One Last Time: Alternative Medicine

There are certain subjects that have come up time and again over the last 9 years. The main benefit of a behavioral approach is that so many seemingly diverse behaviors can be grouped into categories or dimensions to make sense of the consequences that arise from the resulting choices. 

About five weeks ago, in August, I wrapped up the subject of unfounded fears over GMOs with a One Last Time entry. Today the subject is the very broad area of alternative medicine, which I have described as magic pills and miracle cures. Just typing “magic pill” in the search box at the top left corner of the screen will reveal about 20 entries on this subject from vitamins to caffeinated underwear. In these and several other cases I pointed out the fallacies in their advertising and directed attention to the legally required disclaimer: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease."

Recently, I found this informative site with an excellent summary.

First they list the various aliases used instead of alternative including: esoteric, complementary, holistic, integrative or natural medicine. It includes such a variety of treatments that “generally accepted definitions do not exist.” 

An incomplete list includes: acupuncture, anthroposophical medicine, applied kinesiology, aromatherapy, autologous blood therapy, Ayurvedic medicine, Bach flower remedies, bioresonance, chelation therapy, chiropractic, colonic irrigation, detox therapies, dietary supplements, energy healing, herbal medicine, homeopathy, iridology, Kampo medicine, macrobiotic, magnet therapy, mind-body therapies, music therapy, neural therapy, ozone therapy, reflexology, Reiki, shiatsu and Traditional Chinese Medicine. I have discussed many of these elsewhere, here and here, for example, but some I’ve never heard of. 

Since they have no scientific backing, how do they lure in customers? “The realm of EM (Esoteric Medicine) is riddled with fallacies which confuse patients and consumers and are used regularly to undermine critical thinking.” In other words, they trick people. The most prevalent and important of these fallacies from the site are summarized below.

The “appeal to popularity” or “appeal to authority” tries to substitute popularity or the opinion of respected people for scientific evidence. But “medicine is no popularity contest” and “even people of high standing make mistakes.”

The post hoc fallacy wrongly assumes “an event ‘X’ that is preceded by another event ‘Y’ must be caused by ‘Y’. If the rooster didn’t crow, the sun would not come up. If the child skipped vaccinations, he would not have autism. (No and no.) It is not true for individuals or for groups.

Many of these interventions rely on the placebo effect. Scientists are just beginning to understand the power of the mind to heal the body. This effect is present whether the medicine is real or not. Likewise, sometimes people just get better on their own. These alternative treatments take advantage of these facts to gather supporters and celebrity endorsements without bothering with scientific evidence.

Using an appeal to tradition, citing a long history is another fallacy, assuming that if it has passed the test of time, it must be effective and safe. This may be good reason to conduct research, and if the argument is valid, the results will be favorable. But long history is no substitute for evidence. Many treatments were applied in the past that would be unconscionable today. Contrary to some popular opinion, ancient Chinese is not a code for safe and effective.

The article gives a long explanation of why EM is unethical by medical standards. “Informed consent is rarely possible in the realm of EM.” Often there is not a professional diagnosis.

“Another fallacy holds that EM defies science or extends beyond the boundaries of science as it is currently understood. Therefore, proponents claim, it cannot be tested in the same way as one would test conventional treatments.” 

Finally, because it is natural, it is assumed to be harmless. “Nature is pictured as benign and natural remedies are therefore not just intrinsically superior but also safer.” This shows a limited viewpoint and a basic misunderstanding of nature. Hurricanes, tornados and blizzards are natural. No one would argue that tobacco is safe because it is natural. To be enamored with words like “natural” and “non-chemical” or the phrase “available without a prescription” is to succumb to deceptive advertising.

These tools are used to “mislead the public such that even the most extravagant absurdities of EM might appear more plausible. Collectively they help foster and perpetuate a culture of unreason that is essential for EM to thrive.”

Ads for a vast number of bogus alternative medical products and services have cropped up since the advent of the COVID-19, faster than the authorities can alert the public or warn the purveyors about their illegal activity. The best defense is: Don’t be a sucker!

The truth is there is no such thing as alternative medicine (no matter what name it goes by); there is only medicine that works and medicine that doesn’t work. All these tricks, alluring words and excuses do not change that fact. Lack of critical thinking in this area can lead to a waste of money, but worse, real harm to you or your family.

Another Health Scam

With the coronavirus leading every news broadcast, the networks have begun also to highlight the prevalence of false claims, fake cures and scams. To make the point that this is not new, CBS Sunday Morning (4/26) addressed the history of fake medicines and cure-alls, but was disappointingly vague on some of the current scams, ones people fall for every day, probably from fear of offending both promoters and viewers. They did, however, include a few comments from Dr. Stephen Barrett who pulls no punches in his criticism of modern scams.

