What to do about Boots.

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Important Update

Boots have now removed all claims regarding menopause treatment from the website after a complaint was made to the ASA. However, the product is still for sale online and almost certainly in store. The claims are still being made on the product packaging.

Let's continue the pressure until Boots stop making these claims.

In your complaint to Trading Standards you should mention:

• Boots have removed the claims from their website after a complaint to the ASA (not sure if it was because of this complaint)
• Boots have edited the product photo so that the claims stated on the packaging are taken outside the ASA's remit
• However, the claims are still being made on the packaging itself when seen in store.

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If you've signed up to the pledge to complain to Trading Standards about Boots selling quack medical products, thank you. Boots has an agreement with Nottingham Trading Standards so all complaints about Boots are processed there. However, you should complain to your local Trading Standards body rather than the Nottingham one and allow them to forward it.

The initial complaints will be for Boots’ “Menopause relief magnet”. This was chosen because we believe it should be easy for Trading Standards to do something about it. If we are successful we can send them a claim that’s a little more difficult to understand.

When should I complain?

At the bottom of this post, I’ve copied and pasted a list of names and dates. Please look up your name to find your date. If you’re not on the list (some people subscribed anonymously, or after I copied the list) then please complain immediately.

Please put a reminder in your calendar for that day. You can copy this text to make it easy:

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Complain to Trading Standards about Boots Quackery

Before you complain, please check that Boots is still selling the product. If not, let Simon know immediately and we’ll see if they are making other misleading claims.

Full information is available at http://adventuresinnonsense.blogspot.com/2011/02/what-to-do-about-boots.html

Don't forget to leave a comment on Simon's blog to say you've done it.

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What to mention in your complaint

You can make a complaint to Trading Standards with one paragraph (please don’t use this exact text):

“I saw this product in Boots saying it relieves the symptoms of the menopause. I think this isn't right and I want to complain about it.”

However, there are a number of things you can mention to strengthen your complaint:

• You are complaining under the Consumer Protection from Unfair Trading Regulations 2008. Under these regulations, it is up to the seller to provide evidence for any claims they make, rather than up to the Trading Standards body to prove the claims wrong.
• As a Trading Standards body it is their duty to enforce the Consumer Protection Regulations.
• Where you saw the claims being made. This may be online, but if you happen to be near a Boots, pop in and see if they’ve got one in store and complain about that.
• Precisely quote any dodgy claims that you find on adverts, websites, packaging or photos of packaging and state that you do not believe they are backed up by robust evidence.
• Reference the evidence for/against efficacy.
• Why are you doing this? If it’s to protect the public from misleading medical claims then say so.

What evidence is there for using magnets to reduce the symptoms of menopause?

There are only two relevant articles I could find on PubMed, neither were trials.

Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society.

They recommend "Single clinical trials have found no benefit for dong quai, evening primrose oil, ginseng, a Chinese herbal mixture, acupuncture, or magnet therapy."

Advances in the treatment of menopausal symptoms.

In a box labelled "Approach to management of menopausal symptoms" states:

"Homeopathy, magnetic therapy, reflexology, dong quai, ginsing, evening primrose oil and vitamin E have not been demonstrated to be clinically significant compared with placebo."

and within "Non-hormonal options"

"Magnetic therapy: no benefit"

Within a section titled "Homeopathy, magnet therapy & foot reflexology" it states

"In RCTs, neither homeopathic remedies, magnet therapy, nor foot reflexology out-performed placebo in relieving menopausal symptoms."

How do I submit my complaint?

There are several ways to complain. Firstly, the easy way is to use the online form here. The submission will go via Consumer Direct, but that’s fine. There is a limit on the amount of text you can enter.

Secondly, you can contact your local trading standards direct with either an email or a letter. Their contact details can be found by entering your postcode on the form at the bottom of this page.

What about Libel?

Complaints to Trading Standards are protected from libel action, so you can make clear accusations without risk. Avoid saying anything in public and you should be risk free. Boots would be incredibly foolish to proceed with libel action.

Can I make my complaint more powerful?

Most Trading Standards offices prioritise complaints based upon two factors: how many complaints have they received, and how many people have actually lost money. If you buy a magnet, you’d have a more effective complaint.

