I popped into my local Holland and Barrett recently. I was suffering from a self diagnosed migraine. More specifically, I was just recovering from a migraine. I didn’t appear to be in a good way either. I was shaking and had difficulty with the lights of the shop and outside.
I wanted to know if I would have products suggested. Would any concern for my medical history or the self diagnosis make any difference to any sale? I know this place isn’t a pharmacy, but these guys are supposed to know what they’re selling, right?
Here’s a nice picture of the products I purchased:
I did have the idea in mind that I wanted to select a homeopathic remedy as well as a herbal remedy before I went in, just to see if they were recommended.
I’ve received some super fantastic help from Sparkle Wildfire with this post. She’s a community pharmacist from the North East area and writes the blog “A healthy dose of Skepticism“. I’ll position the advice and details I was offered against comments Sparkle has kindly given me, which reflect the advice she would give to a customer in the same situation.
I spoke to the store’s manager. They were happy to answer my questions and to offer their opinions and advice.
I explained that I had been suffering from a migraine and that I suffer from them fairly often (at least one a month, but usually more regularly) and that I had “tried some pharmaceutical stuff that my wife bought, but it hadn’t helped”. I wasn’t asked if I’d sought any medical advice or diagnosis, which surprised me actually, because I ask people that question often, especially if they mention a regular complaint or health issue. They weren’t, in my opinion, hugely interested. Which is a shame from a customer service point of view and because they didn’t show any care in the selection of products I would subsequently choose.
The key to treating migraines over the counter is careful questioning. There are different types of migraine, and often misconceptions about what constitutes one, so I always like to check the diagnosis before recommending anything. Migraine type symptoms might also be indicative of something more serious, so I want to make sure that there are no warning signs that require referral. I would usually encourage someone who has self-diagnosed to book an appointment to see their doctor at some point, just to check the diagnosis, and to discuss other options like migraine preventative treatment if appropriate.
If David had come to my pharmacy counter to ask me for something to treat migraines, I would have used a stepwise approach. Firstly, has he tried “simple” painkillers like paracetamol or ibuprofen? In some patients these are perfectly adequate to treat the symptoms. If sickness is a problem, I might consider Migraleve Pink, which are just co-codamol, but with an added anti-emetic component. I would never, ever recommend Migraleve yellow, because they are merely a ridiculously over-expensive version of co-codamol.
If none of these options work, I may recommend sumatriptan. If the patient hadn’t already been prescribed it, I would have to ask quite a few questions to ensure it was safe for them to use. In fact, there used to be a two page questionnaire for a patient to fill in before you could sell them, although asking a patient with a migraine to fill it in sometimes resulted in some death-laser type looks.
I was standing next to the homeopathic remedies, which coincidently was next to where the first product I asked about was; MirgraHerb. MigraHerb is the trading name for the Feverfew herb. The shop manager told me that this product had been “scientifically tested” and “proven to work” which was “why it can say on the box what it does.” They also went on to tell me that they didn’t sell much of this and that they sold another product (which we’ll get to!) much more often.
FeverFew – This is a herbal medicine, and the most logical choice out of the products Holland and Barrett have sold. It’s also a THM (Traditional Herbal Medicine) registered brand, which means there is at least a guarantee of safety but not necessarily efficacy. There is some evidence that feverfew may reduce the frequency of migraines and pain symptoms, but there is also evidence that it doesn’t make any difference at all. In short, there is conflicting information on whether or not it works, and it would need to be used daily as a preventative, rather than as symptom control during a migraine.
Careful questioning will be required with regards to the patient’s medical history and allergies, as feverfew can trigger allergic reactions and potentially interact with a lot of medicines. It can affect a number of types of a group of enzymes in the liver that are responsible for clearing medicines from our system, so its use may lead to toxicity from conventional medicines or other herbs.
A withdrawal-type reaction (anxiety, headaches, insomnia, muscle stiffness) has been noted in some patients who have been taking feverfew in the long term then discontinue it.
So not “proven to work” as I was told. Product one successfully chosen. I’d already had a look at the homeopathic choices before I’d asked to speak to the manager, so I knew the range. In my haste, I just picked up the nearest one without actually reading which it was! As it turns out, it was Calc. Carb. 30C. Now, as you probably know homeopathic remedies are nonsensical in their basic premise. They are rarely more than sugar and water, especially at a dilution of 30C. The 1023 website provides all the detail you need if you are unfamiliar with this disproven alternative to medicine.