In one of his latest investigations into junk medical science, Dr. Barrett addressed a process known as bioresonance hair testing. Practitioners use a device "based on the pseudoscience of radionics to analyze hair samples mailed in by customers" to "detect nutritional deficiencies; overexposure to heavy metals; and food and environmental intolerances” to serve as a “roadmap to better health.” He calls the practice preposterous, in that “hair analysis is not reliable for evaluating the nutritional status of individuals” as well as giving several other reasons why it doesn’t work.

An earlier article on the same subject he warned its use by “chiropractors, nutrition consultants, physicians who do chelation therapy, and other misguided practitioners who claim that hair analyses can help them diagnose a wide variety of health problems and can be used as the basis for prescribing supplements.” 

Since bioresonance is based on radionics, it gets even more “preposterous.” These theories supposedly rely on quantum entanglement, a central principle of quantum physics where information can be transmitted instantaneously at a distance apparently violating the speed of light. Quantum physics is arcane and incomprehensible to non-scientists, yet many questionable products use it to explain action at a distance to add a scientific-sounding aura to their sales pitch. But it's all bogus.

Then it gets more unrealistic. According to this site, “Radionics can be used for humans, animals and agriculture by means of radionic instruments which amplify and 'balance' the subtle energy field of the subject” by using “a photograph, hair snippet or other biological sample.” It works best with a good quality digital photograph because “the image stores the information of the subject and a digital file cannot be contaminated like a biological sample can,” and the light “creates a crystallization of the energy matrix of the subject.” 

Another site says, it’s “a method of healing and diagnosing at a distance using the unique extra-sensory faculties of the operator supported and amplified by a physical instrument, device, geometric pattern, energy or substance.” Since “every person's energy patterns, frequencies, signatures, vibrations or rhythms are as unique to them as their fingerprints,” they can easily detect and help correct any type of “illness, injury, infection, stress, pollution, malnutrition, or poor hygiene.”

In summary, “patients” send a full digital picture or some strands of hair. "Doctors,” using their powers of ESP, run it through their energy detection machine, make a diagnosis based on an individual energy matrix, vibrations and rhythms and recommend supplements to cure what ails them, all using the magic of quantum physics. Remember, the same technique applies to their pets or their houseplants – with a separate charge for each.

But that’s not all! In some cases, their house may be causing the problem due to the presence of “geopathic stress,” which messes with the occupants’ health. That, too, can be cured at a distance by sending a photograph and using the above technique.

This seems so outlandish that I can’t help wondering who would be taken in by it. Then I see the statement that radionics can be a “supplement to other complementary and Subtle Energy therapies especially Homeopathy, Acupuncture, Reiki,” and it all becomes clear.

CBS might mock citizens of the nineteenth century for buying Stanley’s snake oil concoctions or for making a millionaire of Albert Abrams (1864-1924), developer of devices that were the precursors of today’s radionics, but they needn’t look far to find twenty-first-century parallels.

Arthur C. Clark wrote, “Any sufficiently advanced technology is indistinguishable from magic,” but come on, people! These scams are packaged as advanced technology and sold to people who want to believe in magic.

Opposing Views on Alternative Medicine

The Association to Protect the Sick of Pseudoscientific Therapies (APETP in Spanish) was formed by victims of those therapies along with scientists, doctors, nurses, physiotherapists, computer scientists, lawyers, and many other credentialed health professionals to fight against the rise of unproven alternative medical practices in Europe. They recently published a manifesto to “raise awareness in the media about the problem of pseudo-therapies and the position of the scientific community against them.”

They feel strongly about the dangers and deception of these practices. “More than 150 pseudo-therapies have been identified as being in use throughout Europe. Thousands of citizens’ lives depend on this being prevented. In fact, according to a recent research, 25.9 % of Europeans have used pseudo-therapies last year. In other words, 192 million patients have been deceived.”

They do not list all 150 in the manifesto, but summarize a few. “Homeopathy is the best known pseudo-therapy, but it is not the only one nor the most dangerous one. Others, such as acupuncture, reiki, German New Medicine, iridology, biomagnetism, orthomolecular therapy and many more are gaining ground.” They claim that these are not only unproven, but they distract patients from seeking professional help when desperately needed. They are calling for legislation in countries around the world to combat their spread. 

In the US, practitioners of these therapies are not allowed to advertise or otherwise imply that their products can “diagnose, treat, cure or prevent any disease or any other medical condition,” but the government has not considered consumer protection legislation. In fact, the FDA and other agencies are easier on these products and practices than they are on prescription medicine in terms of testing requirements for safety and efficacy.

