Bullshit for baldness

More amazing than the sheer volume of nonsense products on the shelves of pharmacies are the lies that are allowed to be told in order to sell them.  Take this interesting cure for baldness for example.

Here are the claims by Nanogen Serum VEGF:

Patent Pending Technology

Growth factors are a cutting edge technology, pioneered by Nanogen for treating thinning hair.
The Natural Solution for Hair Loss
VEGF is a growth factor like the ones humans produce naturally. VEGF maintains hair growth and ensures nutrients and oxygen reach the hair, allowing it to grow. It also acts against the factors that cause hair to fall out, maintaining hair growth.

Now, Vascular Endothelial Growth factor (VEGF) is a growth factor produced by your body.  There is such a thing.  It's a big old protein, and if this product contained any synthetic VEGF it would need to be a lot more expensive than £30. The business of manufacturing recombinant proteins is not cheap or simple.  You can buy 25 micrograms (25 millionths of a gram)  for about £200. Even if you did get your hands on some recombinant VEGF, you couldn't use it in a medicinal product without jumping through a lot of regulatory hoops - it would be prescription only.  So, what's going on here?

Apparently:

Nanogen Serum VEGF is a safe, plant derived sh-VEGF growth factor serum that reduces hair loss and promotes existing hair growth

So, it's plant-derived, and it's not VEGF, it's sh-VEGF.  How does this change the story?


You could no doubt stitch together a story about how baldness is due to a lack of blood supply to hair follicles, and that VEGF stimulates the growth of blood vessels. Almost certainly such a notion inspired this product.  However, let's not even consider the possible therapeutic value of VEGF (or sh-VEGF) in treating baldness until there is some evidence the product contains any.  We've already ruled out VEGF itself.  What about this sh-VEGF?


The only mention of sh-VEGF you will find in the scientific literature is short hairpin RNA for VEGF, a man-made tool for preventing VEGF gene expression in experimental cell biology.  Researchers have made sh-RNA to prevent the expression of all manner of genes.  It's a complex, but common technique.  Needless to say, there is no way on this earth that a product containing such a thing would be on sale on the open shelves of a pharmacy either.  This magic potion almost certainly has no active ingredient.  It's just plain bullshit. There really ought to be a law.


What's the point of all this pseudoscientific frippery then?  You could make up any old nano/quantum/etc bullshit as a sales pitch, but Google wouldn't lend any credence to it.  However, if you type sh-VEGF into Google, you will get loads of hits - most of it scientific studies using short hairpin RNA silencing techniques.  Anyone not remotely familiar with the field would think that there is a lot of science surrounding sh-VEGF and have faith in the product.  Googlers with a little familiarity with science might even find some reassuring phrases in what turns up (eg "growth" and "stimulated").

On the other hand, other people might be disturbed by the notion of inhibiting gene expression in their body - playing with your very own DNA.  But nothing could go seriously wrong, could it? Not from something "plant-derived"?  See what they did there?


Again, there ought to be a law.

[See also: Caffeine for hair loss.]

Sugar rots your teeth

Babies make splendid subjects for placebo effects by proxy.  Dogs, horses and cows will do pretty much as well (the rest of the animal kingdom rarely rate a mention). So it's no surprise to find some outright quackery amongst the possibly efficacious teething remedies in a high street chemist.

Mothers may enjoy ease of mind in the knowledge that these powders are reliable and contain nothing harmful.  Charged solely with a preparation of a selected part of the plant Matricaria, they do not contain Calomel or other Mercury Compounds.

These are, in fact, lactose and nothing more.  There's a lot of fun to be had taking the mickey out of pharmacies selling sugar pills (it's all over the internet), but that's not what is interesting here.  Consider the language: it's not from this century, is it?  Calomel? How many people know what calomel is, or know that it has a long history (along with, say, arsenic) of use in medicine as a theatrical poison in the days of heroic medicine.  This reassurance that these powders contain no calomel sounds like a warning from the nineteenth century.

It probably is.

Ashtons and Parsons are an old firm of homeopaths, dating back as far as 1867 (so @quackwriter assures me).  In the Wellcome Library you will find an old pamphlet of theirs from ca. 1910.  In the endpages are some advertisements for their more popular remedies of the day, including these Infant Powders.  The 1910 advert proclaims that:

The Ashton and Parsons Infant Powders are intended to ease pain and sooth the child; check stomach disorders; correct the motions; relieve fever, restlessness, fretfulness and similar troubles incidental to the teething period; and are useful in delayed or unduly prolonged dentition.