You certainly don’t need to do this however.

Details of names & dates below:

Simon Perry	08 February 2011
Dr Michael A Ward	09 February 2011
Danny Strickland	10 February 2011
Dr Tom Williamson	11 February 2011
Richard Stelling	12 February 2011
Johnnie Shannon	13 February 2011
Chris Sexton	14 February 2011
Ian Scott	15 February 2011
Chris Richardson	16 February 2011
Mike Conradi	17 February 2011
Dr Martin Poulter	18 February 2011
Steve Page	19 February 2011
Dr Stephen Southward	20 February 2011
Mandeep Smith	21 February 2011
Dr Stuart Nicholl	22 February 2011
Steve Haigh	23 February 2011
Simon Stanford	24 February 2011
Richard Tomsett	25 February 2011
Marianne Baker	26 February 2011
Jo Hockey	27 February 2011
Rhys Morgan	28 February 2011
Dale Williams	01 March 2011
Jon Pearson	02 March 2011
Giles Wendes	03 March 2011
Conor Pendergrast	04 March 2011
Steve leigh	05 March 2011
Dr Wendy Cousins	06 March 2011
Alan Henness	07 March 2011
Mike Hall	08 March 2011
Nicola Woolhouse	09 March 2011
Gordon Wilson	10 March 2011
Darren Starck	11 March 2011
Martijn ter Borg	12 March 2011
Darren Griffin	13 March 2011
Rebecca O'Neill	14 March 2011
Paul Buckland-White	15 March 2011
B Corcoran	16 March 2011
Dan-Raoul Miranda	17 March 2011
Michael Marshall	18 March 2011
Ralf Neugebauer	19 March 2011
Jo Brodie	20 March 2011
L Pedley	21 March 2011
Ashley Frieze	22 March 2011
Sharon Smiles	23 March 2011
James Thomas	24 March 2011
Wesley perry	25 March 2011
Simon Danaher	26 March 2011
Doogie Brodie	27 March 2011
Sah Winstone	28 March 2011
Dr Cara Laney	29 March 2011
Stew Wilson	30 March 2011
Kash Farooq	31 March 2011
Sid Rodrigues	01 April 2011
David Hughes	02 April 2011
Peter Harrison	03 April 2011
Trish Hann	04 April 2011
Patrick Redmond	05 April 2011
Adam Timberley	06 April 2011
Paul Berry	07 April 2011
caroline panico	08 April 2011
James Lipscombe	09 April 2011
Emma Smith	10 April 2011
Tulpesh Patel	11 April 2011
RobertPettifer	12 April 2011
Tim Reid	13 April 2011
Jane Symons	14 April 2011
Alexandra Beuchert	15 April 2011
Tom Marinan	16 April 2011
Kevin Rose	17 April 2011
Prof Stephen Curry	18 April 2011
Hannah Haines	19 April 2011
Andy Stoker	20 April 2011
David Noble	21 April 2011
Sven Rudloff	22 April 2011
Dr J J Grattage	23 April 2011
Olivia Vinden	24 April 2011
Tony Mansfield	25 April 2011
Julia Matheson	26 April 2011
Bethan Jade McIlroy	27 April 2011
Michelle Goodger	28 April 2011
Dan Sutton	29 April 2011
Sandra hoare	30 April 2011
steven lindsay	01 May 2011
Dawn Mason	02 May 2011
Leo Donnelly	03 May 2011
James Cole	04 May 2011
Sean Ellis	05 May 2011
Stephen Griffin	06 May 2011
Elaine Pickering	07 May 2011
Alastair Grant	08 May 2011
Kevin Lowis	09 May 2011
Dominic Brown	10 May 2011
Jo Thornely	11 May 2011
Julie Williams	12 May 2011
Ms Jane Robinson	13 May 2011
Alan Wellstead	14 May 2011
Karelle Menochet	15 May 2011
Jere Koskela	16 May 2011
stephen hughes	17 May 2011
Audrey Johnson	18 May 2011
Jamie Woolley	19 May 2011
Dr Richard Morley	20 May 2011
Vikki Hurst	21 May 2011
Donald MacCormick	22 May 2011
Matthew Hardy	23 May 2011
Alan Bird	24 May 2011
Ben Harris	25 May 2011
Tim Bennett	26 May 2011

Boots carries on promoting quackery despite the ASA

It’s now been almost seven months since Boots was the target of 240 Advertising Standards Authority complaints by myself and others.