Meanwhile, from halfway around the world comes another example of what that group is fighting against. 

In response to the Coronavirus outbreak and WHO’s warnings, a branch of the Indian government, the Ministry of AYUSH, issued an advisory based on traditional medicine.

The first part of the release gives the typical good advice on how to behave in this environment: maintain personal hygiene; wash hands frequently; drink enough water; avoid touching your eyes, nose, and mouth; avoid close contact with sick people; stay home when sick; cover your face if you cough or sneeze; and use a mask in public places.

But next they recommend “ways and means of prevention of Coronavirus infection through Homoeopathy” and use of a variety of Unani medicines for “symptomatic management of Coronavirus infection.” (This would be illegal in the US but it is government-sponsored in India.)

Unani medicine, not common in the West, is “a form of alternative medicine, which is based on the belief that the human body contains four humors, and that imbalance of these four humors is the cause of disease,…created by the ancient Greek physician Hippocrates, which later spread to the Islamic empires...during the Middle Ages. While this belief has no scientific basis, contemporary adherents still try to propagate these beliefs as science.” [Source: Wikipedia]

 An editorial in the Times of India decried the government advisory: “When all the authorities including World Health Organization claim there is neither any vaccine nor any treatment for coronavirus, the government is promoting unproven therapies to lull people into a false sense of security that they can be safe if they consume such concoctions.” Dr. Misba Hul Bashier added on Twitter that “loads of patients developed acute liver and kidney failure due to alternative medicines.”

Of course, recommendation of useless or even dangerous steps driven by fear of the virus is not limited to the Indian government. A Canadian news story cites “quack remedies and vaccine conspiracies – a global deluge of misinformation” including a recommendation on Facebook to drink a household disinfectant and another source claiming that a saline solution, salty water, can cure it.

What can we do when misinformation abounds – petition the government for new regulations like the Europeans? Critical thinking would be a lot easier and less intrusive by trusting real evidence rather than endorsements and recommendations.

Flashback - The Homeopathy Scam

[It's Friday and time for another flashback. This time we go back to April 2015 when I ask, does homeopathy really work? Since then I have posted a few more times on the same subject. All of that research comes to the same conclusion. No, it doesn't. Here is the original.]

In a widely circulated article from the Guardian newspaper, the news from Australia is that it does not. The headline reads: “Homeopathy not effective for treating any condition, Australian report finds.” After a thorough and extensive review of over 200 research papers on the subject, the National Health and Medical Research Council (NHMRC) states: “there are no health conditions for which there is reliable evidence that homeopathy is effective.”

They go on to warn that people who use homeopathic medicine as an excuse to delay or avoid professional medical help may be putting their lives at risk.

What is homeopathy? The article describes it as the belief “that illness-causing substances can, in minute doses, treat people who are unwell,” and by diluting them in water or alcohol, “the resulting mixture retains a ‘memory’ of the original substance that triggers a healing response in the body.” That is the theory.

Wikipedia defines it as “a system of alternative medicine created in 1796 by Samuel Hahnemann based on his doctrine of like cures like, whereby a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people.” 

The fact that it is not effective is certainly not news as the first paragraph of Wikipedia entry immediately goes on to say: “Homeopathy is considered a pseudoscience. It is not effective for any condition, and no remedy has been proven to be more effective than placebo.” References associated with this conclusion date back to 2000 and earlier. It was known for a long time, but the fact that any government agency has come out so strongly against it is new.

The industry has a different take. The National Center for Homeopathy tells us: “Homeopathy is a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health.... It is extremely safe to use, even with very small children and pets, has none of the side effects of many traditional medications, is very affordable, is made from natural substances, and is FDA regulated.”

This British source sees it differently. After an extensive explanation of the theory behind it they describe it as being rooted in superstition, ritual and sympathetic magic; and cite a comprehensive study from 2005 showing that it is ineffective. For the theory to be true “we would have to toss out practically everything we have learned over the past two centuries about biology, pharmacology, mathematics, chemistry and physics.”

It seems many people disagree with the industry portrayal. Many studies have shown it as ineffective, but what about the claims of safety and regulation? The US Government’s National Center for Complementary and Alternative Health states: “We have a fair amount of research on homeopathic medicine for a variety of conditions, but less evidence on its safety, particularly for over-the-counter products.” The FDA “doesn’t evaluate these products for safety or effectiveness” and “some contain ingredients or contaminants in amounts that could cause side effects, drug interactions, or other safety concerns.” [Note: As of November 2019, no homeopathic products have been approved.]

