Saturday March 15 2008
Doctors love pills: so do the public, and the media, and of course so do pill companies. When one pill dies, another must take its place. Are you feeling tired? Demotivated? I bet you are. But there is a solution – a pill – pushed by no less than Dr Thomas Stuttaford of the Times. Just two days ago in an article about “office tiredness” he cheerfully rehashed a press release on Boots’ exciting new pep pills. He opines at length on how tired we all feel in the office. So tired.
Why not try Coenzyme Q10, at just £4.99 for seven tablets (with a money back guarantee)? There is much talk of “energy”. “Biochemists were interested in the possible role that Coenzyme Q10, also known as CoQ10 (ubidecarenone or ubiquinone) might have in providing energy to cope with modern life.” Big words. “Most doctors will remember learning about the role of CoQ10 as a factor in the oxidative pathway adenosine triphosphate (ATP), upon which all cellular metabolism depends.”
I do remember. CoQ10 is one of many molecules involved in shunting chemical potential energy about cells. That’s chemical energy, from the breaking of bonds, which is used to make other chemical reactions happen.
This is not the same thing as emotional energy, get up and go, zip, welly, or “energy” energy. Stuttaford obediently recycles Boots’ fanciful and lucrative elision of these two distinct meanings. But Boots did have a sciencey-looking reference on their press release: “Energy levels can suffer as the body struggles to convert food into energy*.” The optimistic asterisk is to the authoritative looking reference: “Ernster L, Dallner G., Biochem.Biophys.Acta. 1995 May 24;1271(1):195-204”.
I have it here. It’s an old review paper on the biochemistry of CoQ10, its role in the cell. It has nothing to add on the pills making you feel more zippy. In fact no evidence is presented to support the claim that CoQ10 will make you feel perkier. I don’t think you’ll find any, except for anecdotes that are vulnerable to the placebo effect.
This is called “disease mongering“, and is a well known strategy. Big pharma is running out of new molecular entities (they registered 50 a year in the 1990s, now it’s 20 a year, a lot of them copies).
Because they cannot find new treatments for diseases we already have, they invent new diseases for treatments they already have. Favourites include social anxiety disorder (SSRIs) and female sexual dysfunction (Viagra): problems, in a very real sense, but not necessarily the stuff of pills. In fact, reframing loss of libido, shyness and tiredness as medical pill problems could well be considered crass, exploitative, expensive, and disempowering.
Big pharma is worth £150bn, it pushes products to doctors, who are trained to spot drug company nonsense. The food supplement industry is worth £30bn, and is marketed at you, with sciencey-sounding rhetoric, through the media, where no regulator will touch their claims. Sleep and exercise (not much work, but better than CoQ10 , much of it in the field of cancer eg here) have a much better evidence base for tiredness. They don’t come in pills, and you don’t see them much in the media, because you can’t sell them for 71p a day.
· Please send your bad science to firstname.lastname@example.org
Boots’ killer reference is here:
Ernster L, Dallner G., Biochem.Biophys.Acta. 1995 May 24;1271(1):195-204″
There’s a lot of stuff around on exercise and tiredness in the cancer literature, covered for example in this rather good review.
Assessment and management of cancer-related fatigue in adults
The Lancet Volume 362, Issue 9384, 23 August 2003, Pages 640-650
The commonest cause of tiredness is going to bed too late. I left my nice scan of that page from the don sleep textbook at work, will grab it next week.
CoQ10 also blogged at tremendous length by the excellent David Colquhoun, and from a business and historical perspective by Holfordwatch. I must say I find it fascinating how all these companies from the $60bn food supplement industry really do approach all this exactly the same as big pharma. You might call it cynical.