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?

Science Illiteracy is Real

Earlier this month results of a worldwide survey, the 3M State of Science Index, made a few headlines.  It asked participants a number of questions to discover the general attitudes toward science: do people trust science, do they find it scary, do they take science for granted, do they think science is generally good or bad.  The results were mixed, but disturbing enough to motivate former astronaut Scott Kelly to begin a project promoting an appreciation of science.

After hearing of this survey, I went to the source and found a 46-page slide presentation with the detailed results.  One of the two key findings appears on page 10: “People are unaware of the impact of science in their everyday lives.”  More detail is given below that heading: “Nearly two out of five (38%) believe that if science didn’t exist, their everyday lives wouldn’t be that different." 

It’s hard to believe that people living in the twenty-first century could be so out of touch.  It’s true that it was an international survey and not specifically broken down by country, but they do show a “Science trust index” for each of the 14 countries based on the overall answers and the US comes in very close to the average.  We could attribute this misunderstanding of the benefits of science to the fact that most people (66%) spend little or no time thinking about science. But it’s still hard to believe!

This is extremely unsettling and so easy to confront. It isn’t about the Theory of Relativity or Quantum Mechanics.  Just think about the ideas of two people and about two contrasting events.

The two people are Ignaz Semmelweis and Thomas Malthus .  One was right and the other wrong.

In 1847 while working in a Vienna hospital, Semmelweis observed that the ward where doctors delivered babies had a 10% mortality rate for new mothers, three times the rate of the ward where midwives worked.  After checking many factors he hit upon the fact that the doctors were moving directly between performing autopsies and delivering babies. He suggested that everyone wash hands before entering an obstetrics ward.  As obvious as that sounds today, “his ideas were rejected by the medical community."  They weren’t accepted until after his death when Pasteur and Lister did further work with germ theory – more science.  Common advice today is to wash your hand before eating, and it's based on science.

Thomas Malthus, an Englishman, lived around the time of the American Revolution and believed the increase in food production could not keep pace with the increase in population, leading to famines and a stagnant standard of living.  "The power of population is indefinitely greater than the power in the earth to produce subsistence for man."  He believed that since land was limited, food production could never keep up.  Science, however, proved him wrong, allowing farmers to grow enough for a world population of nearly nine billion with a standard of living he never would have imagined.  His name has become synonymous with baseless pessimism, but up to fifty years ago others were preaching the same gloom and doom about overpopulation.

Developments like these contributed largely to the increase (almost doubling) in life expectancy during the 20^th century.

The two events were the 1918 flu epidemic and the H1N1 scare of 2009.  The first was a worldwide disaster as reported here by the Washington Post.  “Experts believe between 50 and 100 million people were killed” by the flu epidemic in 1918 including 675,000 in the United States.  By contrast, what the media called a pandemic in 2009 resulted in between 10,000 and 12,000 deaths.  That is less than 2% of the devastation from 90 years earlier.  Numbers for this year will not be available until next year, but it’s certain that this flu season, again labeled an epidemic and hyped daily in the news for months, will result in fewer deaths.

What we have today are flu shots, better drugs and advanced medical procedures to treat the complications that arise from the flu particularly in seniors and young children.  We owe that kind of progress, those lives saved, to science.

These are just some quick examples.  In 2018 a person cannot go five minutes without encountering some contribution science has made to our lives. The effect of science on our lives goes beyond everyday conveniences; it’s the reason many of us are alive. This lack of appreciation is not only a sign of ignorance, but it causes people to make costly and dangerous errors about their health and safety.

Perspective About Health Scares (and other things)

Don’t the media love to scare us!  When I hear the talk of Zika virus this summer, I don’t know how seriously to take it.  I was wishing I had kept a diary of the previous health scares (not to mention the year of the shark attacks and the rest).  But a little research went a long way.

Back in 2003 we were warned about Severe Acute Respiratory Syndrome (SARS).  It was the big health story that year but, according to the CDC, it resulted in no SARS-related deaths in the United States and only eight Americans with laboratory-confirmed SARS who were infected abroad.

The following year West Nile virus took the front page, and we still hear about it every summer.  According to CNN by 2013, “More than 1,800 people have died of West Nile virus in the United States since it was first detected in New York City in 1999.”  That would have been a little over 100 deaths per year, which equals less than one-half of one percent of the number of people who died from accidental falls.  But accidental falls rarely make the news.  “According to the CDC, only 1% of people bitten by West Nile-infected mosquitoes become seriously ill.”  Still, we want to keep using repellant, but watching your step to avoid falls is many times more important.

