‘Practitioner Only Supplements’: How Australians Get Tricked Into Buying Snake Oil

those behind-the-counter pills that the pharmacist recommended for your cold? sorry, they're just overpriced vitamins and herbs

You wake up feeling unwell. Maybe you have a cold, a really sore throat, a headache or something. It doesn’t seem bad enough to warrant going to the doctor but you want to see if there’s any over-the-counter medication you can get that might help. You go to the pharmacy and ask the staff for help so you know you’re getting the right pills. But instead of recommending some paracetamol or pointing you towards something on the shelf, they walk behind the counter and grab a bottle of pills labelled 'ImmunoUltra’ (or something that sounds like that). They tell you that these pills are great and will help relieve whatever symptoms you have. They’re ‘practitioner only’ pills – stronger and more effective than what you could get over-the-counter. The pharmacist knows it’s the right choice for you, so they’re happy to sell them to you. You imagine the pills contain pseudoephedrine and paracetamol, probably some codeine too, though it’s a little weird that the pharmacist didn’t tell you to watch out for drowsiness. It’s pretty expensive too, but hey, that’s probably because the medication is so potent and effective. You buy the pills and the pharmacist writes up a label telling you how many to take a day. You go home and read the label on the container. It contains a bunch of strange references to ‘natural' remedies, ‘traditional medicine’ and ‘homeopathy’. You look at the list of ingredients only to see vitamin C, zinc and a few herbs. No medicine, just vitamins and herbs. You just got tricked into buying snake oil.

The complementary medicine industry makes millions off of transactions like these. ‘Complementary medicine’ is the nicer face of alternative medicine – pseudo-medicine that does not meet the evidentiary standards of the modern medical community. Complementary medical products are usually herbs, vitamins, essential oils and other ‘natural’ things that are meant to treat various ailments or be good for you more generally. The evidence for such claims usually consists of poor quality studies or evidence that the product fits into some kind of woo-woo paradigm like homeopathy or ‘traditional medicine’. These products are obviously snake oil bullshit and should not be sold in pharmacies, but alas, they are.

The Illusion of Legitimacy and Efficacy

Many people are already aware of the ills of complementary medicine but far fewer are aware that ‘practitioner only supplements’ are a form of complementary medicine. The Therapeutic Goods Administration (TGA) does not determine which products are practitioner only and which ones can go on the shelf.

If you ask your pharmacist or google ‘practitioner only supplements’, you might get the impression that these products are more potent than over-the-counter supplements. Carla Griscti, in an article for Vital+ Pharmacy Supplies, writes that “they are of a much higher quality, and often contain a more concentrated dosage, than over-the-counter medications". She claims that this is because practitioner only supplements “undergo rigorous quality assurance testing and clinical trials to ensure all the ingredients are both effective and safe”, going as far as to claim that “you’re guaranteed results”.¹ Vital.ly makes the much weaker claim that “the majority of "practitioner only" brands focus on producing higher quality, more potent products” but “this is not to say all "retail" products are inferior”.

In reality, it’s completely up to the supplier to voluntarily list their products as practitioner only. These products are not regulated any differently from other supplements, aside from the fact that they are not required to put therapeutic indications and patient instructions on the label. It’s also untrue that practitioner only supplements are more potent or of a higher quality than over-the-counter complementary medicines. Many practitioner only brands sell vitamins and herbs at precisely the same dosages you can get over the counter. Bioceuticals, a practitioner only subsidiary of Blackmores, sells ‘D3 Capsules’ which contain 1000IU of vitamin D3 – the exact same amount of vitamin D3 you can get in Blackmores’ over-the-counter vitamin D3 supplement. The only thing that’s more ‘potent’ about the Bioceuticals supplement is the price: $31.99 for 240 capsules instead of $22.99 for 300.

Occasionally practitioner only supplements do contain different ingredients from most over the counter supplements, but there isn’t really a clinically-relevant reason for them to be labelled as practitioner only. For example, the article on Vital.ly suggests that a practitioner only calcium supplement could use calcium glycinate instead of the industry standard calcium carbonate, citing some evidence that supplementing with calcium carbonate might lead to constipation in some people (although they don’t cite any evidence that calcium glycinate avoids this problem). Fine, but that’s not a reason for to label the calcium glycinate supplement as ‘practitioner only’.

Preying on the Vulnerable

The real reason why brands list their supplements as practitioner only is because they know having their products behind the counter, being recommended by recognised health practitioners like pharmacists, naturopaths and the like to their patients, lends their products the illusion of legitimacy and efficacy. It makes these supplements seem more like legitimate medicine. If you can’t get it over the counter, then that implies that it might be so potent, and therefore effective, that there are risks to taking it unnecessarily.

Pharmacies might sell a lot of crap but that’s just stuff they put on the shelves to make money. It’s not like the pharmacist wanders around the store trying to convince old men that they need that horny goat weed supplement to fix their erectile dysfunction. It’s pretty easy to assume that whatever the staff recommend to you must be effective.

The saddest thing about practitioner only supplements and how pharmacies shill them to their customers is that they prey on the vulnerable. People go the pharmacy wanting to find something that will help them only to be suckered into buying a blend of vitamins and herbs at a massive premium. Anecdotally, I’ve seen and heard stories of people with complex health problems getting upsold some practitioner only garbage to ‘help’ with the side effects of their actual medication or to ‘support’ their immune system.² I’ve known people who’ve trusted these supplements for years, under the impression that they’re genuine drugs designed to treat various ailments, only to be horrified when I’ve told them that they’re just taking an expensive vitamin C and zinc supplement.

1. There are more false claims in this article, such as the suggestion that practitioner only supplements are regulated unlike over-the-counter supplements.

2. You’ll notice that a lot of these supplements supposedly do things like ‘support the immune system’ because they’re such vague claims that they’re almost impossible to prove or disprove.