I didn’t blog on the outcome at the time; so, here’s a quick catch-up. Once approached by the ASA and asked for evidence, Boots decided to avoid an embarrassing ASA adjudication against them by agreeing to remove the claims.

I checked the Boots web site shortly after this and found the situation hadn’t seemed to improve. In many cases, Boots had not removed the claims, but simply taken away the 3 for the price of 2 offer.

If you remember, the ASA will not adjudicate against claims made upon websites (not until March 1st). But, they will adjudicate against claims made as a part of a promotion wherever they appear. By removing quack products from the 3 for 2 offer, Boots simply side-stepped the claims outside the ASA’s remit.

So what’s the situation now? Well in many cases, Boots has removed the claims completely. In other cases though, they’ve reduced the misleading text but carried on making essentially the same point, or at least carried on implying it. Surprisingly, some of the claims are still sitting there in full with the 3 for the price of 2 offer displayed prominently on the page.

My favourite quack product was what can only be referred to as a “fanny magnet”, what sadly what Boots refers to as a “Ladycare menopause relief magnet”. By simply clipping it to your panties, Boots originally claimed it can help to “reduce or completely eliminate symptoms of menopause”. They’ve now removed this precise claim but are still making essentially the same point. They still call it a “menopause relief magnet”, there’s still a photo of it claiming it’s “the most exciting discovery for menopause”, and there’s a list on the photo of symptoms claiming it’s all you may need for everything from hot flushes to vaginal dryness. They’ve side-stepped the ASA by simply taking it out of the 3 for 2 offer.

Shockingly, Boots is still making implying effectiveness for two forms of homeopathic teething relief. Boots’ own brand “Teething Pain Relief - 24 sachets” makes its claims in the title. And their “Nelsons Teetha” product is apparently “a homeopathic remedy specially designed for the soothing and calming relief of the symptoms of teething”. The product photo contains the phrases "Teething Granules", "Teething and pain relief" and "Soothes and calms".

Overall, Boots has improved since the last complaint. A lot of claims have been removed.

Today, I reported Boots to ASA a second time for 5 separate products. I’m hoping this time the ASA will adjudicate and Boots will finally clean up their act.

It's a real shame nobody will help stop Boots making false claims

Sadly, the 240 ASA complaints about quack medicine products being sold at Boots got nowhere. Boots took the rather cowardly decision of withdrawing the 3 for the price of 2 offer to take their products outside of the ASA's remit, rather than defend the claims they make about their products.

I didn't think they'd be able to get away with this, though I'm continuing to learn about how the ASA operates. When I complained about the GCC's patient information leaflet last year, the GCC agreed to remove the claims, but initially continued making the claims on a PDF on their website. When I queried the ASA about this, they asked them to remove it even though being online, the PDF was presumably outside their remit.

When I asked about this apparent double standard, the ASA replied as below (I'd skip reading it, it's quite dull):

Dear Simon,

Thank you for your e-mail, I’m sorry for the delay responding to you. As I explained, our remit does not cover material on advertisers own websites where it does not refer to a sales promotion. While I appreciate your concern about these claims and the manner in which Boots have brought their promotion into line with the CAP Code, the ASA (at this time) is not entitled to comment on claims on companies’ own websites (outside of promotions), such as the Ladycare menopause relief magnet you mention.

Leaflets available to download on advertisers websites, when they are also distributed to the public as hard-copy (the contents of which therefore fall within the ASA’s remit) are generally also subject to any ASA Council adjudication on the hard-copy. However, this only applies where the leaflet itself is available to download in identical form to that which is distributed as hard-copy material.

Our main aim in cases such as the original investigation into the objections you raised about numerous claims on Boots’ websites is to ensure claims which fall within our remit are amended or removed. In this instance, Boots agreed to ensure that any claims subject to the CAP Code would in future conform, without a formal adjudication from the ASA Council being necessary and there do not appear to be grounds to challenge this decision, nor material within space governed by our remit which appear to give us grounds to investigate further.