In 2005 it was the Bird Flu.  In 2006 Methicillin-resistant Staphylococcus aureus (MRSA) made the news.  It is one strain of the bacteria that resists many available antibiotics.  In 2007 the scare was not over a disease, but over the possible health effects on children from lead paint in toys imported from China.

2009 brought us Swine Flu (H1N1).  It spread worldwide and caused over 18,000 deaths, but by August 2010 the World Health Organization declared the pandemic over.  In 2011 came an Ecoli scare.  In 2012 we were warned of Middle East Respiratory Syndrome (MERS).  0nly 2 people in the US ever tested positive for MERS.

In 2014 as Ebola ravaged western Africa, the news was so scary that people cancelled trips they had been planning to safaris in countries in eastern Africa, half a continent away.  After the final count was in, media reported that only two people had contracted Ebola in the US.  Both were nurses who treated an Ebola patient and both recovered.

This summer, at least up until the conventions stole the spotlight, the media was all agitated about the Zika virus, especially in Brazil for the Olympics.  Any virus should be taken seriously, but where is the perspective?

Undoubtedly some of these were potentially serious and we should be grateful for the good work of the health agencies.  We should also not become complacent about such issues, but in retrospect most didn’t deserve such hysterical coverage.  It is difficult enough to use perspective to separate the important from the trivial without major news agencies conspiring to put us in a panic over every new outbreak just to feed their commercial needs – selling newspapers and keeping an audience.   (Playing on this manufactured fear, the scammers come out with products like wristbands, patches and stickers claiming to prevent these problems.)

And speaking of perspective, that is, moderation along with that ability to separate the important from the trivial, consider two more examples.

Dwayne “The Rock” Johnson is worth about $256 million as a result of his earnings from his wrestling and now his movie career.  His box office popularity helped push his per movie fee to $10 to $20 million. “With estimated percentages of box office take, that climbs as high as $40 million for Furious 7.”  He is reported to be the world’s highest paid actor.  This information reflects not on his perspective but on that of moviegoers who put such a high level of value on his skills.  (Don’t complain about the 1% without including The Rock and your other heroes with those evil Wall Street hedge fund managers.  He didn’t trick you out of your money – you gave it willingly, and now he is rich and you are not.)

In another example of poor perspective from overseas, French President Francois Hollande has been caught in a scandal as it’s been reported that he pays about $11,000 (9,895 euros) every month for haircuts.  How does he expect to maintain credibility with the French voters?  Oh well, that’s their problem.  We have enough politicians in the US, along with many ordinary citizens who struggle everyday to find a little perspective.

Flu Season

Flu season gives the media another excuse to trot out experts to give us advice about how to live.  If we exhibited a little more critical thinking behavior, they might decide that this is not necessary.

Much of critical thinking is pretty simple.  It doesn’t require an understanding of experimental design, statistics or other mathematical concepts.  Mostly it comprises what used to be called common sense or what I call “the rules of the game.”

These rules of the game we have heard often.  They make sense and lead to a happier life.  Despite hearing them over and over, apparently many people ignore them.

Flu season is just one example.  Every year people are advised to get flu shots.  This year, when the outbreak is worse than normal, the call is longer and louder, but it’s not new.  We are also advised to wash our hands more often and to keep them away from our faces.  This article repeats that advice with some very interesting data.  Children who wash their hands regularly miss less school.  “When 40,000 Navy recruits were instructed to wash their hands five times a day, their rate of respiratory infections fell by 45 percent.”  We know we should, but do we?  “Ninety-one percent of Americans say they wash their hands after using a public toilet, but an observational study conducted in the six US airports found that only 26 percent of men and 17 percent of women actually did.”

Once we get through flu season, we will hear from financial experts telling us to "pay yourself first," that is, put aside savings before you start spending.  They will advise us to have an emergency fund and to make a list before going to the store to avoid the temptation of impulse items or unneeded purchases.  They will tell us how much we can save by making our coffee at home or brown bagging instead of buying lunch.  The list is always the same.  The rules of the game don’t change.

In the summer we will be told to use sunscreen.  Before school starts we will hear about the importance of vaccinations and be reminded that rumors about a link between vaccinations and autism are completely untrue.  Don’t forget to see the dentist twice a year and, between visits, to brush and floss.  Eat well and exercise.

The rules of the game don’t change.  They are basic.  We should know them by heart.  If we can’t follow through on these simple, common sense behaviors, how do we expect to grasp and solve more difficult issues like gun violence, education, healthcare, poverty, legalizing drugs, or the national debt?