If potential contaminants along with the ingredients are diluted beyond the point of detection, usually the worst outcome would result from people relying on homeopathy to the exclusion of professional medical help, especially if they avoid vaccinations.

So what’s the big deal? It’s just people again throwing away money on products that have been known for years to be ineffective. But when a company gets you to pay money for something that doesn’t work, how can that be legal? Doesn’t the government also have an agency to protect us from our own foolishness, like credit card scams, payday loans and fraudulent vacation schemes? Out of curiosity I asked, “Where does the government’s Consumer Protection Agency stand on all of this?”  

Their website lists under the heading “Current Scams That You Should Be Aware Of” the following categories:  Benefits and Grants, Business, Cars, Citizenship and Immigration, Computers and Internet, Family, Home, and Community, Health and Nutrition, International Relations, Jobs and Education, Money, and Travel and Recreation. A closer look at the Health and Nutrition link shows no mention of homeopathy (but there are a large number of other very interesting topics where Americans have been sold worthless or dangerous products). Until there are enough complaints on this topic, I guess we are on our own.

The government can’t (or won’t) protect us from sellers of every product or service that takes our money and give us only promises in return. Again critical thinking and just a little research can eliminate a lot of wasted time and money and possibly keep us safer.

It Doesn’t Take Much

A number of weeks ago, one of my loyal readers sent me an email with this excerpt of an article on homeopathy saying I might find it interesting. 

“Something like 5 million adults and 1 million children use homeopathy, remedies that, in fact, contain no discernible amounts of the active ingredients…. Analysts project that the global market for homeopathic treatments will rise 12.5 percent by 2023, and already it’s a $1.2 billion industry. People are beginning to feel cheated: a nonprofit suing Walmart and CVS for hawking such snake oil conducted a survey that found 41 percent of people feel negatively about homeopathy when they learn about the pseudoscience behind it.”

I did find it interesting. I was familiar with the lawsuit mentioned and had referred to it earlier. But this time what struck me was the data from the survey. If 41% are willing to change their minds (and feel cheated) when presented with the fact that there is no science behind homeopathy, that means 59% were unmoved even in the face of good evidence. They were that strongly committed to their opinions. From a critical thinking standpoint, this is very disturbing. Why look for evidence just to ignore it?

My reader thought that those 59% were in trouble, but I responded that we are all in trouble. When more than a majority hold any particular opinion, it is so easy for that to become policy. Cowardly politicians, primarily interested in job security, will go along with any crazy idea.

This phenomenon is not limited to homeopathy or alternative medicine. When I looked through articles on the Post Truth Culture and ignored those that spin the erroneous notion that it began with the Trump presidency, I found this interesting opinion piece arguing that the source lies in the ideas of individual freedom and the trend toward personalizing every experience: especially things like clothing, entertainment and tattoos.

“If you take this culture of hyper-individualism to its extreme, one might come to believe that we have the right to believe whatever we want, to – even if those beliefs are immediately provably untrue… Freedom to believe in one's own, individual universe; freedom to pick and choose facts, and discard those that are disagreeable.”

So we continue to see headlines like this one from last month: “Kindergarten Vax Exemption Rates Up – Again.” The science doesn't matter when people can personalize reality.

Likewise in politics, some recent research shows that “party identification bests ideological identification. And most people will stick with their party long after they’ve abandoned their ideology.”

Critical thinkers would work out their ideological beliefs first and then support the party or candidate that best fits them. They would begin by deciding where they stand on issues before committing.

“The truth, it seems, is closer to the reverse: We choose our party for a variety of reasons – chief among them being the preferences of our family members, core groups, and community – and then we sign on to their platforms.” 

What’s even scarier than this total disregard for information and facts by vast numbers of people is that it takes only a few people, not close to a majority, or a few incidents to incite calls for new laws or even mob action.

In one example, in response to the death of an Indiana woman from strangulation by her pet boa constrictor, the Humane Society of the United States called for legislative action. The news item tells, “at least eighteen people have died from large constrictor snake related incidents in the United States since 1978 – 13 of those since 1990. If less than one death every two years calls for a new law, what of the 350 children who drown in swimming pools each year? 

Another is the legal battle between Oberlin College and a local bakery featured on CBS Sunday Morning. A shoplifting incident by an African American student led to protests and accusations of discrimination and white supremacy, resulting in a substantial loss of business for a local family-owned store. All it took was a few activists using social media to spread a slanted story.

There are so many other examples where a minor action, incident or comment gets people up in arms, demanding changes, revenge or satisfaction, often based not on the facts or intention, but on the firm beliefs of the group. No amount or logic, reason or science will persuade them to change their minds.

Can You Trust Your Pharmacy?