However, claims made on companies own websites is sometimes subject to specific legislation which Consumer Direct (0845 4040506) or the MHRA (020 7084 2000, www.mhra.org.uk) might be able to advise further.

Again, I realise this will disappoint, but thank you for taking the time and trouble to contact us with your concerns.

Kind regards

Sam

So I think I've hit a dead end with the ASA. Next stop Trading Standards. The thing is, Trading Standards doesn't really do anything unless a lot of people complain.

And I can't imagine there will be many people who will have come back inspired by the excellent TAM London speakers, ready and willing to do the following:

• Choose one product to complain about. You might like to complain about the Fanny Magnet that apparently "helps to reduce or completely eliminate the symptoms of menopause". Or maybe about the BioFirm Danish Detox Plan, which they claim "naturally supports the body’s own internal processes of elimination and detoxification." Or maybe you're really angry that they sell "Boots Teething Pain Relief" which claims, in the title, that it is for teething pain relief yet can't possibly work as it's homeopathic.
• Go the Consumer Direct Complaints Form.
• Fill it out. I've helped with that below by making it easy to copy & paste some basic info that will be relevant to all complaints.
• Submit the form.
• Put a comment below so I can see who did what.

Sadly, I doubt anyone will do this. What a shame.

Helpful advice and information to copy & paste:

Section 1:

Clearly quote any text you believe to be unsupported by robust evidence. Point out that Consumer Protection Regulations 2008 require the company to be able to back up any claims with evidence.

Section 2:

Name of Trader: Boots UK Limited

Address: 1 Thane Road West

Town or City: Nottingham

County: Nottinghamshire

Postcode: NG2 3AA

Telephone Number: 0115 918 2000

Trader's website address: http://www.boots-uk.com

Trader's email address: [Leave blank]

Section 3:

Have you paid for goods or services from this trader?: NO

Leave rest of Section 3 blank.

Section 4:

Please let us know how you heard of Consumer Direct: Website/Internet search.

But as I said, I can't imagine anyone will actually do this and comment to let me know they have done so. Real shame.

Off skiing in Tignes.

At Boots, it's 3 for the price of 2 on quackery

At 2pm on the 14th July, Skeptic Kash Farooq alerted me via Twitter to a quack medicine product on the Boots web site that he was going to make an Advertising Standards Authority complaint about.

The only problem was that the ASA does not regulate web site content. And this has been a problem stopping us from tackling Boots for some time. If Boots has false or unjustifiable claims to make about a product, they only seem to make them in areas where the ASA can’t touch them. They use packaging, point of sale materials and their web site to make their claims – all outside of the ASA’s remit. I’ve personally never seen widespread false claims made by Boots on posters, leaflets or in the press where the ASA can start issuing adjudications against them.

Whether this is a deliberate strategy by Boots, or just through chance alone I cannot be sure. But yesterday, they slipped up.

Kash had noticed that Boots had a 3 for the price of 2 offer “across all vitamins, complementary medicines and herbal products”. There are a couple of exceptions where the ASA will regulate claims made on the web. One is:

“We regulate sales promotions, such as special offers, prize draws and competitions wherever they appear.”

Boots appeared to have put their entire range of alternative health products – the products for which they regularly make unjustified claims of health benefits – fully within the remit of the Advertising Standards Authority.

I had no idea of how long this promotion would last, and with the ASA sometimes taking over a week to look at a case, I did not want the claims to fall out of remit before my complaint went in. Boots may have seen the tweets about them and realised they needed to withdraw the promotion. For the best chance of success, the complaint had to go in by the start of business the next morning.

I started going through the claims and realised that there was no possible way I could get through them by myself. Boots had 679 products in the range, many of which were making clearly unjustifiable claims. And in comes the power of Twitter. With a couple of Tweets, I suddenly had a small army of helpers.

I created a shared Google Spreadsheet in which a team of 9 or 10 people started adding URLs from the Boots web site and copying and pasting next to them the unjustifiable claims made about the product. With a little help from technical wizard @tommorris answering my call for help, I found a program that would automatically download the large number of web pages and print them to a local PDF to hold as evidence.

