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Ososillyococcinum and other Flu bits.

Osillococcinum

I keep half an eye on the medicine displays in stores when I shop, and this year is the first time I have seen Oscillococcinum being sold.  Airborne as been a standard for years, but Airborne has been joined by Oscillococcinum on the shelves.  Dumb and dumber.    It may be a bad case of confirmation bias, but it seems I am seeing more  iocane powder, I mean oscillococcinum, at the stores.

On a recent podcast I was listening to one of the hosts suggested a homeopathic remedy for flu symptoms, and then specifically suggested osillococcinum.  This is a technology podcast, the 404, and the hosts are certainly bright, educated people.  Why would he suggest osillococcinum?  Probably because he unaware of how oh so silly the product is.

Look at the box. Seems impressive.
It is non sedating, no drug interactions, no side effects.  It also has no cholesterol and no radon.  It is, I have heard, the biggest emitter of N-rays ever discovered.  It is “officially included in the Homeopathic Pharmacopoeia of the United States”, and we know from yesterdays post how worthless that designation is.

The active ingredient is listed as anas barbarae hepatis et cordis extractum 200C.

Whoa.  The power of Latin,  like a Harry Potter curse. I bet the product has been imbued with the Confundus charm, which may explain why it is “used by millions of people and is recommended by doctors around the world.”

What is the active ingredient, this anas barbarae hepatis et cordis extractum?

In the 1919 flu epidemic a physician who did not understand that artifacts on the slide, probably bubbles, move randomly due to Brownian motion.  Looking at the tissues of flu patients with a microscope, he  found what he thought was not only the cause of influenza, but the cause of all diseases: small cocci (round balls) that oscillated under the microscope.  He found these wiggling bubbles in all the tissues of all the ill people he examined and thought he discovered the true cause of all disease.  Sigh.  Yet another cause of all illness. He is the only person, before or since, to see these oscillating cocci. Hence the name.

Subsequently, for obscure reasons, he became of the opinion that the heart and liver of the Muscovy Duck were the most concentrated source of these oscillating cocci.  I have found the suggestion that it was because duck liver and heart is a source of influenza, but the product predates the discovery of the influenza, so that would be an oh so silly explanation.

So how best to to treat disease?  Turn the oscilliococinum into a homeopathic nostrum:

Into a one litre bottle, a mixture of pancreatic juice and glucose is poured. Next a Canard de Barbarie is decapitated and 35 grams of its liver and 15 grams of its heart are put into the bottle. Why liver? Doctor Roy writes: “The Ancients considered the liver as the seat of suffering, even more important than the heart, which is a very profound insight, because it is on the level of the liver that the pathological modifications of the blood happen, and also there the quality of the energy of our heart muscle changes in a durable manner.”

After 40 days in the sterile bottle, liver and heart autolyse (disintegrate) into a kind of goo, which is then “potentized” with the Korsakov method where the glass containing the remedy is shaken and then just emptied and refilled, and the dilution factor is assumed to be 1:100.

Go to Starbucks tomorrow and get your Americano at 200C made with the same method as oscilliococinum.  They will make your drink. Pour it out and fill the cup with water and shake it. Then pour it out, fill it up with water and shake it again. Pour it out etc..  And so on 200 times, the ultimate rinse, lather, repeat.  And that should potentize the drink such that you will never sleep again.

By the time they are done, the duck goo can be found at one part duck goo in 102000 water molecules, which is damn impressive since there are only about 1080 (+/- 3) total atoms in the entire observable universe.  Then one drop is placed on a bunch of tiny pills and sold for about a dollar a vial in the US.  I bitch that linezolid is 50 dollars a pill, but at least there is something useful, 600 mg in fact, in the pill.

And that is the active ingredient.  Active.  I do not think it means what you think it means.  Is here anyone of sound mind who reads the above who thinks oscilliococinum has any potential to treat flu?  Really?  I have a bridge in Brooklyn I would like to sell you. How this nostrum is supposed to alter the course of influenza is a delusion understood only by homeopaths.  Anyone who understands the life cycle of influenza, the immune response to infection would find this concoction mystifying as a treatment for flu or its symptoms.

Oscilliococinum is popular over the world, and many of the testimonials on the interwebs suggest it is effective as both a preventative and a therapy, a stark example of why anecdotes are considered a suboptimal form of  evidence.

There is no better example of the disconnect between EBM and SBM than oscilliococinum used for the treatment of flu, since the Cochran reviews have evaluated oscilliococinum and suggests that while it is useless for a prevention, it  shortens symptoms by 0.28 days.  For reasons I cannot discover, the  Cochrane review on homeopathy was withdrawn.  Embarrassment would be my guess.  Other reviews have found no effect of oscilliococinum on flu symptoms.

Think about it.  .28 days is about 6 hours.  Have you ever had the flu or other viral illness and could say yes, now, at 3 pm, I am symptom free and no longer ill?  Viral illnesses don’t die, they fade away.  Given the nature of oscilliococinum, it is far more likely that the 6 hours from the studies was the random variation seen in clinical trials. There is zero reason, based on the known pathophysiology of influenza and the known origin of oscilliococinum,  that the latter would have any effects on the former.  And yet, while subsequently withdrawn, the folks at the Cochrane reviews felt it was a reasonable to perform a meta-analysis on nonsense.

Cochrane Reviews and the Flu Vaccine

Fortunately no one needs to go one on one with Death with oscilliococinum as your wingman.  It  has been a very quiet flu season.  Much better than last year, when, thanks to H1N1 we were maxed out in the ICU.

There is a better way to prevent the flu than dilute, liquified duck innards.  The flu  vaccine.  The Cochrane folks put out an update of their systematic review for the effectiveness of influenza. And their conclusions? It is not the greatest vaccine but effective.

In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation, 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms (risk difference (RD) 3%, 95% confidence interval (CI) 2% to 5%). The corresponding figures for poor vaccine matching were 2% and 1% (RD 1, 95% CI 0% to 3%). These differences were not likely to be due to chance. Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms and an estimated 1.6 additional cases of Guillain-Barré Syndrome per million vaccinations. The harms evidence base is limited.

AUTHORS’ CONCLUSIONS: Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost.

You get the feeling it pains them to admit the flu vaccine has efficacy, what with the caveat “In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation”  in the conclusion.

And then, the weirdness in the abstract:

WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.