A recurring comment in the script of an episode of an old TV Western (Maverick, 1958) was the line, “If you can’t trust your banker, who can you trust?” The modern day equivalent of that could well be, “If you can’t trust your pharmacy?” This is nothing against the pharmacists, who studied hard to be licensed. There is no evidence of them not giving accurate advice. The displays in the store itself along with some other corporate and industry practices, on the other hand, can and do imply things that aren’t true. Two recent news items act as a good reminder.

The first is about an on-line survey of 1000 Americans published in August, sponsored by the Center for Inquiry (CFI) and conducted by Lake Research Partners. The survey centered on people’s general trust in their pharmacy at Wal-Mart and CVS, and more specifically their feelings regarding homeopathic medicines at those pharmacies.

They chose these pharmacies because both corporations face a lawsuit over their practice of selling homeopathic medicine side by side with science-based remedies. CFI believes it is deceptive to imply that they are as effective as regular OTC cough, cold and other remedies, when they have “no medical benefits beyond that of a placebo.”

There is, in fact, broad agreement on this point. “After a thorough and extensive review of over 200 research papers on the subject, the National Health and Medical Research Council (NHMRC) [of Australia concluded in 2015]:  “There are no health conditions for which there is reliable evidence that homeopathy is effective.” (For a thorough explanation of homeopathic medicines click the link.)

That survey of Wal-Mart and CVS customers asked them about how they make their purchasing decisions for cough, cold, and flu remedies at the two stores “and about their general knowledge of the basic principles of homeopathy, an 18th-century pseudoscience that has been utterly disproven.” The survey showed that exposure to this new information about the failures of homeopathy in so many independent studies led consumers to have to negative feelings about the products and the companies selling them. More than 4 in 10, “described their feelings about the purchase of a homeopathic remedy in deeply negative” terms.

Remember, one of the companies, CVS, still talks about how proud they are of the decision to discontinue tobacco products five years ago and believe it shows their concern about the health of their customers. Tobacco sales were profitable, but ultimately stood in the way of them being considered “a trusted health care provider.” According to their CEO, they strive to be in the same class of business values as TOMS shoes (which donates shoes to African countries providing unfair competition to African small businesses trying to survive by selling shoes – but that kind of unintended consequence is a topic for a different time). If they value their reputation for being a healthcare resource, one would think they would be as concerned about the accurate representation of their products.

But if you can’t trust your pharmacy about the product displays, what about the prices?

That leads to the second news item. A lawsuit filed in August by PharmacyChecker.com accuses “The National Association of Boards of Pharmacy (NABP), LegitScript, and three Pharma front groups [of] operating a coordinated campaign to suppress market competition, artificially inflate the price of prescription drugs, and spread misinformation to scare consumers away from international online pharmacies.” 

PharmacyChecker.com verifies the reliability of international online pharmacies and compares their drug prices to allow consumers to be confident about their on-line purchases and to inject competition into the prescription drug market. They allege in the lawsuit that those organizations have conspired with Google, Microsoft and others to lower their page on search results and in some cases to display a warning box when the page is opened.

Companies and industries do many things to protect their business and to make a profit. Consumers have to do many things to protect themselves. Mostly it involves research and critical thinking, especially when health and healthcare costs are concerned.

The Miracle (?) of Homeopathy

One week ago I compared adults’ belief in psychic abilities to children’s belief in the Easter Bunny. But that is not the extent of these false notions. Another subject that adults love to believe in is miracle cures. It reflects a problem in the areas of discipline, not wanting to do the hard work or stick to a routine, and critical thinking, not wanting to accept evidence over stories. A good example of this is homeopathic medicines.

The theory dates back to the 1700s and is based on the idea that the body can be stimulated to cure itself by means of a like-cures-like reaction. In other words, substances that cause an adverse reaction in a healthy person can (supposedly) cause the body of a sick person to fight against the same condition.

Here is how WebMD explains it. “Red onion makes your eyes water. That’s why it’s used in homeopathic remedies for allergies.” Similarly, they may use poison ivy, white arsenic, crushed whole bees, and various herbs to evoke a beneficial effect.

“Homeopathic doctors weaken these ingredients by adding water or alcohol. Then they shake the mixture as part of a process called ‘potentization.’ They believe this step transfers the healing essence [from the ingredient to the liquid]. Homeopaths also believe that the lower the dose, the more powerful the medicine. In fact, many of these remedies [are so diluted that they] no longer contain any molecules of the original substance.”

The theory sounds a little like vaccinations where a small number of living or dead cells are injected to fire up the body’s immune system, but it’s not the same. Vaccines have something in them. Homeopathic medicines are diluted to the point where they contain only water, plus any contaminants the water carries. Therein lies the problem.