Watching what was happening on the Google Spreadsheet was awe-inspiring. When I started letting people into the document, there were 80 URLs copied and pasted into the list. By the time I got 15 more URLs into it, @the_beacon, @richardtomsett, @HelenaThomas, @dellybean, @kashfarooq, @nwoolhouseuk, @cherryblack, @RoisinThomas and @kingmuskar had pretty much copied and pasted all of the claims and were now waiting on me.

By the end of the evening, we’d sent off complaints to the Advertising Standards Authority about 107 Boots products.

The claims they were making varied from shocking – claiming that a homeopathic remedy is “to relieve the pain of teething.” To the bizarre – a magnet which you put in your knickers which they claimed “helps to reduce or completely eliminate the symptoms of menopause” – something one of my helpers described as a “Fanny Magnet”. There were some less serious claims such as listing “30c Aconitum napellus” as an active ingredient on a product when I can say with 99.999999999999999999999999999999999994% certainty that if manufactured carefully contains no Aconitum napellus (and I worked that number out, it’s not just a guess).

But my helpers continued after I finished. @nwoolhouseuk, @ScepticLetters,
@GDLockUK, @kashfarooq and @the_beacon together sent in a second complaint with another 133 products listed. @nwoolhouseuk was still going at 1:30 in the morning, and @ScepticLetters finally finished it off at 4am.

Boots will now hopefully be held to account. For years, whether accidentally or by design, they been keeping the misleading claims they make about their products just beyond the remit of the ASA. One slip up, and with excellent teamwork we caught them out in one night with a total of 240 complaints.

Boots avoid admitting there's nothing in it. 10:23

If you thought I'm too old for this sort of childish moron-baiting, I'm afraid you're sorely mistaken. This month I've been emailing Boots to ask how much Arnica is in one of their Arnica 30C remedies. Obviously I know the answer - there is none. Boots also know the answer.

It's quite amusing however, to see them trying to avoid giving me this answer. The email trail follows.

10:23.

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8 January 2010 21:03

Hi,

I'm used to seeing the quantity of ingredients listed in mg rather that as "6C" or "30C" as your homeopathic remedies are labelled.

Can you clarify for me how many mg of Arnica is in one of your "Arnica 30C" tablets? I tried to work it out, but I think I got confused at some point.

Thanks,

Simon

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11 January 2010 17:39

Dear Simon

Thank you for taking the time to email me regarding Boots Arnica 30c (item code 37-71-814) with regard to converting the content of Arnica into milligrams.

I am afraid, however, that it is not possible to convert "centesimal" (c) dilutions of Homoeopathic remedies into milligrams (mg) or micrograms (mcg).

During the manufacturing of Homoeopathic remedies the amount of Arnica is not quantified in milligrams or micrograms. Instead one drop of Arnica (or other Homoeopathic ingredient) is added to ninety-nine drops of diluent (carrier) to produce a 1 centesimal (1c) potency, which is then further diluted to produce a 6c or 30c product.

I hope that this information is of use to you.

Regards

Paul Williams MRPharmS
Medical Information (Pharmacist) Officer

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11 January 2010 18:17

Hi,

Sorry, I'm confused by this. Surely there is a specific amount of Arnica in the pills which can be measured in mg?

If, as you suggest, that a 1C remedy is 1% Arnica then surely if it was a 100mg pill, then this would be 1mg Arnica. Why isn't this correct?

Simon

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14 January 2010 13:27

Dear Simon

Thank you for your second e-mail regarding Boots Arnica 30c (item code 37-71-814).

Unfortunately, the amount of Arnica (or other Homoeopathic ingredient) in the drop that is then subsequently diluted with 99 drops of diluent (carrier) is not quantified in milligrams (mg) or micrograms (mcg).

Thus, although it is true to say that a 1 centesimal (1c) Homoeopathic remedy contains 1 part of Arnica, as the amount of Arnica is not initially quantified then it is not possible to convert this into milligrams (mg) or micrograms (mcg).

Therefore, with regard to Homoeopathic remedies we are not able to state the quantity of Arnica in milligrams (mg) or micrograms (mcg) for the reason outlined above.