Fine.  Who pays for the study can subtly bias the outcomes.  I have written about that before.  It does not necessarily discredit a study, but you do have to read and interpret the studies carefully and take the conclusions with a bit of salt substitute.

That is where, I thought, a meta-analysis comes in.  Someone like Cochrane reviews the data with no concern about the quality of the journal or notoriety of the references. The Ccochrane reviews, I thought, looked at the numbers unbiased by the spin in the conclusions or where it was published.

So I can only think of two reasons why this warning was published.

1)  The authors do not like the conclusions from the data, and are undermining the result, spinning the abstract to try and sway the message casual readers will take away from the review.

or

2) The authors are saying they are biased by the conclusions in the papers and the notoriety of some studies and as a result their analysis of the numbers is not to be trusted.  In other words, they are incredulous rubes who just fell off the turnip truck and were sold a bill of goods by those city slickers with their  manipulated conclusions and spurious notoriety.  Sad either way.

The discussion is odd, with the authors saying that everyone misuses their meta-analysis and ignores the data.

Both generalizations are not supported by any evidence and seem to originate from the desire to use our review to support decisions already taken. The misquotes appear to be based on both the abstract and Plain language summary (which is what you would expect from a superficial reading of the review by people with a specific agenda).

They also use  significant column inches to demonstrate just how the ACIP misquoted them.

and

The CDC authors clearly do not weight interpretation by quality of the evidence, but quote anything that supports their theory.

What a weird, petulant little potshot at the CDC.  I could see a statement like that maybe in an editorial, definitely in a blog entry, but in the text of a major review?  It makes me wonder if the Cochrane reviews have any editorial oversight for their content.  If they do, then their editors have some splainin’ to do as to  how a major evidence based review could revert to ‘Mommy, mommy,  I don’t like the way the CDC is playing with my ball and they are calling me names. Make them stoooopppp.’

It is like reading a review of gold mining efficacy and the purity of the mined gold, and the author noting that some of the mines are near Las Vegas, a den of sin and that gold miners discuss mining at the roulette tables and sometimes the gold in made into baubles that decorate painted women, so the content and conclusions of the mining review should be interpreted in light of these findings.  So weird.

It is probably projection on my part, but I find the Cochran reviews on influenza vaccination to be biased against the flu vaccine in a subtle way that I do not see in the other reviews.  The oscillococcinum review, while fundamentally stupid given the nature of the intervention, brainlessly followed the data, even though there was no plausibility for the intervention.

The choice of adjectives used by the authors seem designed to cast doubt on vaccine efficacy.  Now I am a vaccine proponent, and I could very well be reading into the text something that is not there. For an example, the plain language summary says

Inactivated influenza vaccines decrease the risk of symptoms of influenza and time off work, but their effects are minimal, especially if the vaccines and the circulating viruses are mismatched.

Minimal: of a minimum amount, quantity, or degree;

The data says

In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation, 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms.

In a country the size of the US, that is the difference between 12 million and 3 million getting flu if everyone were vaccinated (yes, I know, all 300,000,000 Americans are not healthy adults).  Worst case, it would be 6 million vrs 3 million. Still, across the whole population of the country, that would not be a minimal effect.

Or the number needed to treat:

The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms.

In comparison, there are 250,000 new cases of Hepatitis B each year in the US and maybe 4000 HPV related cancer deaths a year in the US.  Are the effects of the flu vaccine minimal in preventing these diseases?  Maybe.  But that is a judgement call, not a medical call.

Flu vaccine seems good intervention, a reasonable bang for the buck.  I would say it is a moderately effective vaccine with widespread health benefits beyond the prevention of acute influenza (see below).  The cost effectiveness of flu vaccination is debatable and is ultimately a value judgment.  In medicine they try an calculate the quality-adjusted life-year of an intervention to see if it is worth it to society.

It is form of evaluation that makes my brain hurt and I lack the knowledge to do much except to take them at face value.  The outcome of cost-effectiveness evaluations depends on the assumptions made.  For the elderly, you get conclusions like this:

Vaccination was cost saving, i.e., it both reduced medical expenses and improved health, for all age groups and geographic areas analyzed in the base case. For people aged 65 years and older, vaccination saved $8.27 and gained 1.21 quality-adjusted days of life per person vaccinated. Vaccination of the 23 million elderly people unvaccinated in 1993 would have gained about 78 000 years of healthy life and saved $194 million. In univariate sensitivity analysis, the results remained cost saving except for doubling vaccination costs, including future medical costs of survivors, and lowering vaccination effectiveness. With assumptions most unfavorable to vaccination, cost per quality-adjusted life-year ranged from $35,822 for ages 65 to 74 years to $598,487 for ages 85 years and older.

In the US a cost per quality-adjusted life-year of around $50000 is considered acceptable for an intervention.

It appears to me that the authors of the Cochrane reviewers think flu vaccination is not a worthwhile public health intervention, which is fine, but quit being a weasel and hiding behind words like minimal and complaining that people misuse your reviews for their own ends. The get close to admitting this in the discussion:

Given the limited availability of resources for mass immunization, the use of influenza vaccines should be primarily directed where there is clear evidence of benefit.

If I waited for clear evidence in medicine I would treat no one.  However, the preponderance of data from basic principals to epidemiology to clinical trials leads me to conclude that the flu vaccine is moderately effective and cost effective. Someday, I hope, they will develop the universal flu vaccine and then, with universal vaccination, we will get rid of flu morbidity and mortality.  But, to quote Rumsfeldt, I have to fight the wars with the weapons I have.

The Cochrane reviewers appear to be whiny, little babies.  BTW.  It is not an ad hominem since I do not think the review is wrong or flawed because they are crybabies.  The substance is fine, the style is whiny crybaby. Boo frigity who.  Got an issue?  Here’s a tissue.

Either way, the confidence I have in the Cochrane reviews, at least as far as influenza vaccine goes, is now at an all time low.

A Cherry Picked Study.

There are multiple potential benefits from the flu vaccine:

1) You do not get the flu this year.

1a) You have a milder case of flu.

b) You do not pass the flu to others.

iii) You do not die of flu.

IV) You do not die of short term complications of flu.

FIve) You do not die of long term complications of flu.

6) You may not get the flu in the future with other strains.  It would appear that those who had the 1976 swine flu vaccine has some protection against the 2009 strain and since strains of flu keep returning, if there is a mismatch in the flu and the vaccine this year, it may give you benefit in the future.