This has been updated for a 2011 audience as follows:

Ashton and Parsons Infants’ Powders are intended to soothe the child; check stomach disorders; correct the motions; relieve restlessness, fretfulness and similar troubles incidental to the teething period; and are useful in delayed or unduly prolonged dentition.

So, in 2011 we get much the same text as my grandmother's mother did.  It doesn't stop there; consider the dosing recommendations from 2011:

How to use

For children under six months:

            Half a powder

Above six months:

            One powder; dry on the tongue, night and morning.

When the child is very restless or fretful, the dose can be repeated every one, two or three hours if necessary until improvement.

Compare that with the 1910 version:

Dose: Under six months half a Powder, above six months one Powder, dry on the tongue, night and morning.  When the child is very restless, fretful or feverish, the dose can be repeated every one, two or three hours if necessary, until improvement.

It's only the safety information that seems to vary from century to century. From 1910:

REMEMBER: These Powders are guaranteed to be perfectly harmless

While today, we are warned:

Keep all medicines out of the reach of children.

Fart pills

No, not pills that make you fart, pills that supposedly stop you farting.  People fart on average about 14 times a day, although this varies enormously from person to person and is probably dependent to a significant extent on diet.  Mrs JDM claims to never fart at all, while one of my colleagues is rather famous for his ability to pass gas. Of course, mild gastrointestinal upsets like diarrhea can produce increased gas in the system.  On the other hand, some people become a bit over obsessed about their otherwise normal flatulence. So, what has a leading high street pharmacy got for us in this department?

Windeze - (simeticone)

WindSetlers - (dimeticone)

Both of these remedies contain polydimethylsiloxanes, or silicones. They are thought to act by reducing the surface tension of gas bubbles, making them coalesce.  They were introduced into medicine to aid gastroscopy - all the little bubbles in your stomach make getting a clear image rather difficult.  They have also been used to assist  imaging at the other end, in colonoscopy.  But do they stop you farting?

Here's a cynical answer: Some chiropractors chose  dimetacone as a "control" to test their spinal wizardry against in colicky infants.  It's no surprise to find, then, that we've known for quite a while that they are ineffective in colic, and that chiropractic is only equally ineffective.  That's not farting though.

A more complete answer is that there is no evidence that these compounds provide relief from excessive farting, and we've known that for a considerable time.  The trick is to stop feeding the gas-producing gut flora by avoiding foods that are rich in carbohydrates that aren't fully absorbed by the body, such as those in beans and cabbage.

Another sugar to avoid is lactose, so don't expect homeopathic fart pills to have the desired effect!

 

Something for the ladies

Discomfort during the luteal phase of the menstrual cycle (yes, period pain) has been a drug/quackery target for hundreds of years.  So what does a leading high street pharmacy have to offer?

The majority of products on offer are analgesics (pain relievers).  If you want to be doubly patriotic, opt for one containing ibroprofen - not only is it a British invention, it was developed by Boots themselves.  Many women consider naproxen a better drug though.

Simple pain-killers may not be efficacious in all patients, for whom there are other options a GP can prescribe (for example preventing ovulation with the contraceptive pill).  If you are a bit GP-shy, there are some "alternatives" on offer:

HRI Water Balance tablets

Apparently these help to "relieve water retention and maintain a normal body fluid balance."  It's a herbal preparation containing extracts of:

• Dandelion root
• Buchu
• Parsley Peirt
• Uva Ursi

Folklore, and little else, suggests that each of these extracts have diuretic properties (they make you pee).  Each has a different cultural history (Buchu is South African, for example), so it's a panacea that has been thrown together.  There's no evidence that it works, and no suggestion that the extracts have been prepared in a consistent manner.  You might be better off with spironolactone, a diuretic that has been shown to be effective in reducing bloating and breast tenderness.

Aquaban tablets

These appear to be another diuretic strategy, that supposedly help to " to eliminate water retention that builds up in the body’s tissues and cells."  The active ingredient is ammonium chloride, once used on its own or with other drugs to achieve diuresis (60 odd years ago).  Side effects include serious nausea and vomiting, and the risk of acidosis.  Of course, that's at the therapeutic dose of about 5g; these 0.325g tablets probably have no effect at all.

Cura-Heat Period Pain
It's not clear from the information provided just how these adhesive patches generate heat; they claim to be free from medications.  Equivalent to the old hot water bottle, but less unsightly, these are a comforting distraction, but little else.