The labelling of our products is in accordance with guidelines on the labelling of Homoeopathic remedies, which are derived from The Medicines and Healthcare Products Regulatory Agency (known as the MHRA), which is the UK medicines regulator. These guidelines state that the scientific name of the "stock" (i.e. Arnica) and centesimal dilution should be declared on the labelling.

I hope that this further information is of use to you.

Kind Regards

Paul Williams MRPharmS
Medical Information (Pharmacist) Officer
Medical Services

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14 January 2010 15:39

Dear Paul,

Thank you for your reply, and I understand that without knowing the mass of the original drop of Arnica it would be impossible to determine the subsequent mass of Arnica in the final product. However, it should easily be possible to determine the percentage of Arnica in the final 30C remedy.

Am I correct that a 1C remedy is 1% active ingredient? That it is 99% water and 1% Arnica?

What is the percentage of Arnica in the final 30C product?

I've been trying to work this out myself, but I think I've gone wrong somewhere. This will allow me to make an approximate estimate of the number of mg of Arnica.

Many thanks for your help,

Simon

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18 January 2010 16:29

Dear Simon

Thank you for you further e-mail regarding Boots Arnica 30c (item code 37-71-814).

I can confirm that a 1c Homoeopathic remedy comprises of 1% of the Homoeopathic ingredient i.e. Arnica and 99% of the diluent (carrier).

I can also confirm that to produce a 2c Homoeopathic remedy 1 drop of the 1c Homoeopathic dilution is then further diluted with 99 drops of diluent (carrier). This would equate to 0.01% of the Homoeopathic ingredient i.e. Arnica.

To produce a 3c Homoeopathic remedy this method of dilution is repeated with one drop of the 2c dilution and so on in order to produce a 30c Homoeopathic remedy.

The labelling of our products is in accordance with guidelines on the labelling of Homoeopathic remedies, which are derived from The Medicines and Healthcare Products Regulatory Agency (known as the MHRA), which is the UK medicines regulator. These guidelines state that the scientific name of the "stock" (i.e. Arnica) and centesimal dilution should be declared on the labelling.

I hope that this information is of use to you and is sufficient to allow you to calculate the percentage of Arnica.

If you require further support in understanding Homoeopathic remedies then you may wish to contact the supplier for this product, Nelsons, via enquiries@nelsons.net.

Regards


Paul Williams MRPharmS
Medical Information (Pharmacist) Officer

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18 January 2010 18:02

Hi Paul,

Thanks for your reply, however I'm still having problems with my calculation. While the figures seem to make sense from a mathematical point of view, the percentage of Arnica seems to reduce fairly rapidly to seemingly absurd quantities.

As you said in your email, these products are licensed by the MHRA and of course they are sold by Boots, so I've no doubt as to their effectiveness.

So the only logical conclusion I can draw is that I've made a mess of the mathematics.

Can you confirm the answer you get for a 30C remedy?

Many thanks,

Simon

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22 January 2010 15:37

Dear Simon

Thank you for your further e-mail regarding Boots Arnica 30 c (item code 37-71-814) with regard to calculating the percentage of Arnica.

Whilst the information about the dilutions of Homoeopathic remedies is freely available from validated reference sources, the actual percentage in a 30 c Homoeopathic remedy is not stated and, therefore, I am afraid I am unable to provide this information.

At Boots we take our responsibilities as the leading Pharmacy-led Health & Beauty retailer in the UK very seriously and as part of this we pride ourselves on being able to offer all of our customers a choice of products that support them in their day-to-day lives. We know that many people believe in the benefits of complementary medicines and we aim to offer the products we know our customers want.

I can confirm that Boots Arnica 30 c are a licensed Homoeopathic product without approved therapeutic indications. The pack is labelled in accordance with the requirements placed upon the Marketing Authorisation holder, Nelsons, by the Medicines and Healthcare Products Regulatory Agency. If you would like to contact the Marketing Authorisation holder to discuss the formulation of this product and the manufacturing process in more detail they are contactable at enquiries@nelsons.net.

Our Pharmacists are trained Healthcare Professionals and are on hand to offer advice on the safe use of complementary medicines. The Royal Pharmaceutical Society of Great Britain issues guidance to Pharmacists on the correct selling of Homoeopathy, which our Pharmacists adhere to.