One of the arguments against the efficacy of the flu vaccine as a preventative against death is the fact that those who get the vaccine have decreased mortality when there is no circulating flu.  It is suggested that the decreased mortality is not due to the flu vaccine, but that those who get the vaccine are healthier.

Could there be an alternative explanation?

There are two ongoing themes in the ID literature that have yet to overlap.  One is people who get severe infections that require hospitalization not only have increased short term mortality, but long term mortality as well.  Why they die is not as well worked out, but in those who die after pneumonia have increased inflammatory markers at discharge.

The other theme is that inflammation is a prothombotic state and patients with acute infections are more likely to have strokes, heart attacks and pulmonary embolisms and that risk of  vascular events can be elevated for up to a year.  Even an aggressive tooth cleaning increases the  risk for a vascular event.

The rate of vascular events significantly increased in the first 4 weeks after invasive dental treatment (incidence ratio, 1.50 [95% CI, 1.09 to 2.06]) and gradually returned to the baseline rate within 6 months.

I have said before that if probiotics could really boost your immune function, they should also increase vascular events like stroke and heart attack.

Infection leads to inflammation leads to clot leads to vascular events.  If you could stop that cascade,  say with a vaccine, you could conceivably  decrease the number of deaths. And so it does with a combination of the flu and pneumococcal vaccine.

Of the 36,636 subjects recruited, 7292 received both PPV and TIV, 2076 received TIV vaccine alone, 1875 received PPV alone, and 25,393 were unvaccinated, with a duration of follow‐up of 45,834 person‐years. Baseline characteristics were well matched between the groups, except that there were fewer male patients in the PPV and TIV group and fewer cases of comorbid chronic obstructive pulmonary disease among unvaccinated persons. At week 64 from commencement of the study, dual‐vaccinees experienced fewer deaths (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.55–0.77]; P<.001) and fewer cases of pneumonia (HR, 0.57; 95% CI, 0.51–0.64; P<.001), ischemic stroke (HR, 0.67; 95% CI, 0.54–0.83; P<.001), and acute myocardial infarction (HR, 0.52; 95% CI, 0.38–0.71; P<.001), compared with unvaccinated subjects. Dual vaccination resulted in fewer coronary (HR, 0.59; 95% CI, 0.44–0.79; P<.001) and intensive care admissions (HR, 0.45; 95% CI, 0.22–0.94; P=.03), compared with among unvaccinated subjects.

Note: the beneficial effects occurred up to 64 weeks after receiving the vaccines; influenza vaccine could conceivably protect from death outside of flu season because vaccination prevents the sustained detrimental  inflammatory effect of infections.

This result does not  hold true in every study, but the data suggests that the beneficial effects of preventing influenza are wide-ranging and not limited to avoiding an acute viral pneumonia.  The effects of both influenza and the vaccine are more complicated than a simple flu vaccination prevents flu.

Two Statements

There are two statements that pretty much insure that the writer is an influenza goof.

One is that the H1N1 pandemic last year was no big deal.  I do not know what planet they were on, but H1N1 brought my hospitals right to the edge of the volume of severe illness  we could handle.  In my system we also had around 10 deaths, several in pregnant females and all in young people.  In 25 years I had never had a young person die of acute influenza until last year, and I do not want to repeat the experience.

One of our hospitals is a Trauma Center and we able to save a few patients who would have otherwise died because we offer ECMO.  While the epidemic was not particularly virulent compared to historical disasters like the 1919 pandemic, it was the worst flu season I have experienced.

The other  statement is that the CDC is “backing off” the claim that influenza kills 36,000 people a year, as if the prior estimates were a lie.

The problem with medicine is we develop better methodologies and techniques to try to answer difficult questions.  How many people die of influenza?   For years the answer has been around 36,000 and I have discussed the paper that resulted in that number.  It was, like all epidemiologic studies, imperfect, but was the best at the time. Now they have a better study.

For H1N1 in 2010, the estimates for total direct and indirect deaths is ~12,470, with a range from ~8,870 to ~18,300.  Certainly less than 36,000.  How about other years?  Turns out that, like much of medicine, the answer is complicated and depends on the year and the circulating strain of flu.  Some years are better than others.  Estimated number of annual influenza-associated deaths with underlying pneumonia and influenza  by age group — United States, 1976–77 through 2006–07 influenza seasons cause was 6,309 deaths a year, with a minimum of 961 and a maximum of almost 15,000 deaths, plus or minus the usual margin of error.

The estimated number of annual influenza-associated deaths with underlying respiratory and circulatory causes, by age group — United States, 1976–77 through 2006–07 influenza seasons was an average of 23,000 deaths with a minimum of 3000 and a maximum of 48,000.

Like so much in medicine the answer hinges on the phase ‘it depends.’  The CDC used more sophisticated techniques and came up more nuanced numbers.  When someone asserts that the CDC is backing away from prior numbers, you know they have no understanding of medicine or epidemiology and the constant urge to improve.  Unlike most SCAM’s, which have made almost no substantive improvements since their founding.  Of course you cannot improve on perfection.  Or increase by multiplying something by zero.

So get the vaccine and avoid the o-so-silly-o-coccinum.

Posted in: Homeopathy, Pharmaceuticals, Vaccines

Leave a Comment (54) ↓

54 thoughts on “Ososillyococcinum and other Flu bits.

  1. “In comparison, there are 250,000 new cases of Hepatitis B each year in the US and maybe 4000 HPV related cancer deaths a year in the US. Are the effects of the flu vaccine minimal in preventing these diseases? Maybe. But that is a judgement call, not a medical call.”

    If you are asking whether sore arms and reduced mortality from influenza are effective in preventing Hepatitis B and HPV, I would say not. It seems like a pretty clear medical call to me. Dead people don’t acquire STIs, and that lasts forever; that has to be balanced against people with sore arms acquiring them at a lower rate, but that lasts only for a short period.

  2. qetzal says:

    About a month ago, I saw a prime time TV ad for Oscillococcinum. I believe it even aired on one of our local netwrok affiliates. Not only did it promote Oscillococcinum, it also featured Boiron’s name quite prominently. They are the French company that is really big in homeopathy in Europe. My guess is they’re making a push for more of the US market.

    Why let Airborne and HeadOn have all the action? Plenty of suckers, er, customers to go around.

  3. Chris says:

    Dr. Crislip, the dilution is a bit off. It is not 10200^100 (raised by 100), 10200</sup)*100 (but simply multiplied by 100 or 102), with is 10400. I went through the serial dilutions for 30C in my post Make Your Own Homeopathic Remedies.

