Thursday, September 20, 2012

Why Is Weight Loss Quackery Being Sold By Pharmacists?

A reader sent me the photo up above. It shows at best non-evidence based, at worst completely useless and not necessarily safe weight loss quackery is being prominently sold by placard in at least one Ontario pharmacy at their pickup counter.

How is this legal?

The short answer is that it's legal because Health Canada just doesn't care. They don't care that pharmacy shelves are filled with nonsense that not only wastes their money, but also potentially their health as they may supplant physician visits and medical care for the promises festooned on the side of a bottle.

But do pharmacists care? In this case do they care that my reader thinks customers will take the promotion of Dr. Oz miracle pills at their pickup counter to be a professional endorsement by the pharmacists themselves?

Pharmacists are highly educated health professionals and here in Ontario (where the photo up above was taken), they're regulated by the Ontario College of Pharmacists (OCP), and represented in Canada by the Canadian Pharmacists Association (CPhA).

Peeking at the OCP website I came across their Model Standards of Care document and in it, this statement,
"23. recommend non-prescription drug therapy only having collected and interpreted patient information to ensure that:

• there are no significant drug interactions or contra-indications, and
• the medication is the most appropriate in view of patient characteristics, signs and symptoms, other conditions and medications, and
• the dose and instructions for use of the medication are correct
But given that there is no dose (no human trials) how could any amount of it ever be considered "appropriate"?

And what of the CPhA?

While they don't have the same sort of Standards of Care document, they do have one on Direct-To-Consumer Advertising and in it they note,
"the information available to patients must be objective, accurate and comprehensive."
Does that sign up above suggest objectivity, accuracy and comprehensiveness?

I know I have pharmacists who read my blog. Given the ability to comment anonymously, would love it if you might weigh in on how you feel selling products that have no scientific basis whatsoever behind their use and whether or not you feel it challenges your ethics or your College's codes of conduct.


  1. This is so widespread. Big in the UK at the moment is the Celebrity Slim programme. Stylishly packaged bars and powder meal replacements designed for 'safe' and 'sustainable' weight loss. Prominent eye-catching displays. It's sickening.

  2. Anonymous7:55 am

    Pharmacists aren't selling this. Pharmacies are.

    1. Anonymous8:19 am

      Pharmacists aren't glorified sales clerks. They're regulated health professionals. Consequently it's not a given the, "just following orders" argument suffices.

    2. Darius Szpilewski8:20 am

      I almost wish I could be nicer about this, but above comment is just nonsense. It's equivalent of saying people don't kill other people, guns do.

    3. Darius Szpilewski8:23 am

      I was referring to the original " Pharmacists aren't selling this. Pharmacies are." comment.

    4. Anonymous2:43 pm

      Agreed. My local pharmacy sells chips, chocolate bars, frozen pizza, McCain's Deep N' Delicious cakes, sugary cereals and poor quality breads and cookies. They also sell cosmetics, bath products, lotions and deodorants that all contain toxic chemicals that are readily absorbed through our skin. How about the cleaning products and air fresheners?

      If we took all of the dangerous and unhealthy items out of drug stores INCLUDING the Rx and OTC medications, we would be left with a guy in white coat with an empty store.

      We need to give our heads a collective shake. These stores and products exist to make money... your well being is not at the top of their list.

    5. Rosemary Killeen9:06 am

      Exactly. Perhaps we should forward this post to Rexall head office for comment? If they thought the practice of promoting this type of product was a detriment to their business, maybe it would change?

  3. A quick search of the Licensed Natural Health Products Database will indicate that this product has not been approved by Health Canada.
    Also - how creepy is this guy? -->

    1. The product has an exemption number: EN-146475 that allows it to be on the market while the NHPD processes its license application. The exemption is listed as valid since August 2010. You can search for the product here:

      It's possible that the product will not receive final market authorization with its current ingredients and claims, but in all likelihood it will eventually be granted a NPN. Health Canada sets the lowest of bars for natural health products.

  4. I remember Robb Wolf getting a question about these raspberry keytones. Given the dose they gave to the rats (? or mice?) you'd have to choke down half a bottle of these per day to match. Even then the results would be questionable

    1. Anonymous2:35 pm

      Robb Wolf. Now there's a guy who knows what is going on. If everyone reading this blog went over there and read his info and listened to his podcasts, they would be much better served and much better informed than they are by reading this stuff.

    2. Agreed! Robb is highly educated, well respected, and just simply rocks the world of health and fitness. Check out his blog for sure.