I would like to conclude by confirming that Boots support the call for scientific research and evidence gathering on the efficacy of Homoeopathic medicines as this would help our patients and customers make better informed choices about using Homoeopathic medicines.

I hope that this information is of use to you.

Regards
Paul Williams MRPharmS
Medical Information (Pharmacist) Officer
Medical Services

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23 January 2010 08:52

Hi Paul,

I get the impression that you are trying hard to avoid answering my question.

In an earlier email you say that it is possible to calculate the percentage of Arnica in a 1C and 2C remedy but then without reason you say you cannot do it for a 30C remedy. Yet in a previous email you state that the information you gave me should be sufficient for the calculation.

The problems I was having when calculating the amount of Arnica is that every time I did the maths, the result came out that there was no Arnica remaining in the 30C remedy.

This is a perfectly simple and clear question: is there any Arnica remaining in an Arnica 30C remedy?

Many thanks,

Simon

---

As yet - no response.

Trust Boots

This is a repost of my article in the Leicester Mercury. I wanted to repost it here so I could fix the messed up text. When they copied and pasted it they lost all the formatting and most importantly the scientific notation. I've fixed it below.

“Trust Boots” is the tagline that has been offered by the high street pharmacist since 2005. According to Boots’ 2006 Corporate Responsibility Strategy, “Everything we do that builds trust is good for our business; anything which could compromise it, a risk we can't afford to take.” So have Boots shown themselves to be worthy of our trust?

On the shelves of their pharmacy on Gallowtree Gate in Leicester you will find a small section devoted to homeopathy. Many people I meet are confused about exactly what homeopathy is – some thinking it is simply a type of herbal or natural medicine.

Allow me to explain.

The first principle of homeopathy is what they call the “law of similars”. Homeopaths look for a chemical that produces a similar symptom to the disease they aim to treat. For instance, caffeine causes you to stay awake, so homeopaths may decide to use this in a remedy to treat insomnia. Another example is hay fever. Hay fever causes runny eyes and so do onions – so some homeopaths will treat hay fever with a preparation of onions. I realise that all this may sound a little bit unconventional, but please bear with me – in a moment it’s going to sound even more so.

Turning a chemical such as onion juice into a homeopathic preparation involves a process of “dilution” and “succussion”. To create the centesimal or “C” remedies they sell at Boots, the homeopath takes one drop of the chemical and mixes it with 99 drops of water (dilution). In centuries past, this was then banged against a leather covered board or book, often a bible, although in modern times the shaking is often done by machine. This shaking is called "succussion". This is now a 1C homeopathic preparation. It contains 99% water and 1% “active ingredient”.

To turn this into a 2C remedy, the process is repeated. One drop of the solution is taken from the 1C remedy is mixed with 99 drops of water and then shaken. The 2C remedy now contains 99.99% water and 0.01% “active ingredient”. Repeat the process again to create a 3C remedy at 0.0001%, and so on. Homeopaths believe that the higher the level of dilution, the more powerful the remedy.

Many homeopaths will use the solution directly, but Boots and many others prefer to sell homeopathy as pills - or pillules as they call them. One pillule is meant to contain the equivalent of one drop of homeopathic solution.

We can calculate approximately how many molecules of “active ingredient” get into the one drop that makes it into the pillule. A drop of water contains about 1,700,000,000,000,000,000,000 molecules. Scientists write this as 1.7x10²¹. That’s a 17 with 20 zeros after it. Boots sell remedies at 6C and 30C. A 6C remedy will contain around 0.0000000001% “active” ingredient – which works out at about 1.7 billion molecules of active ingredient. But what about when we dilute this further? By the time you get to 10C, there are only 17 molecules of active ingredient left. And at 11C, you only have about a one chance in 6 of finding a single molecule.

The branch of Boots on Gallowtree Gate in Leicester display a guide, provided by the manufacturer, that states a Bryonia 30C remedy “Relieves the symptoms of a dry painful cough, pressure and dehydration headaches” and that a Kali Bich 30C remedy “Soothes the symptoms of sinusitis”.