Last summer the FDA released a warning about one particular manufacturer saying, “Consumers and pets who use these products could have an increased risk of serious infection, that could require medical attention, due to the high levels of microbial contamination.” They warned three other companies for violations of (1) inadequate investigation of test results that found high levels of microorganisms, (2) lack of quality oversight of ingredients with potentially toxic effects, including snake venom, and (3) having insects in their ingredients.

The usual disclaimer applies to all these remedies: "Products labeled as homeopathic have not been approved by the FDA for any use and may not meet modern standards for safety, effectiveness and quality." 

It strains credibility that medicine containing not a single molecule of the active ingredient would be effective. The doctor who runs this site calls homeopathy “the ultimate fake,” giving a thorough explanation of his position. So if it does actually work, it must be a miracle. But what does the evidence show?

Here is a headline from Science Direct a few months ago: “A randomized, blinded, placebo-controlled trial comparing antibody responses to homeopathic and conventional vaccines in university students.” Their conclusions from this well designed experiment were four-fold: 

• Homeopathic vaccines failed to elicit an antibody response.
• The antibody response to homeopathic vaccines was similar to placebo.
• In contrast, conventional vaccines showed a robust response.
• These findings suggest homeopathic vaccines should not be licensed.

How does a half-billion-dollar industry react to these facts? They continue to promote their products as “a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health. It is extremely safe to use, even with very small children and pets, has none of the side effects of many traditional medications, is very affordable, is made from natural substances, and is FDA regulated.”

Add "holistic" and "alternative" to that sales pitch and people will ignore facts and fall all over themselves trying to obtain some magical relief! Of course, with nothing in it, it is safe and has  no side effects, except possibly from contamination the manufacturer has overlooked. Here’s an idea: skip the trip to the health food store and feed your children and pets tap water. It’s basically the same thing, but even safer. 

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 9^th 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?

One More Time – The Placebo Effect

Way back in early 2012, I first brought up the placebo effect – the tendency of the body to heal itself when belief in the cure is strong. How it works is still a mystery but that it does work is indisputable.

The example I used over 6 years ago was a $30 performance wristband, one endorsed by famous athletes and touted to improve athletic performance. In a test people were given the advertised wristband and exposed to some physical performance and balance tests. The before and after results showed some improvement. Then they were given a similar-looking one-dollar replacement band and told it was also special, performance on physical and balance tests improved comparably. Conclusion: it wasn’t the band at all; it was the perception that they were getting some extra, outside help – mind over matter.

Since then I have mentioned the placebo effect in essays warning about vitamins, acupuncture, forest bathing, chiropractic, healing crystals, gluten-free diets, cryotherapy, homeopathy, ear candling, essential oils and a few other subjects. (Wow, that’s a lot of toes to step on in only six and a half years!)

The point is not to make people angry and defensive, but to make them aware of the difference between science and marketing, and how the placebo effect can lead to an erroneous conclusion that a treatment really works.

When a cure is proposed, competent scientists will split a relatively large group in two, randomly assigning one to test the treatment while giving the other a placebo. Both groups usually show some improvement due to the placebo effect. To validate the treatment however, the improvement of the treated group must be significantly better than that of the control group. Otherwise they declare the treatment “no better than a placebo,” that is, no better than no medicine at all.

The placebo effect explains many of the endorsements we hear from celebrities, friends and neighbors. They sincerely (and enthusiastically) believe whatever they are recommending has beneficial effects, but with no scientific evidence it may be “no better than a placebo.” When you buy one of these products, the money spent is money wasted. That’s why the small print in ads, where they explain how the FDA has not approved their magic formula, they often add something like “results will vary.”

That takes us to a health story from England where the BBC reported a pure placebo experiment. With help from University of Oxford, they tried to see if they could “cure real back pain with fake pills.”

One hundred people with severe back pain were asked to participate in a study of a powerful new painkiller. What they didn’t know is that everyone would be given realistic looking pills that were really placebos, “capsules containing nothing but ground rice.”

The blue-and-white-striped pills “came in bottles, carefully labeled, warning of potential side effects and sternly reminding patients to keep out of the hands of children” to further the impression that this was powerful stuff.

Three weeks later researchers found “nearly half of our volunteers reported a medically significant improvement in their back pain” and that those who spent a little more time with a doctor merely discussing the pills were more likely to improve. In one case, a man went off his morphine but continues to take the ground-rice pills.

Placebo effect is not a trick that works only on the gullible. Taking a placebo can cause the body to release endorphins, natural painkillers. And sometimes subjects improve even when they know they are taking a placebo.