This wasn’t quite what I was told in Holland and Barrett. In fact, to the uninitiated what I was told could prove fairly confusing. I asked if it would help, they said “yes”. No qualifying detail, just “yes”. So I asked what homeopathy was and was then given completely inaccurate information which actually relates to herbal medicines and THM registered brands! I was told that the homeopathic range was being discontinued and that soon they would only be selling brands with 30 years traditional use within Europe and 15 years traditional use in the UK. This is just wrong. While I would welcome Holland and Barrett discontinuing homeopathic remedies, this seems unlikely. I was also told that despite this “everyone who takes it swears by it”. Sparkle’s thoughts would seem to contradict those of the shop’s manager:
Homeopathic calc carb 30C – There’s basically no point in discussing the choice of calc carb (plain old chalk) because there will be no molecules of it in the product. It’s slightly bizarre that a homeopathic product is being sold in combination with a herbal product as this is in direct contravention of the “law of infinitesimals” which (despite being nonsensical) is fundamental to homeopathy.
If this is being sold, the person selling it needs to give enough information to the patient to be able to make an informed choice.
Sparkle makes a good point. Why would you sell them together? Well, I guess if you weren’t the “wise owl” you’re supposed to be. My general feelings about the manager at this point were that she neither knew what she was talking about or really cared. They were significantly more interested in the sale than abiding by homeopathic principals. I guess when you manage a shop that sell contradictory alternatives to medicine you either need to be credulous, ideologically involved or a bit of both.
Now, my third choice was probably the most interesting, because I didn’t choose it. Also, it seems to make equally as little sense as the homeopathy, but with significant actual risks. It was recommended as the “best selling product for migraines” and that this “would certainly help relieve the pain caused by migraines”. The product is dl-phenylalanine. I didn’t really know anything about this product, so my questions were fairly limited. I accepted the recommendation and completed my purchase of the three. The manager didn’t serve me at the checkout, but oddly waited until I had entered my pin before leaving. It seemed as though they were suspicious of my motives and were ready for me to leave having gained the information I was after. I may not have been the first person they had dealt with who had done that.
Sparkle provided my first real insight into why dl-phenylalanine was such a strange and potentially dangerous recommendation:
dl-phenylalanine – This is a dietary supplement. I can see no reason at all why Holland and Barrett would think this would work to treat migraines, and indeed it would seem that some sources suggest it can actually be a cause of them. There is no evidence whatsoever that this could improve migraines.
It is imperative to check if a patient wanting to buy this product does not have a disorder called phenylketonuria. In such patients, consumption of this product could lead to a wide range of adverse effects including mental retardation, hypertension, and stroke. Pretty serious, eh? Additionally, it can worsen certain aspects of schizophrenia and Parkinsons Disease.
It strikes me as a fairly odd recommendation, but she was probably just going on what some else had told her. Herein lies one of my main concerns. You’d be right to ask me, “what do you expect? After all, they are a shop attempting to make a profit”. Well yes, they are. But they don’t market themselves accordingly.
If I went into Wilko’s I wouldn’t expect to be offered advice or for them to make informed recommendations. But Holland & Barrett do market themselves as a shop that can provide advice and answer questions about their products. They claim to be “qualified to advise”, but I saw no evidence that, in this case, the manager was. If you want to play at being a pharmacist I recommend you do more than a one year course in ‘Understanding the application of Holland & Barrett Vitamins, Minerals, Supplements and Health Products’.
Their recent “Ask our Owls” campaign was not well received. I feel this has only lead to increased pressure on Holland & Barrett employees to offer ‘any advice’ and not necessarily ‘good advice’ or ‘no advice’ in order to avoid having to offer people an extra 20% off their purchases, as the offer promotes.
As a company they lend legitimacy to their recommendations through their staff training and their advertising. Members of the public expect to receive good, sound advice. Members of the public will probably be disappointed.
I’m not going to say that pharmacists aren’t prone to selling alt-med. Some do and that puts them in a similar category as Holland & Barrett. Probably worse. Nothing was asked about me or my medical history. It was just another sale, disguised behind the pretence of informed advice.
All I can say with some confidence is that Holland & Barrett training doesn’t mean they should be offering advice to people about treatments and conditions that they simply don’t know enough about. It’s foolish and potentially dangerous. I expect more from any company that wishes to be seen as a purveyor of advice, that hold themselves to any kind of ethical standard.
I’ll leave you with some wiser words than mine. A summary of why Sparkle as a skeptical pharmacist wouldn’t recommend any of the products I was sold:
I would not recommend any herbal, homeopathic or dietary supplements. For a number of reasons:
1. Because NHS Guidance for primary care practitioners (Clinical Knowledge Summaries) states this, and these are researched and based on evidence or expert opinion where possible.
2. Because in a community pharmacy setting I am unlikely to have access to the information resources (and time!) that I would require to properly ensure that any remedies were going to be efficacious and safe for a patient
3. Because homeopathic “medicine” contains no active ingredient, and there is no evidence that it works, there is zero evidence that phenylalanine works for migraines, and only limited evidence that feverfew may possibly be effective.
4. Because supplements, herbal medicines and homeopathic medicines are often very expensive.
Big thank you to Sparkle Wildfire! (This obviously isn’t her real name, by the way!)
I’d be interested in your good and bad experiences with Holland & Barrett and pharmacists when it comes to alternatives to medicine. Let me know your thoughts!