have sent greetings cards to the pharmacists and staff of nearly 2,000 Boots pharmacy stores up and down the country.

You can download and send your own homeopathic greeting to pharmacists here.

The campaign highlights an important difference in homeopathy regulation between countries. In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) recently ordered pharmacies to stop providing point-of-sale information on homeopathy products. That is, the regulator is prohibiting medical claims for products with no active ingredients.  The opposite occurs in Canada, where Health Canada approves homeopathic products, many with specific “recommended uses”, and also deems these products to be “safe and effective”.

Homeopathy in pharmacies is an embarrassment to the profession of pharmacy, and an abuse of the trust our patients place in us. Kudos to the Nightingale Collaboration for politely asking the profession to do the right thing for patient care.

Hypothyroidism: The facts, the controversies, and the pseudoscience

As glands go, we don’t give the butterfly-shaped thyroid that straddles our trachea too much thought — until it stops working properly. The thyroid is a bit like your home’s thermostat: turn it high, and you’re hyperthyroid: heat intolerant, a high heart rate, and maybe some diarrhea. Turn it down, and you’re hypothyroid: cold, tired, constipated, and possibly even depressed. Both conditions are associated with a long list of more serious health consequences. Between the two however, hypothyroidism is far more prevalent. The mainstay drug that treats it, levothyroxine (Synthroid), is one of the most prescribed in the world.

One of my more memorable pharmacy experiences involved levothyroxine. The store had recently changed its prescription labelling standards: It switched from listing the brand name, to only including the generic name (with the manufacturer in parentheses). Few patients noticed. But one elderly patient, taking Synthroid, was furious, and accused me of making a dispensing error. I assured her that levothyroxine was the active ingredient in Synthroid, and she was getting the exact same product as her last visit — but she would have none of it. Her symptoms had worsened, she said, because the medication wasn’t the same. “I want Synthroid — this levothyroxine stuff does not work,” she screamed at me across the counter. No amount of reassurance would satisfy her — I think we eventually resorted to custom, typewritten labels.

I mention this anecdote not to dismiss the symptoms of hypothyroidism as sensitive to placebo effects — hypothyroidism is a real condition with objective monitoring criteria. But this episode was one of my earliest lessons in understanding how perceptions can shape expectations of effectiveness — something that I’ll come back to, when we look at the controversies of this common condition. Any the treatment of hypothyroidism is not without its controversies – most of which occur outside the realm of medicine, and can more accurately be labelled pseudoscience.

Point of Inquiry: Dispensing Skepticism

For those interested, I recently spoke with Karen Stollznow for the Point of Inquiry podcast.  What is Point of Inquiry?

Point of Inquiry is the premier podcast of the Center for Inquiry, drawing on CFI’s relationship with the leading minds of the day including Nobel Prize-winning scientists, public intellectuals, social critics and thinkers, and renowned entertainers. Each episode combines incisive interviews, features and commentary focusing on CFI’s issues: religion, human values and the borderlands of science.

This discussion focused on the role of the pharmacist and the need for science-based pharmacy practice. We touched on a lot of issues including the changing role of the pharmacist, the ethical responsibilities of pharmacists when it comes to products like homeopathy, what compounding pharmacies do, what generic drugs are, what an expiry date means, what pharmacists think about vitamins and other supplements, and more. You can listen to the podcast here.