  5. That sign might be better-placed next to all the crap candy that drug stores sell.

    When I walk into my local drug store, I'm not sure if I walked into a drug store or candy store.

    Ken Leebow
    Author: 101 Incredible Diet, Health, and Lifestyle Tips

  6. Anonymous8:46 am

    @Darius What do you expect pharmacists to do? Take all non-evidenced based products off the shelves at the beginning of every shift? Lecture shoppers about the evils of potato chips in between counseling and dispensing?

    1. Darius Szpilewski10:00 am

      To be part of the solution.

      And there is rather significant difference between "non-evidence based" and flat out fraudulent, "delusion-based" quackery you see on display in Yoni's blog.

    2. Anonymous11:43 am

      There's also a difference between having that product on a shelf in the dietary aisle and putting it right in front of the pick-up counter.

    3. Anonymous12:09 pm

      As the person who sent in this picture, I'd like to add this: when I stood at the counter, waiting to receive the prescription my physician had ordered for me, I saw this display less than a foot to my right. I immediately assumed it was endorsed by the pharmacist in the same way I assumed the prescription I was picking up was.

      The only items that appear by the pickup counter are medicinal ones. I don't go there to find Vitamin water (or even vitamins for that matter). Had this display been with the candy or anywhere else, it would not have bothered me.

  7. I would add the naturopathic and homeopathic remedies on offer at a pharmacy in the Westboro neighbourhood of Ottawa. Cochrane Collaboration has never found any better than placebo effect (which I don't knock, by any means)for these types of treatment. Yet, the pharmacists in question provide third party endorsement by virtue of their status as medical professionals.

    Speaking as a PR professional, it's a dream come true for the product manufacturers. Speaking as a client, it's downright irresponsible and incredibly troubling.

  8. Anonymous10:19 am

    I laughed when I saw this picture this morning!

    Unfortunately, I work as a relief pharmacist for the offending company shown here, and this, along with the Hemocode nonsense (you can see the "digestive health" poster in the background) that they have been promoting, the McDonald's like drive thru, and the Aeroplan loyalty program... Enough said!

    I make no apologies to the corporate gurus (of whom some are pharmacists - shame on them!) for not promoting anything that doesn't have a scientific reason for being on the shelves. I now try and keep track of how many non proven remedies I can talk patients OUT of each shift!

    1. Anonymous9:06 am

      As a pharmacist, I completely agree. I spend more time talking people OUT of products & remedies rather than using things that have little or no evidence (cough & cold products, anyone?!). Using resources that we have available, it is often disconcerning some of the decisions that the purchasers make. Pharmacists are not the ones deciding what is stocked on shelves in many stores. I agree, having this stand in front of the dispensary does imply the pharmacist support of this product. Poor placement, and if I had been working, would have it moved away from the dispensary area.

  9. Anonymous1:06 pm

    I saw in my No Frills all over the drug store aisle shelves little signs to ask your pharmacist about weight loss, pregnancy, healthy eating, and diabetes. Pharmacists are specialists in medication and I don't think they should be advertised as lifestyle counsellors in all these areas. Do they know the Canadian Diabetes dietary recommendations? It's great that they are one of the few health care specialists who are accessible to the public, but pharmacies should not advertise they are experts on everything.

    1. Anonymous2:31 pm

      Agreed. Did you know that most doctors are also grossly uneducated about nutrition, and they should not be dispensing nutritional advice, either.

    2. First of all, anyone commenting on this blog as anonymous needs to grow a set. Second of all, yes, we do know the Canadian Diabetes dietary recommendations, as well as myriad other non-drug components of healthy living. We aren't just pill pushers like we once were. And I can guarantee you those signs you saw didn't say "expert" on them. Most pharmacists when asked about the issues listed in your comment would provide evidence-based, rational, and realistic recommendations based on the extensive knowledge they've gained from their evidence and experience. But if you prefer not to utilize this incredibly underappreciated group of health professionals, feel free to find your answers online. I'm sure that would serve you better.

    3. Anonymous9:52 am

      As a nutritionist, I often send clients back to the pharmacist. There are many people who don't go over side effects and interactions with their doctors. When the pharmacists ask if they want more information about a drug they say no. I often see them eating foods that interact with their drugs. I'm not a pharmacist, so I have to say "please talk to your pharmacist about xyz drug and abc food before continuing to eat abc food."

