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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Naturally Nicole’s Elderberry Flu Treatment Debunked (part 1)

naturally nicole elderberry syrup

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

So many snake oil peddlers, so little time.

In “Evidence Based Proof Elderberry Syrup Is Better Than The Flu Shot”,1 Facebook saleswoman “Naturally Nicole” offers up more misinformation on the flu shot than can possibly be debunked in one sitting.  In the interest of time, I’ll take on two of the three “scientific studies” she cites to support her flu cure, then come back for more in future articles.

Fasten your seat belts; make sure your tray tables are in a locked and upright position. It’s going to be a bumpy ride.

Claim #1
An extract of black elderberries has natural antiviral properties in vitro, and reduced flu symptoms in 3-4 days2

We have an epic failure right off the bat.  In layman’s terms, in vitro means the study was performed in a glass test tube or petri dish, not a live human.  So how did the elderberry extract reduce flu symptoms in humans?

Answer: it didn’t.  This study wasn’t performed on humans, and Nicole & the abstract essentially tell a bald-faced lie.  Here’s what happened:

Nicole starts you off with this abstract2 which describes a study performed courtesy of twelve volunteers who donated blood that was treated with elderberry extract in vitro.  The humans didn’t have the flu.  They didn’t have symptoms.  The test was simply to determine if the elderberry triggered an immune response in the extracted cells.  If you don’t read the paper behind the abstract, you never learn this vital fact.

It’s only when you read the full text of the study3 that you see the abstract’s reference to a reduction in symptoms isn’t for the study actually being done.   This mysterious second paper and the reduction in symptoms in humans is never even mentioned anywhere but the abstract.  I have to repeat myself, because it’s so important: the study cited by Nicole never tested a single flu patient, yet she and the abstract claim it reduced symptoms in humans in 3-4 days.  Pretty amazing since it was an in vitro test only! (wink wink, nudge nudge.)

I’ve laid it out graphically for you below, and you can follow the results yourself via the hyperlinks in the article to see for yourself how you’re being misled:

bait and switch study

Figures lie and liars figure.  The study cited by Nicole didn’t actually test patients who had the flu, even though it seems to claim a reduction in symptoms. It slyly refers to ANOTHER study in the abstract.  You have to actually read the paper to figure this out.  Nicole makes a false claim because of this.   (click/enlarge)

 

As for in vitro testing… that’s a necessary first step, but pushing it as a “cure” as Nicole does is dishonest.  My wife and I have a great in vitro germ killer under the kitchen sink:

an in vitro germ killer another in vitro germ killer

 

Claim #2
A “complete cure” was achieved in 2-3 days in 90% of patients receiving elderberry syrup.4

At least we’ve switched to live humans (an in vivo study).

I think the most damning indictment of Nicole comes on the second page of the study that this vehement anti-vaxxer once again apparently didn’t take the time to read:

“Vaccinating those at high risk of influenza-related complications before the influenza season each year is the most effective and most commonly used ways [sic] of reducing the impact of influenza.” 4

That’s right. The very paper Nicole cites recommends the flu vaccine as the most effective way of combating influenza.  (This is going to come back to haunt her, because the lead author of this study is also the lead author of the third paper she uses to prop up her product.  You’ll never guess what he does for a living!)

So how was this study conducted?  Did doctors do something objective, like, I don’t know… record the patients’ temperatures every day?  Maybe some bloodwork?

No.  Test subjects were asked to record in a diary how they felt.  How well did they sleep?  Were they coughing more or less?

I’m not making this up.4

from the study

(From the paper) That’s it?  Couldn’t you go even to the trouble of taking their temperature?

Look, I get it: you can’t measure a body ache.  But checking for a fever?  And Nicole glosses over some facts.  Twelve of the patients receiving the elderberry syrup (almost half!) needed a rescue medication during the study, because the syrup wasn’t working for them.  It’s true that those in the control group (receiving a placebo) needed the rescue meds at a higher frequency, and recovered somewhat more slowly.  But some recovered completely with no elderberry syrup at all, just as fast as those receiving the syrup.  So what can you conclude?  Well, the authors thought maybe they had something, maybe not, and said:

“These findings need to be confirmed in a larger study” 4

Nicole seems to have missed all of this.

 

OPUS2

 

Coming Up Next Time
In part 2 of this series, we’ll look at Nicole’s third study, a “switcheroo” piece that would have made Harry Houdini proud.  Our Doctor of Syrup quotes from the abstract of a $51 per-view paper hidden behind a paywall–a paper that has some hidden surprises in it.

A paper Nicole very clearly didn’t read.  It looks like this:

image

Coming up in part two of this series: why it’s always a good idea to read the papers you cite.

 

Image Credits
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.

Bloom County/Opus image is used within parody constraints of 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.

Obfuscated image in closing sequence 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.  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.” used to provide commentary, review, and increase public health knowledge as provided under Title 17 U.S.C. Section 107 of United States copyright law (commonly known as “fair use law”).

 

References
(1) Evidence Based Proof, Elderberry Syrup Is Better Than The Flu Shot
http://naturallynicolexo.com/evidence-based-proof-elderberry-syrup-is-better-than-the-flu-shot/

(2) The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. (ABSTRACT)
Eur Cytokine Netw. 2001 Apr-Jun;12(2):290-6.
Barak V1, Halperin T, Kalickman I.
http://www.ncbi.nlm.nih.gov/pubmed/11399518

(3) The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines.  (FULL TEXT)
Eur Cytokine Netw. 2001 Apr-Jun;12(2):290-6.
Barak V1, Halperin T, Kalickman I.
http://www.jle.com/fr/revues/ecn/e-docs/the_effect_of_sambucol_a_black_elderberry_based_natural_product_on_the_production_of_human_cytokines_i._inflammatory_cytokines_90261/article.phtml?tab=texte

(4) Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections
The Journal of International Medical Research
2004; 32: 132 – 140
Z ZAKAY-RONES , E THOM , T WOLLAN AND J WADSTEIN
http://imr.sagepub.com/content/32/2/132.long