  4. Chris says:

    Okay, why didn’t the sup’s work? (and I had a typo in one, so you know I tried) And why can’t we have a preview function?

    Well, it is not (10^200)^100 but (10^200)*100, which is 10^400… which is still much more than the atoms in the known universe!

  5. @Chris, love the naturally cheap recipe! But I am taken aback. Oscillococcinum is from duck liver? As in, could be used to make a yummy pate, but is instead diluted into ephemera*? What a waste.

    *ephemera – “transitory written and printed matter not intended to be retained or preserved.” well oscillococcinum is written on the bottle and the duck liver is not retained or preserved within the bottle, so technically this may the the appropriate word, sadly I could not remember the word I really wanted.

  6. Chris says:

    Thank you! That flu “remedy” is made from duck bits. It is definitely the golden duck, not has one duck made so much money for one company!

  7. JMB says:

    The CDC authors clearly do not weight interpretation by quality of the evidence, but quote anything that supports their theory.

    The Cochrane reviewers are criticizing the CDC for using an SBM approach. Hooray to the CDC! I don’t think we’ll ever see the CDC suggesting that homeopathic vaccines deserve further study.

    ******************

    Given the limited availability of resources for mass immunization, the use of influenza vaccines should be primarily directed where there is clear evidence of benefit.

    Well, thank God the USA has been willing to devote a higher percentage of GDP to healthcare (17% versus 10%). While I couldn’t use this mathematical assessment without many caveats, if the estimated deaths from H1N1 in 2010 was 12,470, assuming the vaccine uptake was 40%, and assuming the mortality rate would be reduced by the same percentage as the hazards ratio for experiencing flu symptoms with, versus without the vaccine (75%), then (12,470 * .4 / .25) about 20000 lives were saved in the USA. That’s rounding up considering the additional life saved when pregnant women were affected. (How do you count quality adjusted life years for a pregnant woman, do you add the life expectancy of the mother and the fetus?).

    ***************

    From my mathematical/computer modeling viewpoint, I also think that the Cochrane Review makes a huge mistake assuming EBM qualified evidence (RCT) is a predictor of the future. What good are the numbers cited from the meta-analysis of studies of recent flu epidemics for future flu epidemic? Do they think that the same number to treat will be the same with every future influenza strain? Virulence varies, as well as population factors such as resistance and mixing, I believe the post World War I troop demobilization and celebrations were contributing factors in 1918. There are chaotic events (in this case primarily mutations in the virus genome) that indicate the limitations of judging benefit of future applications of vaccine intervention. Are the Cochrane Reviewers so naive to think that another mutation (or combination of mutations) could not result in an influenza strain with virulence and mortality rate similar to witnessed in 1918? What are the odds that we will encounter another mutation that will allow a trans-species jump of a pathogen for which there is no reservoir of immunity in the human genome? Good luck on finding an RCT to make such an estimate. Ironically, if we are effective at using vaccination to prevent another 1918 pandemic, we might not even be aware of our success.

    The Cochrane Reviews’ favored strategy would have been ineffective in stopping the 1918 pandemic, because influenza epidemics in the short time frame before 1918 would not have resulted in the prediction of the severity of the 1918 pandemic.

    Unfortunately, the popular press has short term memory, and every year mistakes are made selecting the strains to include in the vaccine the process of vaccination will be criticized. At least by trying, I think we have a 50% chance in the next 100 years of avoiding a pandemic with over 50 million people dying. The 50% chance of saving 50 million lives in the next 100 years is just my guess, but I’d wager it is a better estimate of probability than the Cochrane Review estimate of no lives saved.

    *******************

    One is that the H1N1 pandemic last year was no big deal.

    Makes one wonder if any of the authors were infectious disease specialists, or even practicing clinicians.

    In my system we also had around 10 deaths, several in pregnant females and all in young people.

    Are you suggesting that in your experience that the 2009/2010 flu epidemic was more significant than indicated by the data?

    I think that if you notice bias in the Cochrane Reviews in your area of clinical expertise, you could expect others to witness bias in other areas of their clinical expertise. Experience in dealing with patients with a particular problem is valuable in assessing the scientific literature, resulting in better decisions than focusing only on quality of evidence in the EBM definition.

  8. windriven says:

    “In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation, 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms.”

    Cochrane ignores the power of herd immunity. During the 2006-2007 influenza season less than 40% of adults received the trivalent vaccine (CDC – National Immunization Survey – Adult, 2007). I was not easily able to find herd immunity threshold estimates for influenza but for other viral infections the threshold is in the mid 80% range (University of Wikipedia entry: Herd Immunity).

    As Dr. Crislip noted, 1% is still 3 million people. Herd immunity would knock that down to an insignificant number* saving countless resources and many lives along the way. Influenza kills several thousand people every year and causes the hospitalization of many more. There aren’t many simple and relatively inexpensive medical initiatives that could be taken that would yield benefits on that scale.

    *Of course this wouldn’t happen every year because the match between influenza strains represented in the vaccine and the strains that actually appear in the population isn’t always perfect.

  9. BKsea says:

    I am very disturbed by the appearance of Osillococcinum on the shelves next to real medicines. This strikes me as a deceptive practice that gives Osillococcinum the appearance of being held to the same standard as tested medicines. I don’t think the average consumer will be able to recognize the difference.

    I’m not usually one to argue for more lawsuits, but this strikes me as a great opportunity for a class action suit. To me, placing these items together makes Walmart, Target and the like guilty of misleading marketing practices. I’m sure people have been duped into purchasing this without knowing what it really is.

    I also wonder what would happen if someone stuck something like Theraflu into a rack of homeopathic nostrums. I’m sure the SCAMmers would welcome it, after all, they’re all just “medicines.”

  10. David Gorski says:

    Personally, I am now reluctantly coming to agree with Mark’s argument that the current Cochrane Reviews influenza staff is biased against vaccination for the flu. The language used in this most recent article, as so ably demonstrated by Mark, is simply the last nail in the coffin of Cochrane’s objectivity. I can’t believe the whining.

