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January 30, 2019

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r

Homeopathy may be quackery, but it isn't necessarily useless.

There are two distinct questions about the usefulness of homeopathy:
(1) is homeopathy more effective than a placebo and (2) is homeopathy useful. Although one might assume that a medicine that is no more effective than a placebo is worthless, that assumption is wrong. Studies have repeatedly confirmed that placebo treatment can be extremely effective. And, because homeopathy has no adverse side effects, it makes for a great placebo treatment.

See https://www.integrativepractitioner.com/topics/news/harvard-study-has-good-news-for-homeopathic-medicine

"Weighing the public health potential of homeopathic medicine requires a wading into a river of twin ambiguities. These can each be true simultaneously: 1) homeopathic treatment only has value as a placebo, and 2) expanded use of these medicines can be useful tools in the public health campaign against antibiotic overuse. This 2008 study, for instance, found that 13% of doctors use antibiotics as placebos. Mightn’t we have been better off, from a population health perspective, had they prescribed homeopathic remedies and not delivered this extra load of antibiotics onto the terrain?"

Of course, there are many many instances where placebo treatment is not effective or not effective enough, and the danger of homeopathy is that patients may continue to rely on it when they really need more traditional medicines.

Steve L.

Interesting point. I agree that homeopathy-as-placebo is not as troubling as the overuse of antibiotics. But oscillococcinum is sold over-the-counter, so it does not do anything to minimize doctors' use of antibiotics as placebos.

Ellen Wertheimer

Another problem with placebos of the homeopathic variety--and especially with products like the one under discussion here--is the problem of payment. Someone who buys a placebo like this is paying money for something that is quite literally nothing. The label may provide information that, when thoroughly parsed, reveals that the product is in fact nothing but sugar, but will the average consumer figure this out? It is unlikely, and indeed the purveyors of these products are counting on the consumer not discovering that he or she is being persuaded to buy nothing. And what producer is going to step forward with this information?

How can such products not be frauds in the good, old-fashioned, snake-oil sense?

concerned_citizen

"instead of in the candy aisle"


Humorous, but couldn't the same be said for a lot of the snake-oil stuff (to borrow from EW's comment) sold as supplements for this or that?

Although I agree with the point in your earlier segments that at least all the other snake oil stuff at least contains, well, snake oil.

As to the broader problem, "We're not supposed to give opinions", I agree its bothersome both to consumers and to the professional requirements of the pharmacist. But I don't think individual pharmacists have any power at all to deal with this. Their professional organizations might be able to supply some pressure, though.

Oh, note for part 1 you went back and hyperlinked 2, 3, but for part 2 there is only currently a hyperlink for part 1 (with "Part Three is here" being dead text).

Thanks for the education.

concerned_citizen

"reveals that the product is in fact nothing but sugar, but will the average consumer figure this out?"


Hey, Ma'am, that's "Purified Evaporated Organic Cane Extract" to you!

(Actually saw that on a label some time ago. Or most of it - not positive the "purified" part wasn't tacked on later by my imagination.)

anon

Comment?

https://www.ncbi.nlm.nih.gov/pubmed/10796675

r

Steve,

To clarify my earlier post on the placebo effect, I was not attempting to justify either the gag rule on pharmacists or the ethics of marketing homeopathic remedies. The intent was simply to address the subtext of your posts that homeopathy is worthless and to show that there are some real benefits to homeopathy.

One of the reasons that homeopathy remains so popular (much more so in Europe than in the U.S.) is that users often really do experience a positive benefit, at least when compared to taking no medication. While the ethics of marketing and selling homeopathic remedies is quite shady, and the medical profession should be able to develop a better method for effective placebo treatments (they certainly should have a better method than using antibiotics as placebo), purchasing and using homeopathic remedies can be a rational and beneficial decision.

anon

Let's try it this way:

ncbi

.nlm.nih.

gov/pubmed/14973976

concerned_citizen

anon - this paper has been withdrawn as of 2009 (see same general link as you already provided but change number to 19588329).


I can't tell why it was withdrawn. I suspect it may have something to do with the number of participants in the two of seven studies that they felt were sufficiently powered to draw conclusions from, being too small to support the overall conclusion that this preparation reduced length of symptoms by some 7-ish hours as claimed.


"Seven studies ... (n) = 2265 and... n = 1194... Only two studies reported sufficient information to complete data extraction fully."


Otherwise they could have updated it to supply n=X for the actual studies from which they drew their conclusions. And probably should have supplied this information in the first place. It seems strange to have said 7 studies, n=3459 (total), but not report n=X of each of the only 2 studies they relied upon.

concerned_citizen

anon - I followed the trail of updates through the two final updates, #23235586 and #25629583, in which the authors eventually concluded:


"There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling. There was no evidence of clinically important harms due to Oscillococcinum®."

anon

cc

Thanks ! I didn't "key cite" the study; I was only wondering about the fact that it showed SOME effect: how could plain sugar have had this effect?

