What the heck is “evidence based” proof? Is there another kind?

In part one of this series,¹ we began the arduous task of tearing apart an internet snake oil saleswoman going by the moniker “Naturally Nicole.”  Nicole’s claim to fame is selling an unproven Elderberry syrup as a flu medication.²  This alone would be cause for eye rolls and muffled giggles from anyone who’s worked in a pharmacy, but things take a darker turn as Ms. Au Naturale goes on to lambast the safe, #1 recommended preventative for a disease that has so far claimed nearly 100 lives at this writing:³ the flu shot.

Just a quick recap of part one, where we looked at two of three Elderberry fantasy claims:  First, Nicole lied to her audience, saying that a study was performed on human–when it was actually done in test tubes and petri dishes.  She also references a junk science paper whose abstract claimed results that actually came from another study–not the one described.

Out of the frying pan and into the fire, Nicole’s second claim was that the flu vaccine was dangerous and ineffective, when in fact the very study she referenced said vaccination was the most effective way to combat influenza.  While the efficacy of the flu vaccine does vary from year to year, 2018’s rate of 36% is better than Nicole’s elderberry rate of 0%.  You do the math.

So now, without further ado, we move on to the conclusion of this series, taking on the third of Nicole’s perjurious claims:

Claim #3
A 93.3% improvement in symptoms in 2 days for elderberry-treated patients vs 91.7% in the control group, and a complete cure rate of nearly 90% in 2 days vs. 6 days in the control group.

Rule #1 for citing a paper as evidence would seem to be: read the damn paper.  I can’t prove the Duchess of Elderberry skipped her reading assignment, but I strongly suspect it, based on the fact the study she quoted is hidden behind a $51/copy pay wall, and she claims the paper looked at patients suffering from a flu outbreak on a kibbutz in the country of Panama.

In reality, the patients studied were in Israel, and the strain of flu virus under investigation was a strain of Influenza B named B. Panama. Nicole’s first clue should have been that kibbutzim are technically unique to Israel.

From Nicole’s article.  No. Just no.  The outbreak occurred in Israel. The virus was named Influenza B. Panama. Read the damn paper Nicole!

When you don’t even bother to read the abstract Nicole, you’re off to a bad start.  However, I dropped $51 on this pay-per-view Elderberry Extravaganza, and Naturally Nicole would have done herself a great service had she done the same.

You’re welcome:

The paper that Nicole didn’t read. When research is hidden behind paywalls, it’s easy to cherry-pick and misquote, even when it disagrees with you.

Most conspicuous in the paper cited by Naturally Nicole is what it doesn’t say.  Presented are nine pages of details on a study that produced a 40% two day “total cure” rate, complete with graphs and exquisite detail on methodology.  However, in the abstract, we find a “significant improvement in symptoms (93.3%)”.  Where did this number come from?  Not from the science described in the nine pages!  Buried on page 367 (this comes from an alternative health journal with many articles) are two small paragraphs mentioning, almost as an afterthought, a separate study involving twenty-seven patients.  Our 93.3% number comes from a different study.   Deus ex machina.⁵

Meanwhile, Back on the Kibbutz…
Meanwhile, back in the medical literature Naturally Nicole never laid eyes upon, on page 363 of Vol 1, #4, 1995 of the Journal of Alternative and Complementary Medicine, the authors discuss a double-blind study involving 40 individuals living on a kibbutz in Southern Israel. They had fevers, runny noses, body aches, and coughs. Blood was drawn and statistical analysis performed using influenza antigens provided by the World Health Organization to decide whether these 40 patients actually had the flu.

Time went by. Corn grew higher and the wind came sweeping down the plain. Patients were treated with elderberry extract. Then something not so incredible happened…

Forty percent of the patients were determined “completely cured” within two days.

“Complete cure was observed after 2 days in 40% of patients treated with SAM and 16.7% treated with placebo.” — J Altern Complement Med. 1995 Winter;1(4)p.366 (emphasis mine)

But wait! Incredibly, even though a “complete cure” was claimed within two days, page 365 reports that fever persisted for four days in the group being treated with elderberry syrup. Explain to me, please, how you’re completely cured in two days if your fever runs for four?

And, very important: how long had the flu sufferers already been infected before they presented themselves for the study?  It’s easy to claim a total cure in two days if you’ve already been sick for five to twelve before you present yourself for the study (the flu normally runs its course in one two two weeks).

Oh, By the Way…
It’s interesting to note (but doesn’t affect the results of the study) that the lead author of the paper reviewed here is the pro-vaccine author of Nicole’s second study: Professor Zichria Zakay-Rones. He’s the Chief Science officer of Theravir Management Ltd., a biotech startup company that develops vaccines.⁶ I mention this only to point out that the scientists who wrote the papers enshrined by Nicole are not as vehemently anti-vaccine as she is.

So we’re left with three papers whose bodies don’t at all support what’s claimed in the abstract, and, in one case, openly lie about it. They’re presented by a fervent anti-vaccination advocate who somehow didn’t notice (or care) that the lead author of two of the papers is the chief science officer of a company that produces vaccines, and openly advocates vaccines as the best defense against the flu in one of the studies she uses to sell her products.

The last paper cited by our saleswoman came out nearly fifteen years ago. As serious a problem as influenza is, are we to believe major pharmaceutical companies are looking a gift horse cure in the mouth and rejecting it?  Sorry, I’m a bit skeptical.

Last but not least: Nicole, B. Panama is a virus, not the country Israel where a medical study was performed.  Please, the next time you quote a study to prop up your product sales, please and least read the abstract–and consult Google Maps first!

Image Credits
Map courtesy of and ©2018 Google Maps.  Used under terms of service provided via link attached to map.

Naturally Nicole screen snapshots and product image captures are used in strict compliance with Title 17 U.S.C. Section 107 of United States copyright law (commonly known as “fair use law”). This material is distributed without profit with the intent to provide commentary, review, education, parody, and increase public health knowledge.

Photograph of partially visible pages of “Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama” is presented as proof the author actually purchased the article.  As provided for in Title 17 U.S.C. Section 107 of United States copyright law, small portions or extracts of a copyrighted work may be used for purposes of citation and review.

References
(1) Naturally Nicole’s Elderberry Flu Treatment Debunked (Part 1)
https://badsciencedebunked.com/2015/10/21/naturally-nicoles-elderberry-flu-treatment-debunked-part-1/
Retrieved 18 Feb 2018

(2) Evidence Based Proof, Elderberry Syrup Is Better Than The Flu Shot
From Internet Archive
https://web.archive.org/web/20160205185840/http://naturallynicolexo.com/evidence-based-proof-elderberry-syrup-is-better-than-the-flu-shot/
(Author has moved/deleted post)  Archived 02 Oct 2015
Retrieved 20 Feb 2018

(3) Weekly U.S. Influenza Surveillance Report (CDC)
https://www.cdc.gov/flu/weekly/index.htm
Retrieved 20 Feb 2018

(4) Interim Estimates of 2017–18 Seasonal Influenza Vaccine Effectiveness — United States, February 2018
https://www.cdc.gov/mmwr/volumes/67/wr/mm6706a2.htm
Retrieved 20 Feb 2018

(5) Deus ex machine (Merriam-Webster Definition)
https://www.merriam-webster.com/dictionary/deus%20ex%20machina
Retrieved 19 Feb 2018

(6) Zakay-Rones Profile (Bloomberg)
http://www.bloomberg.com/research/stocks/private/person.asp?personId=30559942&privcapId=6085242&previousCapId=6085242&previousTitle=Theravir%20Management%20Ltd.