    Remember, though, that last year, right in thick of the H1N1 pandemic, the man who is in charge of all the influenza vaccine reviews, Tom Jefferson, accepted the Courage in Science Award from the anti-vaccine crank group the National Vaccine Information Center. He only decided not change his mind and turn down the “honor” after he realized that he would be on the same stage as Andrew Wakefield, who was slated to receive the NVIC Humanitarian Award. I described the whole sordid affair here:

    http://www.sciencebasedmedicine.org/?p=1723

    Dr. Jefferson did ultimately come to his senses, but I strongly suspect that it was more because of his dislike for Wakefield than for anything else. That’s a good thing, but the fact that Jefferson ever accepted in the first place tells me he is either (a) clueless or (b) sympathetic to the anti-flu vaccine message or (c) both.

  11. David Gorski says:

    BTW, my good bud has sited Osillococcinum at his local Target as well:

    http://scienceblogs.com/insolence/2010/11/at_a_local_target_store.php

  12. dlpfc says:

    Not to worry – one go-round of H5N1, if the virulence is even a tenth of what it is in birds, should be enough to kill off a good chunk of those who choose homeopathy and vitamin megadoses over vaccination. Natural selection at work.

  13. David H says:

    Nice article but there may be a problem with your math. If four percent of unvaccinated and only one percent of vaccinated got flu the figures can not be 12 million and 3 million. Based on the above reported 40% vaccination rate and assuming the best case scenario then 1% of the 40% of 300 million people in the US would mean 1.2 million vaccinated would get the flu whereas 4% of the 60% of 300 million would give the figure of 7.2 million unvaccinated would get flu. Ok it is a bit pedantic but I think we should do our best to be as accurate as possible.

  14. Bogeymama says:

    Ocillo has been available up here for years, and is wildly popular. I think that it was 1st line during the H1N1 outbreak last year – word of mouth spread like wildfire, and all the pharmacies in town were sold out. There is a children’s version as well! Of course, my city has a higher-than-normal per capita of quacks, and a shortage of actual MDs. Combine that with higher-than-average education and matching incomes, and it’s a perfect storm of quackery. One of the local naturopaths takes full-page ads out in the local paper to advertise his DAN affilliation, and I see my kids school principal (has a Masters) going in there often to get treatment for her “adrenal fatigue”. They have become primary care docs. The council member who garnered the most votes in the last municipal election is a popular chiropractor.

    This week’s paper had an article about a new nurse-practioner clinic opening up to help ease the MD shortage. While they admit they can prescribe some medications, the NP interviewed stressed that “they take a more holistic view of the patient, rather than throwing a pill at them”. What are we coming to when even the RNs are distancing themselves from family doctors? Her clinic is located in a family practice.

    Seriously, sometimes I think that if I even try and speak up, I will be run out of town. Too bad I can’t speak up when I see these same quacks coming to me for conventional treatment for themselves and their children. Must adhere to patient confidentiality though!

  15. colli037 says:

    Great post, less the 24 hours after the lecture I gave to the neuro-residents at my university about the fairy tail science of homeopathy, chiropractic and acupuncture.

  16. Mark Crislip says:

    See what happens when the gullible take the Cochrane at face value:

    Do Healthy Adults Really Need a Flu Shot?
    A Best Evidence Review

    Charles P. Vega, MD

    http://www.medscape.com/viewarticle/734387

    AAAARRRRRRRGGGGGHHHHHHHHHHHHHH.

  17. Werdna says:

    but their effects are minimal,

    I admit Cochrane has me stumped as to what they where expecting here. They even seem to admit that the flu vaccine saved some lives. Yet in their (now retracted) review of infinitesimally-weak-butchered-duck-and-viscera-mixture it doesn’t appear that the alleged six hours it shaves off my sitting-around-in-my-bathrobe-getting-caught-up-on-TV time qualified as “minimal”.

  18. Samantha says:

    It’s pissed me off to be in my local, been-there-forever drugstore, and slowly see the questionable remedies encroach on the desk. Before they partnered up with some sort of chain something-or-other, the woo was so strong I hated going in to pick up my prescriptions.

    In any case, I was cranky about the Oscillococcinum being sold, recognizing it for the uselessness it was…

    I grew up with a Muscovy Duck named Buddy. He protected me from all sorts of bugs. I fed him worms. =(

    Wonder if PETA’s aware of this?

  19. BillyJoe says:

    Once upon a time we had a beagle and a duck. The beagle thought the duck would be a pushover like the chicken we once had that he disposed of on day one. Imagine his surprise when the duck actually defended itself. They became “good friends” in the long run. Not that they didn’t go at each other. That happened on a regular basis. In fact that was the reason they became “good friends”. The duck’s best defence was to peck the beagle in the middle of his back and the beagle enjoyed that so much he completely forgot that he was supposed to eat the damn thing.

  20. BillyJoe says:

    I maybe mistaken. ..it’s possible that it was a goose.
    Which makes my story even more irrelevant. :(

  21. Joe says:

    I’m tellin’ you, the Cochrane reports have gone to the birds.

  22. BillyJoe says:

    “I’m tellin’ you, the Cochrane reports have gone to the birds.”

    I came to that conclusion a couple of years ago whilst researching systematic reviews of clinical trials of acupuncture on the cochrane database. Yeah, small c for cochrane.

  23. Bogeymama – “While they admit they can prescribe some medications, the NP interviewed stressed that “they take a more holistic view of the patient, rather than throwing a pill at them”.

    It’s always helpful to hear the anecdotes for other areas. We love near a university town with a med school that is a very desirable area or the state. I think we have access to some of the best medical care in the state, definitely above average compared to many parts of the country.

    But to nitpick, setting aside the context of CAM, holistic care and avoiding medication, when possible, should be considered a good thing IMO. Example, awhile back my daughter was suffering from daily tummy aches and constipation. Called the doctor and they set me up with the nurse practitioner who specializes in such complaints. The NP did a physical, ran a urine test and concluded that the tummy ache was most likely from the constipation. She recommended some lifestyle and diet changes, that were relatively easy to implement and recommended a mild laxative if the lifestyle diet changes didn’t work after a couple weeks. Also, the urine test showed an excess of sugar*, so they brought my daughter back in for a blood test and doctor consult for diabetes, which was negative. If it had been positive, I feel my doctor would recommend a treatment plan that avoids medication if possible, recommends it when needed.

    To me this is “holistic care and not just throwing a pill at the problem” In short, it is what I look for in my SBM.

    The woo-meister are just using people’s concerns about bad doctors to negatively redefine conventional medicine as a whole, to their own advantage. Don’t let them.

    *is that right? It was a year ago, my memory is not completely clear on the test.