30C. I already explained that at 11C, you only have about a one in 6 chance of finding a single molecule of active ingredient. At 12C, there is only about one chance in 600 that you will find a molecule and at 13C just one chance in 60,000. By the time you get to 30C, you have more chance of winning the National Lottery jackpot five weeks in a row than you do of finding a single molecule of active ingredient.

Or think about it this way: how much water would you need to contain one molecule of active ingredient at 30C dilution? According to my calculations, the body of water would weigh 5 billion times more than the planet you are standing on. If you want that in pillule form, you'd need to buy 6x10³⁸ pillules (a 6 with 38 zeros after it). At Boots' retail prices, that would cost you 35 trillion trillion trillion pounds. That's a rather expensive molecule.

These pills do not contain any active ingredient.

To my way of thinking, homeopathy is entirely implausible, but science is incredibly open-minded to seemingly implausible ideas. Ideas such as Einstein’s theory of general relativity and quantum theory are utterly bizarre, but once they were demonstrated to be true with fair tests then scientists accepted them.

Testing for a pill is essentially simple. Take a large number of people with a particular disease and randomly divide them into two groups. Give one group the pills you want to test and the other group some placebo pills that don’t contain anything. Neither the patient nor the researchers working with them can know which patients were given which pill. After an agreed period of time count how many people in each group got better.

So what do the trials show? Actually, that’s a little complicated. Some of the poor quality trials where the patients were told which drug they were getting, or had very small sample sizes showed an effect. But those effects could easily be down to the placebo effect or random variation due to the small sample sizes.

But when the experiments are done properly with larger numbers of patients, the vast majority do not show homeopathy to be any better than a placebo. A quick search of Cochrane articles leads us to reviews of homeopathy for the treatment of dementia, chronic asthma and attention deficit/hyperactivity disorder. They all end in similar conclusions: “No evidence that homeopathy is effective in treating dementia”, “Until stronger evidence exists for the use of homeopathy in the treatment of asthma, we are unable to make recommendations about homeopathic treatment.” and “Overall the results of this review found no evidence of effectiveness for homeopathy for the global symptoms, core symptoms or related outcomes of attention deficit/hyperactivity disorder.”

But what do they tell you in Boots? When I popped into their Oadby branch and asked about homeopathic treatment, the pharmacist tried to politely steer me away from the homeopathic remedies citing the lack of evidence. Fair enough.

But a pharmacist at the Gallowtree Gate branch was not so off putting. Despite a couple of points in the conversation where I felt she certainly gave the impression that she did not believe in homeopathy, she was still happy to say things that I would never expect to come out of the mouth of professional pharmacist, by explaining that homeopaths “don't just treat the condition, they look at the whole person” and “If you want absolutely spot on accurate treatment you need to see someone who is a qualified homeopath."

Boots' professional standards director Paul Bennett was asked about homeopathy at a parliamentary science and technology sub-committee on the 25th October: "Do they work beyond the placebo effect?" He replied, "I have no evidence before me that they are efficacious and we look very much for the evidence to support that."

I think it's unlikely that Boots don't know where to look for medical evidence. So what we're being told by Boots' professional standards director is that they've looked around, found evidence - but he hasn't found any that show homeopathy to work.

He was asked to clarify with the line, "You sell them, but you don't believe they are efficacious?" He replied, "It's about consumer choice for us."

If it is about consumer choice, I personally believe that Boots should be ensuring that their consumers are properly informed to make a choice. Their labels should clearly state "the best evidence shows that these products work no better than placebos." But their labels don't say that. The information on their shelves makes claims such as "Relieves the symptoms of a dry painful cough." Selling this quackery may well be about consumer choice. Making these claims of efficacy is most certainly not.

Is this likely to lead you to “Trust Boots”?

A quick maths quiz

Here's a quick maths quiz. Post your answers, ideally with your working and I'll be able to see how well they compare to mine.

1. What is the probability of there being a single molecule of active ingredient in a 30C homeopathic remedy? Assume no contamination and pure water.
2. What is the probability of winning the National Lottery 5 weeks in a row. You get one ticket per week of course.
3. Which is more likely?
   
4. How much would it cost to buy enough pills that you'd expect to have one molecule of active ingredient? Note: At Boots, they're about £5 for 84 pillules.

I'll post my answers tomorrow.