Sweets in Boots

Here’s a piece I just wrote for the Guardian’s Comment is Free. Except in this case it isn’t, because comments have been prematurely terminated. That may be rectified soon, if you want to join the rush.

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In the 13th century, £164 was an awful lot of money. But that’s how much the ailing Edward I spent on making over two thousand pounds in weight of medicinal syrups. Sugar was rare, and its very sweetness was taken as evidence of its medicinal value. Our word ‘treacle’ comes from theriac, a medieval cure-all made from roasted vipers, which could prevent swellings, unblock intestinal blockages, remove skin blemishes and sores, cure fevers, heart trouble, dropsy, epilepsy and palsy, induce sleep, improve digestion, restore lost speech, convey strength and heal wounds. No wonder town authorities monitored the apothecaries who made it, to make sure they didn’t palm people off with substandard stuff.

We like a good laugh at medieval medicine, don’t we? Then we walk into the sweetie shops for grown-ups known as Boots to buy lozenges, pastilles and syrups (hmm, suspiciously olde words, now that I think about it) for our aches, coughs and sneezes. Of course, some of us consider this sugaring of the pill to be prima face evidence of duping by the drug companies, and we go instead for the bitter natural cures, the Bach remedies and alcoholic tinctures which, like the medieval syphilis cure called guaiac, are made from twigs and wood, cost the earth, and taste vile.

Each to his own. I quite like the sugar rush. And I’m not surprised that Edward I did – on a medieval diet, a spoonful of sugar would probably work wonders for your metabolism, you’d feel like a new person for a few hours until your dropsy kicked in again. This, I surmise, must be why there is Benylin in my medicine cabinet. Because surely I didn’t – did I? – buy it because I thought it would make my cough any better?

An ‘expert panel’ convened by Which? Magazine has just announced that “We spend billions on over-the-counter pharmacy products each year but we’ve found evidence of popular products making claims that our experts judged just aren’t backed by sufficient evidence.” Cough syrups are among the worst offenders. They sell like crazy in winter, are mostly sugar (including treacle), and probably do sod all, despite the surreally euphemistic claims of brands such as Benylin that they will make your cough “more productive”.

Let’s be fair – Boots, at least, never claimed otherwise. Its “Web MB” admits that “The NHS says there’s not much scientific evidence that cough medicines work… The NHS says there are no shortcuts with coughs caused by viral infections. It just takes time for your body to fight off the infection.” Sure, if the syrup contains paracetamol, it might ease your aching head; if there’s any antihistamine in there, your streaming nose and eyes might dry up a bit. But if you want to soothe your throat, honey and lemon is at least as good – the Guardian’s told you that already.

The Which? report also questioned evidence that Seven Seas Jointcare tablets, Adios Herbal Slimming Tablets and Bach Rescue Remedy spray (to “restore inner calm”) do any good. Are you shocked yet?

Consumers deserve protection against charlatans, for sure. But as far as the over-the-shelf pharmacy counter is concerned, you might as well be expecting scientific evidence for palm reading. Can we, in this post-Ben Goldacre age, now ditch the simplistic view that medicine is about the evidence-based products of the pharmaceutical industry versus the crystal healers? That modern conceit ignores the entire history of medicine, in which folk belief, our wish for magical remedies, placebos, diet, fraud, abuse of authority, and the pressures of commerce have always played at least as big a role as anything resembling science. Modern drugs have made life longer and more bearable, but drug companies are no more above fixing the ‘evidence’ than some alternative cures are above ignoring it.

We’re right to be outraged at Big Pharma misbehaving, especially when their evasions and elisions concern drugs with potentially serious side-effects. But the sniffles and coughs that send us grazing in Boots are the little slings and arrows of life, and all we’re doing there is indulging in some pharmacological comfort eating. I’m a fan of analgesics, and my summers are made bearable by antihistamines, but a lot of the rest is merely lifestyle-targeted placebo. There’s no harm in that, but if we are going to be affronted when we find that those saccharine pills and potions won’t cure us, we’ve misunderstood the nature of the transaction.