  24. I’m wonder if the preponderance of woo remedies for h1n1 and flu last year in anyway relates to the lack of availability of the vaccines.

    It seems that the lack of availability of vaccine was unavoidable, but I do wonder if the amount of fear that was generated by h1n1 and a certain amount of helplessness at not being able to get the vaccine, may have directed more interest toward alternative remedies.

    That is entirely speculation.

  25. Dr Benway says:

    F_ck Cochrain. They’ve been infiltrated by ideologues seeking the patina of science as a marketing strategy.

    F_ck ‘em.

    The genuine physicians involved with them ought to resign.

  26. nybgrus says:

    @ Michelle: That is the kind of medicine that I am currently being taught to practice. It is also the kind of medicine I WANT to practice. I think that many aspiring physicians (such as myself) often cave to the pressures though – seeing more patients in less time to increase their profit margin, going down the formulary for what treatments are covered by what diagnostic codes, etc. Oh yes, and lets not forget that the majority of patients themselves want a simple “cure!” One thing these woo-meisters (and the rest of us, really) miss is that this culture is all about the “give me a pill to fix {insert ailment here}” As doctors we can (and do) offer lifestyle changes, exercise, diet, etc but do people really want to make those hard changes? No! How many people with hypertension, type 2 diabetes, and a BMI of 38 will go to the doctor and say “Oh! You mean I need to put down the Krispy Kreme and go running? Well hot diggity let me get on that!” No… more often than not they want the blood pressure pill and the diabetes pill and then continue in their slovenly ways (saying that they will, of course, TRY and get healthier). Some even come in demanding specific pills and/or tests – like the physician is just some conduit/barrier to what they already know they need (want). So I reckon a number of physicians, after a while, just cut out this middle man and become jaded and simply proffer the pills cynically thinking how the effort they would spend trying to offer diet and lifestyle change options would still lead to the same result and garner them less money since the consultation was longer.

    Sorry for the rant – and I am not saying that is all physicians (nor any that are a part of this site) or patients, but it certainly is not an insignificant number.

    As for your daughter – it makes sense: urine dipsticks to test for sugar and if she had some show up they would want to check her for diabetes. If you have diabetes, you have increased blood sugar. Increase that enough and the transport systems in your kidneys get overwhelmed and sugar (glucose) stays in the urine that you end up peeing out. In fact, in the old days, physicians used to smell and taste urine to determine if a patient was diabetic – now that is dedication!

    On a side note, I used to run so many urinalysis in the ER that I got to the point where if I looked at the sample, shook it vigorously, and then looked again and smelled it I could pretty accurately tell you the specific gravity, protein content, ketone content, sugar (if it was a lot), and be better than random on determining whether the turbidity was due to UTI or contamination. Ah, the skills we gain as we get older….

  27. Werdna says:

    “holistic care and avoiding medication, when possible, should be considered a good thing IMO.”

    I’m not sure what “when possible means” in this context. It is possible to not inoculate against diseases or to take antibiotics when you have a serious infection. Given the remediation available to most people in large communities the chance of serious consequence is probably pretty small.

    The trick is to apply a therapy when it is *appropriate* when the likely benefits significantly outweigh the risks. The problem is that such things are often non-trivial to quantify.

    So your assumption is that if someone was positive for diabetes the Doc wouldn’t prescribe lifestyle changes. It’s hard to generalize to other docs but the one I live with constantly tries to get their patients to do lifestyle changes to avoid this increasingly common disease. Sure if a doc sees a high blood sugar the right thing to do may well be to prescribe something. Why? i) Although we know the symptoms of diabetes it’s unclear how long it can stay asymptomatic ii) We know the outcome of long term symptomatic diaobetes which can be very bad. IMHO even if your assumption is correct as to what the doctor would have done it’s not necessarily an example of *inappropriate* use of pharmacology.

    The schism of CAM vs real medicine (yeah I say that deliberately) is that CAM practitioners vastly…sometimes astronomically overestimate the benefits of their solutions and mildly to drastically downplay the risks.

  28. My assumption is that diabetes in a four-year old would be Type I and require medication – probably one of those portable insulin pumps. I would be very nervous if someone told me that my small child’s diabetes only needed diet and exercise, and would look for a second opinion and do a lot of googling.

    I don’t know a lot of doctors who “just throw a pill at something” and I think it’s obnoxious of that NP to suggest that all someone will ever get from a doctor is a pill thrown at them. Lifestyle interventions *are* SBM.

    It makes sense for a doctor to work with nurses and dieticians to help with ongoing counseling and support for lifestyle modifications. Doctors are supposed to ask about inmate partner violence as a routine part of a general exam (and my doctor does) but I don’t think they are expected to provide all the follow-up support on their own. My preference would always be to go to my GP first and then use the ancillary professionals my GP recommends. I’d be worried that if I went to an ancillary professional first that they would be tempted to hang on to me a little too long before referring me to a doctor. While that may not be typical, it seems it would be an inherent risk I would be concerned about.

  29. Bogeymama says:

    “holistic care and avoiding medication, when possible, should be considered a good thing IMO.”

    I agree too! But it’s very insulting to family doctors because, as others have pointed out, most family doctors do promote lifestyle changes. GP/FM’s are not simply “pill-pushers”, and it annoys me when quacks try to paint us as such. It is not necessary for a nurse practitioner to say something like that when we’re supposed to be in this together.

  30. JMB says:

    @David H

    In my opinion, if you are going to advocate a policy, such as vaccination of the general population, you should give figures based on the assumption of 100% compliance. You should specify that the calculation makes the assumption of compliance. However, two estimates should be made attempting to account for the possible effect or lack of effect from herd immunity. The biggest effect of herd immunity is that the public will ask if they really needed to take the vaccine, because the prediction of an epidemic seemed to fizzle.

    You don’t advocate by telling the public that we know only 40% are going to comply, so these are the expected benefits. You advocate by saying if everybody would get the vaccine (with the specific exclusions normally cited), we could see this many people benefit.

    In the calculation I made, I was trying to give an estimate of the possible number of lives saved last flu season. Consequently, I had to find an estimate of vaccine uptake. It was a quick and dirty calculation full of assumptions and poorly documented estimates. It was merely trying to point out the magnitude of benefit that could be guestimated from the statistics of observed mortality, a rough estimate of uptake, and the hazard ratio of developing flu after vaccination. Discussing absolute numbers saved sometimes has more of an impact than percentages or numbers needed to treat. 20000 lives saved with 40% compliance in a population of 300000000 means 6000 people had to receive the vaccine to save one life (but that is not based on an RCT). Those that advocate that we do not have the resources for that intervention smell a little worse when you point out that 20000 lives were potentially saved, as opposed to saying 6000 people needed to be treated to save one life (and those people receiving the vaccine suffer discomfort and anxiety, risk of overtreatment of a flu like syndrome, and chance of developing Guiilan-Barre syndrome).