But that doesn’t mean the gullible aren’t tricked. In the earlier case of wristbands, even after the people learned that there was no difference and the improvement in both cases was psychological, they still wanted to buy the $30-wristband over the equally effective $1 bands. It’s like when people think the same wine tastes better when the bottle has a higher price tag. 

It does no good to understand science when critical thinking fails to kick in.

Real Medicine

There is no such thing as alternative medicine.  There is only medicine that works and medicine that doesn’t. (Paraphrased from Dr. Harriet Hall’s excellent lecture series on YouTube.)

 I’m reminded of this wisdom when I hear news like this from NBC. “Complementary therapies may sound good, but they don't cure cancer.” Last Thursday researchers published the results of a study showing that “cancer patients who choose alternative medicine over standard, proven cancer treatments are more likely to die.”

The practice of using herbs or meditation is fairly common among cancer patients and may make them feel better and more at ease; but it does nothing to cure the cancer. People who rely solely on complementary medicines are more likely to opt out of proven treatments and twice as likely to die from the cancer.

The study also found that those who relied on alternative cures tended to be younger women with more education and more money. This is an exception to data showing that the poor generally have worse outcomes. It is only natural to look for a gentler, less intrusive solution, but better-informed people should know that doctors and the FDA “have warned for years that unproven treatments may lure patients away from legitimate therapy that can save their lives.”

That last sentence is interesting in light of another recent piece of medical news. “The Center for Inquiry has filed a lawsuit in the District of Columbia on behalf of the general public against drug retailer CVS for consumer fraud over its sale and marketing of useless homeopathic medicines.” Their objection is that CVS sells homeopathic products side by side with scientifically proven medicines, leading customers to believe that the products are as effective as standard remedies for pain, insomnia, and cold/flu symptoms.

The Center for Inquiry (CFI) characterizes homeopathy as “a total sham” and explains their reasoning. Of course, they are a skeptical group, and this opinion would be expected. However, the experts come down on their side. “The FTC declared in 2016 that the marketing of homeopathic products for specific diseases and symptoms is only acceptable if consumers are told: ‘(1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.’ And last year, the FDA announced a new...policy of regulatory action against homeopathic products.” (It's only the CAM lobby that deflects stronger action.)

 Isn’t this CVS that seems to endorse homeopathy as legitimate medicine the same CVS that made headlines a few years ago by refusing to sell tobacco products, because they cared so much about our health?

That’s right. And now they are trying to take credit for a 1% decrease in the number of packs of cigarettes sold in 13 key states where they do business. But critics of the CVS claim see it a little differently and don’t think CVS should get much credit for the improvement.

With such a small percentage of the market, most analysts don’t believe the CVS claim that smokers made the switch from cigarettes to “mostly ineffective nicotine patches and quit smoking. [It] only illustrates how little the company knows about the difficulty of quitting." With so many smokers trying to quit anyway, it’s hard to believe the CVS decision had much influence.

CVS counters that their studies show an impact on public health. Also, a spokeswoman adds that the company is trying to drive impulse buying away from the traditional junk food by “placing healthier foods – such as yogurt and fresh fruit – in key locations in the front of the store.” But they still place homeopathic products under signs that imply real curative power when CFI, the FTC and the FDA see a problem with that.

CVS and many others try to convince us that they are really interested in our health while they sell ineffective homeopathic products, dietary supplements and "alternative" medicines.  I wouldn’t trust them with my health decisions, but I’m a critical thinker.

The More Things Change...

The old saying is true: the more things change, the more they remain the same.  But today we must be far more careful than ever when facing old-fashioned threats.

This thought came from a new book I picked up at the library.  It's called Quackery:  A brief history of the worst ways to cure everything.  It contains several short sections, each covering one of the weird and often painful or disgusting medical practices of the past.

On page 47 in the radium section, I was stunned by the familiarity of ideas.  “Despite the passage of the Pure Food and Drug Act in 1906, radium remained entirely unregulated because it was classified as a natural element.  (Many today still make the automatic assumption that a natural substance is always pure, useful and has no side effects.)  Because it was natural and unregulated guess what happened.  “Advertisements sprang up in newspapers touting the ability of this radioactive and sometimes deadly element as, for example, an aid to youth and beauty, health, and relief of aches and pains in joints and muscles.”

Radium is related to radon gas, and you can’t buy or sell a house without an inspection confirming safe levels, because it can cause lung cancer.  Radium in general is dangerous and anything but healthy, so this is an extreme example, but it did remind me of a couple of my comments posted at the beginning of this year about raw water, which can be dangerous, and hydrogenated water, which is expensive and backed by weak science.