The conclusions of the authors was, from the outset, that there was insufficient evidence of prevention. Yet, there was evidence of shortening, as you say.

The authors only reviewed "Placebo-controlled trials of Oscillococcinum or homeopathically-prepared influenza virus, influenza vaccine or avian liver in the prevention and treatment of influenza and influenza-like syndromes."

Perhaps the authors could and did withdraw their observations about other studies, but they can't withdraw the underlying studies. And, to add: "Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect" was extremely significant. Why not rule our an clinically useful effect?

This possibility is without doubt incompatible with the entirety of Lubet's investigative conclusions, no?

Are we to accept that the Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021, USA, is a less knowledge and credible source?

I don't know whether Oscillo can have a beneficial effect. Can Lubet and the experts here both be right?

an on

To clarify: Lubet rules out the possibility of any beneficial effect (absent a placebo effect, which was eliminated by the studies cited).

The experts, who have written five or six updates of their work, don't.

Who should we believe?

concerned_citizen

anon, I really don't read this the way you do. Note the final conclusion states inability to conclude usefulness in prevention OR treatment - i.e., my comment about reducing symptom tenure was prior to finding the updated, final conclusion.


Based on what the papers as updated eventually stated about the poorness of the available data in all the studies they reviewed, I wonder if even the weak statement "findings do not rule out the possibility" lacks justification.


I could be wrong. I'm not versed in the subject matter of homeopathic remedies (and hadn't even heard of Oscillococcinum until here), but I do have some familiarity with the publication submission and review process for scientific papers. I review on average 150/year manuscripts for scientific publication (pre-submission review) as a small part of my job. I see what gets them kicked back and the reviewers thinking that the data and conclusions mismatch is probably the most common.

anon

"I wonder if even the weak statement 'findings do not rule out the possibility" lacks justification'"

Ok, so that the key to your position. The experts have reviewed many studies, over a period of many years ("Placebo-controlled trials of Oscillococcinum or homeopathically-prepared influenza virus, influenza vaccine or avian liver in the prevention and treatment of influenza and influenza-like syndromes.") and state that ""Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect"

Lubet has done his review, and, he has ruled out the possibility that Oscillococcinum® could have a clinically useful treatment effect.

Apparently, like Lubet, you don't accept this possibility, based, again, on what? Upon what evidence is this based?

The ingredients on the box and the manufacturing process?

anon

PS
Again, I am not advancing the theory that oscillo can reduce the duration of flu symptoms for a measurable period (as found by one of the studies) or not.

I am simply wondering how it is that a law professor can rule out the possibility that this study was not inaccurate, based on his presentation in three consecutive blogs.

We can assume that most here in the FL believe that here in the US, ignorant bigots (i.e., republicans) supply the market for oscillo (though, as the Lubet shopping excursion demonstrated, the market for oscillo is probably another group.) But, what about millions of citizens of France? What about its regulatory system?

Lubet wholly fails to account for this acceptance. His implied thesis is that people are stupidly paying big bucks for sugar pills. Yet, he has no evidence to support his opinion, and, the evidence extant does NOT support his blanket condemnation of oscillo, but rather, leaves open the possibility that findings in the studies reviewed were valid.

One would presume that the true experts in this field would say that sugar pills cannot have any effect on influenza and would not say that they might.

concerned_citizen

"Apparently, like Lubet, you don't accept this possibility, based, again, on what? Upon what evidence is this based?"


I can accept the *possibility*, but see it as extremely unlikely. I'm still a scientist at heart and if someone tells me that a preparation of X containing no X has a certain benefit, I look askance.

If I was setting up a clinical for this, I'd say you need two test preps and a placebo/control in double blind. One of your test preparations would be the one we're talking about here, the other would be identical, and identically prepared, except no duck organ grindings in the initial stage. Or perhaps even a third arm having some organ grindings from an animal not believed to contain this oscillating microbe.


And "findings do not rule out the possibility" is little more than a statement of hope from someone with a reason to hope (the mission of the IM center at MS-K is to find alternative medicines that might help in the course of cancer treatments; and the final updates were authored from the British Homeopathic Association).


The only way the findings would "rule out the possibility" that the preparation has clinically useful effects is if the tested preparation worked worse than placebo (e.g., increased duration and/or severity of symptoms).

anon

CC

Well, wait a minute: First you cite the later articles, and now you seem to discredit them as biased and untrustworthy.