    It would be very easy to challenge the figure of vaccine uptake of 40%, I am sure there are different estimates available from credible sources. Estimates for vaccine uptake in 2009-2010 may be revised as more reliable information becomes available.

    The biggest source of error in any calculation is the fact that we are dealing with different strains of influenza. Last years’ flu epidemic was notable for the higher percentage of deaths occurring in otherwise healthy people.

  31. Regarding “holistic care” I didn’t mean to stir a bees nest. But I was just doing a quick read at lunch and can’t take much time to respond.

    In short. By using the example of our doctor I meant to say that SBM IS holistic and doesn’t just throw a pill at things, that we shouldn’t let the woo folk appropriate the terms for themselves.

    Alison, thanks for the diabetes info. I don’t know much about it, sorry if I misrepresented how treatment would be approach from a SBM perspective.

    More later is it seems necessary.

  32. rwk says:

    @Mark Crislip

    I keep half an eye on the medicine displays in stores when I shop, and this year is the first time I have seen Oscillococcinum being sold.

    Maybe you should get out more often. I’ve seen it sold in Jewel /Osco
    a grocery/pharmacy for years. Good way to start a article!

  33. Mark Crislip says:

    I just came across this old study in a editorial on schools as the epicenters for flu spread:

    Considerable evidence indicates that herd immunity is operative in the control of influenza as well. In Tecumseh, Mich- igan, 185% of 3159 schoolchildren were given TIV over 4 days and compared to a similar population in the neighboring community of Adrian, where vaccine was not administered. Three times more influenza-like illness occurred among people of all ages in Adrian than in Tecumseh, demonstrating that immunizing school- children in a community significantly protects the population at large in that community [38].

    Monto AS, Davenport FM, Napier JA, et al. Effect of vaccination of a school-age popula- tion upon the course of an A2/Hong Kong influenza epidemic. Bull WHO 1969; 41:537– 542.

  34. Mark Crislip says:

    And this weeks NEJM

    Background
    After the first monovalent 2009 pandemic influenza A (H1N1) vaccine became available in September 2009, Chinese officials conducted a mass vaccination program in Beijing. We evaluated the safety and effectiveness of the vaccine.

    Methods
    During a 5-day period in September 2009, a total of 95,244 children and adults re- ceived the PANFLU.1 vaccine (Sinovac Biotech), a monovalent split-virion vaccine of 15 μg of hemagglutinin antigen without adjuvant. We assessed adverse events after immunization through an enhanced passive-surveillance system and through ac- tive surveillance, using diary cards and telephone interviews. Active surveillance for neurologic diseases was implemented in hospitals citywide. To assess vaccine ef- fectiveness, we compared the rates of reported laboratory-confirmed cases of 2009 H1N1 virus infection in students who received the vaccine with the rates in those who did not receive the vaccine, starting 2 weeks after the mass vaccination.

    Results
    As of December 31, 2009, adverse events were reported by 193 vaccine recipients. Through hospital-based active surveillance, 362 cases of incident neurologic diseases were identified within 10 weeks after the mass vaccination, including 27 cases of the Guillain–Barré syndrome. None of the neurologic conditions occurred among vaccine recipients. From 245 schools, 25,037 students participated in the mass vac- cination and 244,091 did not. During the period from October 9 through November 15, 2009, the incidence of confirmed cases of 2009 H1N1 virus infection per 100,000 students was 35.9 (9 of 25,037) among vaccinated students and 281.4 (687 of 244,091) among unvaccinated students. Thus, the estimated vaccine effectiveness was 87.3% (95% confidence interval, 75.4 to 93.4).

  35. Mark Crislip says:

    And this (I find stuff each week preparing for my puscast)

    from CID

    Background. Influenza is an uncontrolled epidemic disease that is vaccine preventable. New recommendations for universal immunization present a challenge to the implementation of vaccine delivery. This field trial examines the effectiveness of school-based clinics for vaccine delivery before an epidemic caused by 3 new influenza virus variants not contained in the vaccine.

    Methods. Live attenuated influenza vaccine (LAIV) was offered to eligible children in elementary schools of eastern Bell County, Texas. Age-specific rates of medically attended acute respiratory illness for health plan members at the intervention site were compared with those for members at comparison sites during the epidemic, defined by viral surveillance at all sites.

    Results. Almost 48% of children in elementary schools were vaccinated. Significant herd protection attributed to LAIV was detected for all age groups except 12–17-year-old students, who were not offered free vaccine. Approximately 2500 medical encounters were prevented at the intervention site. Inactivated vaccine provided marginal protection against the epidemic viruses.

    Conclusions. LAIV delivered to elementary-school children before an epidemic caused by 3 new variant in- fluenza virus

    Effect of Influenza Vaccination at School • JID 2010:202 (1 December) • 1627

  36. JMB says:

    In Tecumseh, Mich- igan, 185% of 3159 schoolchildren were given TIV over 4 days and compared to a similar population in the neighboring community of Adrian, where vaccine was not administered.

    I am not sure of the correct percentage (18.5%?), but the observation seems to imply that herd immunity can be partly achieved if the main vectors within a community (children attending public school) are immunized. Perhaps last years flu epidemic was curtailed by herd immunity effects even though estimated overall uptake was 40% (that figure will vary by geographic locale). So maybe we have already witnessed the backlash (media reporting usual big pharma conspiracy overstating risk) expected when vaccination is successful at curtailing the epidemic.

  37. ConspicuousCarl says:

    I saw osillococcinum in a Whole Foods store. I noticed that it says it is for “flu-like symptoms”.

    That’s OK because you really only know that you have certain symptoms. I think real medicine is sometimes advertised that way as well.

    Or it would be OK, except that osillococcinum is a homeopathic preparation, and the inventor of homeopathy accused non-homeopath doctors of treating symptoms rather than causes.

    http://en.wikipedia.org/wiki/Allopathic_medicine
    Allopathic medicine and allopathy are terms coined by Samuel Hahnemann, the founder of homeopathy.[1] It meant “other than the disease” and it was intended, among other things, to point out how regular doctors used methods that Hahnemann felt had nothing to do with the disharmony produced by disease, merely addressing symptoms, which, in Hahnemann’s view, meant that these methods were harmful to the patients.

