Monday, December 17, 2018

Is It False Advertising?

A couple of years ago plaintiffs brought a class action suit against Boiron Inc., the maker Oscillococcinum, a homeopathic cold and flu remedy claiming that it didn't work. What was unusual in this case is that it went to a jury trial. Most of the time, in fact twice in the past in other lawsuits against Boiron, these types of cases are settled before they go to trial. Apparently this time the company decided it was time to take a stand and risk the decision of a jury. Surprisingly, the company won in court. The jury simply felt that the plaintiff hadn’t presented sufficient evidence that the product did not work as advertised, that is, they had not shown that it did not relieve flu symptoms.

 The reason this is coming to light now is that the plaintiff appealed to the 9th Circuit, but the court sided with the company. The court found that “the jury appeared to have believed Boiron’s expert, clinical studies, and anecdotal evidence more than it believed the plaintiff’s expert." According to the court, there was no legal reason to overturn the verdict.

 But what exactly is going on here? Is there a scientific reason to doubt the claims of the company?

More can be learned from the website Rxlist.com. “Homeopathic products are extreme dilutions of some active ingredient. They are often so diluted that they don't contain any active medicine.” Due to legislation passed in the 1930s this type of product can be sold in the U.S. but, like dietary supplements, are not held to the same safety and effectiveness standards as approved drugs.

Oscillococcinum claims to relieve flu symptoms, but not cure the flu. It’s effectiveness is based primarily on self-reporting. The website finds “no reliable evidence that taking Oscillococcinum can prevent the flu and evidence of any beneficial effect at all is questionable “due to flaws in the study design.”

It is made by highly diluting in water a compound extracted from the heart and liver of the Muscovy duck. Its dilution rate is coded in homeopathic terms as 200C. This means there is one part duck in a solution containing 1-followed-by-400-zeros parts water. That is an insanely huge number. There isn't even a name for this number. It is more than the estimated number of molecules in the entire universe! It is physically impossible for any part of any active ingredient to survive that level of dilution. But homeopaths explain this away by saying that the water retains the essence of the ingredient (even though there is none left). The remaining water is then combined with inactive ingredients of lactose and sucrose.

“Most experts believe that it will have no beneficial effect and also no negative side effects.” How could it not be safe when it’s primarily sugar water, unless the sugar was somehow contaminated? The company relies on the placebo effect to influence customers and then uses endorsements and personal accounts in their advertising and in this court case.

In my opinion this is nothing but snake oil and that people are basically throwing money away. However, I agree with the jury and the court that they did not advertise falsely. People who are willing to pay about a dollar per dose and take three doses per day really believe in its power to reduce flu symptoms. That belief alone is often enough to make them think they feel better and to report a reduction of symptoms. (Note: Some people take it to prevent the flu, a benefit the manufacturer doesn’t even claim.)

 We each get to decide how to wisely spend our dollars. (Annual sales of Oscillococcinumin in the U.S. were $20 million in 2013, and they probably only had to use one duck!) Information on homeopathic medicines is so easy to find, but the ability to overcome most people’s longstanding beliefs is so difficult to sway.  And suppose those people who still have the flu, but strongly believe they feel better, decide to come to work or school and spread it around. What then?

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