 The following week I featured some of those miracle cures in newspapers that promise instant results and portray themselves as such a threat to Big Pharma that behind the scenes moves are supposedly afoot to banish them from the market.  (So you’d better act fast!)

And in December I wrote about the British National Health Service no longer paying for what they consider low value treatments including:  homeopathy and herbal medicines, fish oil, glucosamine and chondroitin combination products and lutein and antioxidant combination products.  The NHS reject these and some others as having low clinical effectiveness, with scant scientific backing while presenting significant safety concerns.

The next paragraph in the Quackery book tells how radium was so expensive that most of the so-called radioactive products “did not actually contain any radioactive ingredients at all.”  Instead of buying a dangerous product, they were buying a worthless product relying on placebo effect for its curative powers, a fact that doubtless saved lives but still emptied pocketbooks.  We see the same advertising schemes and mislabeling today.

These tactics of taking an unregulated substance and touting its supposed miraculous health benefits have been going on for years.  But the promotions today are even more insidious.  They go to the very edge of their legal boundaries, using scientific sounding words, enthusiastic endorsements and often trying to pass as news articles while burying required disclaimers at the end in small print.  The speed and breadth of communications in the modern world, as I explained last time, distributes misinformation quickly.  Particularly in the case of health issues, dangers are compounded by the fact that diseases and conditions may clear up on their own fooling users into attributing a cure to a worthless product.  That’s why listening to friends who swear by the effectiveness of this or that cure is so problematic.  Finally, as this Scientific American article on fake news points out, the more you hear an idea or opinion, the more familiar it becomes and the more you tend to believe it, even if you already know better.

Things stay the same, but in this modern age critical thinking, being skeptical and doing good research from reliable sources are much more urgently needed to protect your health and your wallet.

In Search of Longer Life

We love to believe that certain products will help us live longer and healthier lives.  The problem is we are often wrong, but continue to spend lots of money on these supposed preventions and cures.

In light of this, the latest research should come as no surprise.  “Calcium and vitamin D supplements may not help prevent bone loss and fractures, according to a new study released Tuesday in the Journal of the American Medical Association.”  This article goes on to say that in 2016 Americans spent close to $2 billion on these supplements hoping to enjoy the benefit of stronger bones.  In conclusion the researchers remind us that the best way to get nutrients is not through supplements, but through food rich in vitamin D and calcium.  And stronger bones are also promoted by regular exercise.

The part about skipping the supplements and getting vitamins and minerals through healthy eating is standard in much of this scientific health advice, but often ignored.  Taking a pill or two is much easier, and the idea of exercise to promote health just seems like too much work.  The result is $2 billion wasted.

Calling it a waste may seem harsh, but here is a direct quote from WebMD from about 3 weeks ago:  “Seniors are wasting their time and money taking calcium and vitamin D supplements to ward off the brittle bones of old age.”  They are unnecessary and there is little evidence that they work.  But try to tell that to anyone committed to a daily regimen of supplements of any kind and they will resist, saying it works for them or it makes them feel better.

The problem is even greater for those buying homeopathic remedies.  Here is an excerpt from a Food and Drug Administration (FDA) press release from last month with the subtitle “FDA continues to find that some homeopathic drugs are manufactured with active ingredients that can create health risks while delivering no proven medical benefits.”

The press release continues:  “Until relatively recently, homeopathy was a small market for specialized products. Over the last decade, the homeopathic drug market has grown exponentially, resulting in a nearly $3 billion industry that exposes more patients to potential risks associated with the proliferation of unproven, untested products and unsubstantiated health claims.”  The Federal Trade Commission is also cracking down due to the unsubstantiated claims that these substances cure anything.

I don’t think it is a coincidence that the popularity has grown over that last decade when social media began to spread so many false reports about health, miracle cures, and vast conspiracies by the medical profession and insurance companies to keep the truth from the public.  Again I am not being harsh in exposing this information.  Consumer Health Digest puts it even more bluntly:  “Although homeopathic products have no proven effectiveness and their theoretical basis is senseless, a complete ban is not politically feasible.”  Isn’t it a shame that popularity trumps science in this and so many other cases?

These ideas get embedded so deeply in the social consciousness that no amount of persuasion will change habits.  Take for another brief example this from the New York Times a little over a year ago:  “Misconception: Drinking buckets of cranberry juice can cure, and even prevent bladder, infections.”  Yet how many will continue to swear by cranberry juice for those mythical benefits?

There is no fighting it.  Weakness in discipline leads us to rejoice at the thought of an easy answer and weakness in critical thinking leads to the victory of emotion and popular opinion over science.  What’s the problem here?  After all, it’s only $5 billion wasted, and the cranberry juice will at least keep us hydrated.