Posted by: Connie Pringle16 SEP 2011
This week, I attended a commercial press conference hosted to promote the launch of a natural health supplement product cited to relieve the joint pain associated with osteo- and rheumatoid arthritis. The whole experience was pleasant (after all, who can say no to free champagne, tea and scones?), but for me, it raised more questions than it answered.
The patented active ingredient of the new Litozin drink powder is GOPO, glycose of mono and diglycerol, an extract from rose hip. GOPO is thought to inhibit cell migration in the inflammatory process that causes tissue damage and joint pain. There is more evidence for the role of the GOPO in pain relief and increasing mobility than for similar supplements, such as glucosamine, but the evidence base is by no means overwhelming. Studies seem small, possibly underpowered, few and far between. There is no evidence suggesting that the new drink powder formulation is as ‘effective’ as the capsule formulation previously on the market, and as with all unlicensed naturally sourced products, little guarantee can be made with regard to the purity of the active ingredient it contains. Personally, I can’t see why a pharmacist would wish to recommend a product with such little evidence for benefit to a patient.
Although LitoZin is not recommended by its manufacturer as a replacement for other treatments, championing supplements of questionable efficacy over NSAIDs (‘taking LitoZin can reduce the amount of other pain relief medication you need’) doesn’t seem that wise. Though not ideal long term, unadvisable for some patients (particularly those suffering renal impairment), and sometimes considered ‘nasty’ due to GI side effects and other risks, at least NSAIDs are known to work, properly regulated and available on prescription!
However, there is undoubtedly power in placebo. This is wielded by advertising, patient expectations and the opinions of trusted health professionals. Dr Rod Hughes, speaking at the event on the role of joint health supplements in arthritis, was keen to promote patient choice. If a patient really wants to try a product which may provide benefit and isn’t known to cause harm, why stop them? This is probably a fair comment for a GP relaying the facts when meeting a patient who has brought a variety of water pills and herbs sourced on ebay into the surgery for a second opinion. However, I think this issue is more complicated when community pharmacy is added into the equation.
The cited benefits of LitoZin drink powder for community pharmacy retailers, according to the manufacturer, include a modern new formulation conveying improved concordance which will in turn, improve customer loyalty. At £20.42 for 20 sachets (to be taken once daily, with or without champagne), another ‘benefit to pharmacy’ of the new LitoZin product is its premium price. That is to say, it will make for a good income generator. My questions are predominantly ethical.
Dr Hughes mentioned the desperation and fear experienced by some patients who will literally try anything to improve their long-term health risks, or to achieve symptomatic pain relief. With money to be made from products like LitoZin, I can’t help being a little concerned about potential exploitation of this ‘market’. Some patients have ‘nothing to loose’ (except pennies and pounds) by taking a supplement which might (just might) provide some benefit. This introduces a tangible temptation to use patient choice as an excuse to sell products that don’t work to people who don’t need them. In light of this, community pharmacies should be warned to use their professional judgement wisely, and keep patient care their first priority.