Naturally Nicole’s Elderberry Flu Treatment Debunked (Part 2)

naturally nicole elderberry syrup

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.

the outbreak wasn't in panama

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:

image

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)  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.
J Altern Complement Med. 1995 Winter;1(4):361-9.
Zakay-Rones Z1, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, Mumcuoglu M.
Article hidden behind paywall.  Purchased October, 2015.

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

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If it Quacks Like a Duck — Oscillococcinum

It’s perhaps the most amazing drug on CVS’ shelves today:  It features:

  • No side effects
  • No drug interactions
  • No active ingredients

That’s right.  No active ingredients.  Read on to see if Oscillococcinum might be right for you!

Oscillococcinum thumbnail

Oscillococcinum, a drug with no active ingredients. (See footnotes for image credit.)

Oscillococcinum was a drug originally made from the non-existent oscillococcinum bacterium (wink wink nudge nudge) and marketed as a cure for the flu.  This is curious, as the flu is viral, not bacterial, in nature.

Now made from duck parts that don’t exist — perfect for a quack cure — Oscillococcinum is homeopathic.  One of the features of many homeopathic medicines is that they are repeatedly diluted during production.  Oscillococcinum is typical:  the dilution is so extreme that there’s no original product left in the box when it goes out the door.

CVS-branded oscillococcinum

CVS-branded oscillococcinum. Get your sugar cheaper! (click to enlarge image.)

The dilution factor for CVS’ duck-based medicine is “200C”.  In homeopathy, “200C” means that:

  1. The original product is diluted with water to 1/100th the original concentration
  2. A small sample of the dilution is set aside
  3. That 1/100th sample is taken, diluted with water, and the process is repeated for a total of 200 iterations

As is the case with any homeopathic medicine diluted to such extremes, the odds of receiving any end product (in this case, duck) are so astronomical they border on impossible.

But would you actually want the duck?

A quick look at the CVS product info sheet tells us that Oscillococcinum:

“is made from tissue that might be infected with flu—ducks, which are known to carry influenza”

Wait.  What’s happening here?  Is CVS selling me an infected bird?  That’s freaky scary.  When I get the flu shot, at least I know the virus in the shot is dead.

Or, is CVS selling me pure water & sugar… a product from which all the duck has been removed?  Back to the product info sheet:

“Oscillococcinum is of 200c potency, meaning that it is diluted to one part in 10 400 (a dilution so high that even if you started with a chunk of duck the size of the sun, not one molecule would remain).”1

Wow.  Balls the size of… (!)

The imaginary active ingredient has been completely removed from this product, and CVS doesn’t even try to hide it:  they brag about it!

If you’re a CVS customer paying for this stuff, you’re paying for filler product.  Water and sugar.  Actually, it’s questionable whether or not you’re even getting any water.  The ingredients list only shows sugar.  What you’re definitely not getting is duck.  (For that reason, we’ll leave the dangers of ingesting a disease-laden bird for another article.)

Oscillococcinum gets a special mention in Jean-Marie Abgrall’s “Healing or Stealing?: Medical Charlatans in the New Age”.2  The drug was invented in 1919 when a Frenchman noticed an “oscillating” condition in flu patients and a corresponding “oscillating” amount of an imaginary germ he decided to call “oscillococcus”.  The only problem was, he thought he noticed the same microbe in herpes, chicken pox, shingles, and cancer patients — and decided all the diseases were caused by the same thing.  Mon dieu!8

The Frenchman tested a vaccine he developed on his cancer patients who, of course, died.  Afraid of being infected by his patients, the doctor went in search of his oscilloccinum bacterium in the wild.  He claims to have found it in a duck.  I’m not making this [expletive deleted] up.  No one else has ever seen oscilloccinum.  It doesn’t really exist.  But this hasn’t stopped snake… erm…  duck oil salesmen from cashing in.

oscillococcinum contains no active ingredients

Oscillococcinum isn’t all it’s quacked up to be.  It contain no active ingredient(s)! (Photo by the author)

Manufactured by the French company Boiron, Oscillococcinum has been singled out for deceptive marketing in the United States.  In June 2010, Homeopathy for Health, a Washington vendor, was cited by the FDA for a slew of violations, including marketing Oscillococcinum as a treatment for H1N1 (“Swine Flu”) and “relief of flu symptoms”.3 Although the CVS literature lists one late 1980s study with marginal results touting Oscillococcinum efficacy,2 no other studies back the CVS claims.  This is not surprising.  If you only have one study to back you up, take that study, trumpet it loudly, and hope nobody notices.

When sugar pills are shown to stop the flu virus, let’s all meet in the bakery aisle of the supermarket when we get sick, and skip the trip to the doctor.

As I write this, CVS is actively removing protests regarding Oscillococcinum sales from its Facebook page.  These posts, to the best of my knowledge, truthfully inform consumers that the product contains no active ingredients, has never been shown to be of any help in combating the flu, and, in fact, could be dangerous: influenza is a serious disease and can be deadly.5, 6

CVS places homeopathic medicines next to real medicines on their shelves (with similar packaging) with no consumer warnings, making it difficult for a trusting public to know what they’re buying.  When a pharmacy dispenses real medicine and real flu vaccines along with sugar pills without any cautionary text, it’s a problem.  Skipping real treatment in favor of Oscillococcinum could do real harm.

A “drug” made from sugar and non-existent duck parts?  A company that takes pride in its public health outreach programs4 should be ashamed of itself for this quackery — no pun intended.  I hope readers will take a moment to go the CVS Facebook page7 and express their unhappiness.  As consumers, we deserve better.

Postscript (18 December 2014)  Alert readers have pointed out that CVS is not the only vendor selling this fake medicine.  Indeed, since writing this article, I’ve found it online at Amazon and Drugstore.com.  It’s reportedly been seen on the shelves of Walmart, Walgreens, and Rite-Aid–though I haven’t witnessed that myself.  I’ll be writing follow-up articles to cover this.  No matter where you find it–if you find it–please encourage sellers of oscillococcinum to remove this useless product from their shelves.

References

(1)  CVS: Influenza: Studied Homeopathic Remedies
http://health.cvs.com/GetContent.aspx?token=f75979d3-9c7c-4b16-af56-3e122a3f19e3..&chunkiid=38325#scientific

(2) Healing Or Stealing?: Medical Charlatans in the New Age
Healing Or Stealing?: Medical Charlatans in the New Age. pp. 40–41. ISBN 1-892941-51-1

(3) FDA Inspections, Compliance, Enforcement, and Criminal Investigations: Warning Letter
http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm215236.htm

(4) CVS stops selling tobacco, offers quit-smoking programs
http://www.usatoday.com/story/news/nation/2014/09/03/cvs-steps-selling-tobacco-changes-name/14967821/

(5) CDC Fast Stats: Influenza
http://www.cdc.gov/nchs/fastats/flu.htm

(6) Key Facts about Influenza (Flu) & Flu Vaccine
http://www.cdc.gov/flu/keyfacts.htm

(7) CVS (Facebook)
https://www.facebook.com/CVS

(8) Mon Dieu! (My God!)
http://www.youtube.com/watch?v=x0oMQu2id6I

 

Legal Stuff

CVS Oscillococcinum product image used in accordance with Title 17 U.S.C. Section 107, 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.

Duck image by the author.  Copyright (c) 2014 Mark Aaron Alsip.  All rights reserved.