Femlieve
The most interesting of the lot, Felieve is a "traditional herbal medicinal product for use exclusively based upon long-standing use as a traditional remedy."  It's another herbal extract, this time from the chasteberry (Vitex agnus-castus), which has been in use for a variety of ailments (including unholy libido) for centuries.  Two clinical trials suggest that it is effective in PMS at the dose provided.  Might be worth a shot, if the ibuprofen doesn't do the job and you're feeling adventurous.


 

Man up with Prelox

Erectile dysfunction (ED) is always a curious subject for discussion.  It's the one area that even the most rational, skeptically-minded people get squeamish about.  Quacks can rip off people with ED as much as they like, and nobody says a word.  Offer a boob-enhancing lotion, though, and the internet goes nuts.

So, what has this notable high street pharmacy come up with, do you think? 

It's a combination of two ingredients: pycnogenol and arginine.  The former is a mixture of chemicals (yes, they are chemicals all the same) extracted from the bark of a tree, while the latter is an amino acid (another chemical) that your body produces of its own accord anyway.   

Schwing?

The purveyors of this cocktail are sensible enough not to suggest that it produces instant erections. It is a food supplement that supposedly protects your blood vessels, and an erection is completely dependent on blood flowing to the nether regions.  Readers familiar with the work of Lou Ignarro - a chronic sufferer of Nobel Prize disease and supplement pusher - will probably be aware of the link between arginine and the endogenous vasodilator nitric oxide.  Whether munching on arginine-rich food or supplements encourages the production of nitric oxide and protects your cardiovascular system is still an open question.  At any rate, it's a poor treatment for ED.

What about pycnogenol? This extract of the bark of the Maritime Pine contains the usual suspects that are supposed to be good for us (but trials invariable show aren't): antioxidants.  Unsurprisingly, when you search PubMed for pycnogenol, you open the door to a library of journals you never knew existed.  Temper your cynicism though! There is some evidence that this muck is effective in ED, and may act in synergy with arginine.  See here and here for starters.  So long as Boots is very careful about what it's pycnogenol does and doesn't contain, this could prove to be an effective long-term treatment.

Caffeine for hair loss?

It would take a lifetime to blog on all the junk that pharmacies knowingly sell as remedies.  I've probably got about half a lifetime left, so I'm only aiming to cover 50%, starting here.

A notable high street pharmacy is selling a shampoo to treat hair loss, which contains caffeine. Coffee for your hair?

People who are interested in transdermal (or percutaneous; through the skin) delivery of drugs use caffeine as a standard to compare the success of different approaches.  Using this as a benchmark for development, several other drugs are now successfully delivered into the blood stream from a patch (eg nicotine).  It's a clever approach, and when done cleverly it means someone wears a patch for a day, rather than taking 3+ pills (and having to remember to).

Caffeine is used experimentally because it's relatively easy to measure in blood, and because it's toxicological and pharmacokinetic (how it is destroyed by the body) properties are known.  So, investigators can see how much caffeine entered the body, and reassure volunteers that the drug that they are absorbing is equivalent to a fraction of a cup of coffee.  Then they can compare their approach - say a new adhesive for a patch, or a spray as an alternative - to previous attempts.  So, there are a large number of studies of the absorption of caffeine by the skin, but that doesn't prove that it does anything to skin, of course.

More recently, several studies have found that a significant amount of a drug that is applied to skin is absorbed via hair follicles.  When hair follicles are blocked, drug absorption is slowed by four-fold.  Caffeine was routinely used in these studies, of course.  So caffeine applied to the skin, gets into the skin, and mostly into hair follicles.  In fact, there's even a study demonstrating that if caffeine is incorporated into a shampoo, it will find its way into the hair follicles within two minutes (Boots' recommended exposure time, interestingly enough).  Caffeine was used in this study, like all the others, because it's the standard for these types of tests.

We're still left with the problem of whether caffeine makes hair grow, or less likely to fall out. This is where two fields collide. Caffeine has a rather complex pharmacological profile, but it is widely held to be an inhibitor of phosophodiesterase enzymes (we don't need to know any more than that for our purposes).  In theory, inhibiting these enzymes would increase hair growth.

And there's one study that shows that caffeine has this effect on isolated human hair follicles.  Yes, just the one.

Now, if you're cynical enough, you can guess how the development team threw that product together.