      I also have a lot of people admit to taking natural health products (to me and not to Doctor or pharmacist) because they think I'll be jumping up and down saying how great it is. Often the natural health product interacts (and can very severely) with their drug and I need to send them back to the pharmacist for that as well.


  10. Very interesting and thought-provoking. As a consumer (not anyone involved in the health care profession, but someone who uses various health care products and treatments), I'm of two minds: First, I rarely trust the front of package claims made by product manufacturers - whether that item comes from the grocery store or the pharmacy. But secondly, I guess I do have a belief that "health" products sold in a pharmacy should be a) safe, and b) effective. Even thought junk food is sold in pharmacies (hey, remember when cigarettes were, too?), I don't see that as being promoted as a healthy product simply because it's being sold in a pharmacy. Same goes for all the beauty and personal grooming products. But if I go in looking for a health-related product, I DO have an expectation that the products sold will be both safe and effective.

    1. Anonymous11:50 pm

      They still sell cigarettes in my pharmacy AND alcohol. They actually have wine tasting parties once a month!

  11. Anonymous2:28 pm


    How you feel about prescribing and promoting drugs that have no scientific basis whatsoever behind their use, have been poorly tested and in many cases have been proven to be downright DANGEROUS?? Do you feel it challenges your ethics or your College's codes of conduct?

    Do you sleep well at night knowing that drugs that you prescribe to naive and trusting patients are likely causing diabetes (Lipitor), cancers (Actos, to name only but one), and likely set off a cascade of worsening health conditions that will negatively affect the length and quality of a patient's life and impact the lives of those around them as well?

    Before you start hoisting pharmacists up for judgement, perhaps you should pause to reflect on the direction and motives of your own profession as a whole.

    Thank you.

  12. Anonymous4:05 pm

    As a pharmacist I find this photo most unfortunate, and think it ought to be embarassing to the big pharma-chain pictured. If this poster was in the dispensary I work at hopefully it would be located down the dietary aids/ weight loss aisle, where I could counsel patients that scarcely any of those products are proven, they should stick with diet and exercise. On the plus side located right next to the pick-up counter maybe the pharmacist will get more questions about it. Then they could report that there is no evidence to support it's use.
    Embarassing to the pharmacy profession but when store displays are decided at a corporate/head office level it's difficult for the white coats on the ground!

  13. CanadianChick/SkepCdnChick1:28 am

    I used to be a pharmacy technician with a national chain pharmacy. The pharmacists AND the franchise owner had little to no say in what was stocked on the shelves. All the pharmacists could do was try to steer people away from the crap.

    A friend in Ottawa asked a pharmacist about the homeopathy they sold. He looked sheepish and eventually admitted that the ONLY time he offered it was when he was dealing with a PITA parent who INSISTED on having some sort of medication for their child.

    Boiron et al wasn't selling in the pharmacies when I was a tech over 20 yrs ago...but here in BC at least, techs were absolutely not allowed to give ANY advice at all, including not being allowed to dissuade a customer from purchasing something, and we rang up most of the sales that were brought to the pharmacy counter...and we couldn't be asking the pharmacist to come to the counter every time a customer bought something stupid.

    I'm glad I'm not doing that anymore - I don't know that I could handle it.

  14. As a consumer, I do not expect the pharmacist at big chain pharmacies to be endorsing all products in the store, I only expect that he or she in direct contact with me will give me the straight goods, even if it means telling the truth about products in the store. What I find more troubling is the sign in my local big chain pharmacy informing people they will not sell needles without a prescription for an inject-able drug. Now that is irresponsible, causes far greater and more direct harm than Dr Oz endorsed nonsense.

  15. Anonymous8:54 am

    Agree with everyone who has said that pharmacists aren't selling these things. Head office says to stock it and people buy it without talking to the pharmacist.

    BUT - why aren't more pharmacists pushing back against head office? or choosing to work elsewhere?