Should we accept your earlier assertion that these later articles disproved the first one that was cited, or now, your later assertion that these later articles were produced by less than honest motives (self - interest).

You describe how you would design a study. Apparently, based on the extant studies and the well-known ingredients of oscillo, those who actually do studies (and conduct meta studies of the studies) do not share your surmise that, what they really meant to say was the "findings rule out the possibility" that ocscillo has any effect (you state your belief that the counter statement "lacks justification".).

So, just to close this out, I haven't notice a scintilla of evidence provided by you or by Lubet that oscillo has no effect (other than possibly a placebo effect). I have not noticed in these three blogs any evidence that Lubet has a medical degree, has conducted medical research, has had pharma training, clinical training or any relevant training of any sort. In fact, the way he conducted his "investigation" -- mainly, by reading the label, opining on concentration of those ingredients and contacting a "pharmacist" at a big box store -- was inherently very suspect and, shall we say, unreliable?

Perhaps Lubet has and will tell us the extent of his expertise and qualifications to opine based on the label of a box and an interview with a clerk in a big box pharmacy. If he has done that, my apologies.

On the other side of the coin, we have millions of customers in the EU, including France, and here in the US, placebo controlled studies, and two reputable sources that can't rule out, as Lubet has, any positive effect (other than a placebo effect) for oscillo. Lubet says that those millions are stupidly and foolishly spending big bucks on sugar pills.

As far as Lubet has told us, which agencies in the world have objected to this or even informed the public?>

Could these be because ... wait again, what is the reason exactly?

Perhaps because they don't read the FL!

Now they know!

concerned_citizen

You seem really hung up on this, but I think this part I've quoted below explains what your issue may have been here:


"what they really meant to say was the "findings rule out the possibility" that ocscillo has any effect (you state your belief that the counter statement "lacks justification".)"


No, no, no, no and no.


If "the findings do not rule out the possibility" is unwarranted (given what the reviewers have said about the poorness of the data available), this does not automatically and inescapably lead to the notion that "findings rule out the possibility" is the only remaining alternative.


Neither one of these two conclusions seems warranted based on what the reviewers have said about the data.


When you do not have reliable evidence one way or the other, silence is appropriate. Again, just my opinion, often wrong but seldom in doubt, but I would strip out that second sentence and leave the below only as a conclusion. But I certainly do not think anything I've read in these papers or their updates supports that the conclusion must be that the "findings rule out the possibility" of useful effect.


"There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. There was no evidence of clinically important harms due to Oscillococcinum®."


As for your appeal to argumentum ad numerum ("millions of customers"), what answer would you like? People spend their money as they will - sometimes on things that harm them. In this case, no harms are done them. Better than a 3-pack a day habit.

anon

"When you do not have reliable evidence one way or the other, silence is appropriate."

Prof Lubet: Take note.

That really has been my point, and good to see that we have finally reached agreement.

Lubet has no reliable evidence that oscillo doesn't work, but he says so anyway. After multiple studies, there is no way to claim that the studies reliably provided that evidence. There was some evidence of a positive effect. The most the experts can say is "inconclusive." That is not the same thing as evidence supporting Lubet's position that he has proved oscillo can't work based on a conversation with a box store operator and reading the ingredients on the box.

As for the millions supposedly stupidly duped by sugar pills, again, you have no explanation for inaction by any agency -- even to inform -- either in the US or the EU. For leftists, the government is the answer to everything! We are to make nothing of this silence?

Finally, tobacco is a wholly different matter, and, even given its historic role in the economy of the US, just witness the extent of warnings required. Of course, tobacco is a completely inapt comparison, in every respect, inter alia, because it is harmful and oscillo hasn't been shown to be harmful (Lubet infers that this is because it is but sugar).

Incidentally, you know someone is losing the argument when they resort to insulting the other person. You say "You seem really hung up on this." That was self-directed, right?

YOu can have the final word, if you are really that hung up on this.

concerned_citizen

Awright, you're going to get shirty with me (again), I guess it's time I get mildly shirty back.

Yay!!!!!!!!!!!

Hollow Victory Declared By Anon!!!!!!!!!


Haha.


Have a nice week.


"losing the argument when they resort to insulting the other person. You say "You seem really hung up on this." "


Seriously, you finally see that observation as an insult, when you've been insulting throughout this thread?


Well, okay, go ahead and "Declare Victory" again, if you want to, but seriously that was not any kind of insult. Just an observation about which particular logical fallacy you were stuck upon, this time.


And of course, bless your heart for insulting me gratuitously, but then graciously "giving me the last word".


No one's seen THAT trick before!


Haha.


Last refuge, and all that.


Have a nice night.

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