  16. Let's state some facts here because there is obviously a lot of emotion tied up in this. First, someone made the poor decision to place that display at the counter and that someone was on the ground. It has no place in front of the dispensary counter. The dispensary counter should be clear of all product promotions. Second, it is true that we have no control over what is shipped to the store. If you work for a corporate pharmacy, the only thing you can do is actively discourage patients from purchasing these products, which I do multiple times a day. In fact, my response when I'm reluctantly pulled to the weight management section of our pharmacy, which is thankfully far away from our dispensary counter, and asked which of these products is best is "None of them. They're all useless and will only cause weight loss in your wallet." And then I delve into a discussion about lifestyle, our obesogenic society, etc. etc. about which, despite comments made above, pharmacists actually have plenty of science-based knowledge. Third, I love your blog Dr. Freedhoff and I think you are a great guy, so I hope you would agree that pharmacists and/or pharmacies are certainly not the only regulated health professionals frequently promoting junk medicine. And, despite common belief, pharmacists are not the only health professionals who are in an uncomfortable tug of war between ethics, professionalism, and money. Let us have a quick run down of some of the outright nonsense I've seen prescribed by physicians in my town. The HCG diet. And not just the pills. The full on injections with the very-low calorie diet to boot. Prescribing ketoconazole orally to treat "yeast in the body" based on a spit test that apparently shows "too much yeast". Yup. An actual MD did that Dr. Freedhoff. Not some naturopath. An MD. "Oh, before you start the diet and the HCG injections, we need to clear the yeast from your system, so take this expensive and potentially harmful antifungal that you don't need." Except for the fact that the pharmacist, me, refused to fill it on the grounds that it was unethical to do so. Antibiotics for every sniffle and sneeze that walks through their office. ASA for primary prevention. LABA/steroid combos for acute upper respiratory symptoms. And don't even get me started on physicians who treat patients like cattle to be herded through their office as quickly as possible to get as many billings into the shortest time frame. Especially when said physician consistently hands out whatever the patient asks for, including copious and irresponsible amounts of opioids, which they are addicted to in the first place because of the physician's propensity to prescribe Tylenol #4 for every bump, bruise, and scratch that presents to his clinic. His College has ethics guidelines too, but somehow, by some miracle, he still has a medical licence. And since the above post implies that pharmacists are somehow behaving unethically by merely being in the presence of these products, take a second look at the ethics guidelines. They state that a pharmacist shall only "recommend" appropriate therapies. Not be in the midst of, be temporally or spatially associated with, or be under the same roof as. Next time you are in a local doctor's office, check out the signs in the waiting room. They are placed there by a pharmaceutical marketing company that changes out the displays every so often. There are 3 in my local clinic. One for a travel vaccination that no one actually needs and one for the apparently prevalent yet medically nonsensical epidemic of low testosterone. "Ask your doctor if you have Low T." Let me ask you Dr. Freedhoff. Is every physician in that office now in violation of their college's ethical standards because of those posters?

  17. Rhodia3:47 pm

    I was in France last year where the pharmacies have a completely different vibe. You really get the impression that you are in a place run by a health professional. We had to actually ask for vitamin D, it wasn't on the shelves but behind the counter.

  18. CanadianChick/SkepCdnChick8:22 pm

    Why aren't they pushing back or refusing to work there? Because they need to pay for many years of schooling? Because if they want to work retail there's a very limited number of pharmacies that aren't chains or franchises with all manner of marketing agreements?

    Of the half dozen or so pharmacists I worked with only one had dubious alt-med leanings, and that was more toward vitamins and the like (the supplement industry wasn't nearly as scary in 1992 as it is now, IMO). The rest simply 'rebelled' by refusing to recommend crap and trying to gently steer people away from it.

    There's only so many jobs out there for pharmacists that aren't in big retail stores, and even fewer of them have ANY say in ordering non-prescription products.

  19. With proper evidence, I feel comfortable recommending things that do not have standardized dosages or government approval. I live in the US, so we have carte blanche with regard to "nutritional supplements" thanks to the DSHEA, but there is no good evidence for this particular product. I have read every reference the Oz Show listed, and then some, and remain unconvinced.

    The only valid excuse here is, "I did it for the money." Anything else is just pussyfooting around the truth.

    The Oklahoma pharmacy code of conduct actually states, "A pharmacist will not lend their support or their name to the promotion or exploitation of objectionable or unworthy products, nor will they participate in any advertising or promotional program which would tend to lower the honor and dignity of their profession." However, I believe that statement has yet to be enforced.

  20. the problem is, these products make money and are in high demand. Unless the pharmacist is also the owner, which is the case in fewer and fewer pharmacies these days, he or she has no say in what is promoted and sold in the drugstore. Here in the US we're only just beginning to see pharmacies that are removing cigarette sales for ethical reasons, and that's a much more serious health risk than raspberry ketones. But really it would be a losing battle for a pharmacist to try and get the products taken out of the stores, they are just too popular- so not only would they lose those sales, they would probably also lose customers who look for those products and all the incidental sales those people bring in. All we can do is counsel people not to purchase them. It's one of the reasons I'm very happy to work in a specialty practice where we don't have any of that crap.