  38. @ Werdna
    I said “holistic care and avoiding medication, when possible, should be considered a good thing IMO.”

    Werdna said “I’m not sure what “when possible means” in this context. It is possible to not inoculate against diseases or to take antibiotics when you have a serious infection.
    The trick is to apply a therapy when it is *appropriate* when the likely benefits significantly outweigh the risks. The problem is that such things are often non-trivial to quantify.”

    My bad. “when possible” was a poor choice of words*. Your use of “when appropriate” is more what I meant.

    Werdna also said “So your assumption is that if someone was positive for diabetes the Doc wouldn’t prescribe lifestyle changes.”

    No, That’s not my assumption, but I can see how you read it that way (damn) I said “If it (test for diabetes) had been positive, I feel my doctor would recommend a treatment plan that avoids medication if possible, recommends it when needed.

    Maybe this is a better way to say it. I feel my doctor would have considered and advised me on BOTH the appropriate lifestyle and diet for my daughter as well as prescribed medication as appropriate.

    So, overall I think we agree. Sorry for any confusion caused by my wording.

    * Sometime I think language is my second language.

  39. @ Bogeymama
    I said “holistic care and avoiding medication, when possible, should be considered a good thing IMO.”

    Bogeymama – I agree too! But it’s very insulting to family doctors because, as others have pointed out, most family doctors do promote lifestyle changes. GP/FM’s are not simply “pill-pushers”, and it annoys me when quacks try to paint us as such.

    Yes, I agree. It is obnoxious and counterproductive. My expectation is that GPs and NP will work collaboratively together, as needed. In this case it appears to me that the NPs attempt to undermine the credibility of a “team member” through innuendo, in order to gain more patients, is not only underhanded but works against their ability to provide quality care to the patient, as I see it.

  40. Alison Cummins
    “It makes sense for a doctor to work with nurses and dieticians to help with ongoing counseling and support for lifestyle modifications. My preference would always be to go to my GP first and then use the ancillary professionals my GP recommends. I’d be worried that if I went to an ancillary professional first that they would be tempted to hang on to me a little too long before referring me to a doctor. While that may not be typical, it seems it would be an inherent risk I would be concerned about.”

    Sorry – this is increasingly off topic, but – In both my doctor’s office and our pediatricians, The doctors and NP work in the same office, same appointment desk, billing, etc. With my doctor’s office, my GP does the annual physicals and the office GPs share more complex or serious sick appointments (for instance they always set me up with a GP when I come in with asthma symptoms). In my experience the NP handle less serious sick appointment. When I’ve had appointments for sinus pain, back pain, shoulder pain, I’ve often seen a GP.

    Our pediatrician’s office is similar only they also alternate annual physicals between Ped and NP (First year appt. Ped, next year NP, etc) with the approval of parents. As a parent, you can choose to only see the Ped for annual appointments. Sick appointments are made same day with office Ped or NP, with more serious issues being given to Ped. A couple times our NP has turned the appointment over to the Ped when the illness looked more serious based their physical exam.

    As a patient, I’ve been very satisfied with this system. As far as I can see, the GPs and the NP in our office work very well together. I have not noticed either group to be more or less lifestyle/medication inclined. Until reading comments here, I’d never heard of NP working in separate offices. Kinda surprising for me. Not sure I really get it.

  41. Dr Benway says:

    We love near a university town with a med school that is a very desirable area or the state. I think we have access to some of the best medical care in the state, definitely above average compared to many parts of the country.

    Is that the place that promotes “anthroposophic medicine”?

  42. Dr Benway, It is the place that treats my son for his cranio-facial conditions as well as treating my neighbor’s baby girl for a severe congenital heart condition. In addition to that, they treat many other children that I have meet in our weekly visits to the speech/ot department, the testing my son needed in genetics, cardiology, ultra-sounds and or pre-post-op care and inpatient care. Like I said before, I’ve never been advised to engage in any therapy that I’ve read to be woo or CAM (and I check). On a couple occasions I’ve been warned off of therapies that are unproven or disproven (they weren’t CAM related though).

    I’ve been impressed with the quality of care that my son and other children I’ve come in contact with have recieved. I’ve also been impressed with most of the medical staff’s ability to communicate with parents and treat children in a gentle and thoughtful way. I recommend the hospital regularily for that reason.

    This is in direct contrast to stories I have heard from other parts of the country that do not have that quality of medical care available.

    If there is an integrative medicine group working out of our hospital, I’ve never been referred to them. I have a hard time thinking that it’s existence should reflect negatively on the professionals I’ve worked with. The point that I was making is that I am lucky to have access to so many medical professionals that do NOT engage in CAM. That is a good thing. Isn’t it?

    If I am ever in the position to advocate for or recommend a particular healthcare approach (Conventional Medicine vs CAM or Chiropractic, etc). I do it by talking about the care my son has received and how it has improved his life. I talk about the care that is taken by his doctors and other staff to diminish risk and maximize benefits. I think, sometimes people I talk to end up with a changed perspective on “conventional medicine”. I think, sometimes afterwards, they are more inclined to set aside some of their mistaken beliefs and consider conventional medicine in a more positive light.

    I do this not because I think conventional medicine is perfect, but because I genuinely believe it’s the best bet for people with a healthcare need.

    That’s about all I have to offer in that arena.

  43. Also Dr Benway – See, you provoking me onto my soapbox on this thread and now I will not have time, today, to lecture you on branding and marketing in the “death by alternative medicine” thread.

    Boy, are you missing out. :)

  44. Dr Benway says:

    I just find integrative medicine endlessly fascinating. How do doctors’ brains manage the contradictions?

    The fact that woo is now taught at all our leading medical schools proves that doctors rely chiefly upon arguments from authority rather than critical analysis of the scientific evidence.

    Hey here’s an idea: teach something totally batshit to a second year med school class. It has to be semi-plausible, cuz they’ll Google. After final exams and before they hit the wards, reveal hoax. Then say, “Yeah sorry, we trained you to follow our every word like meek little sheep. We thought you should be aware of this. Hopefully one day you’ll snap out of the hypnotic spell.”

  45. Dr Benway says:

    I’ve never been advised to engage in any therapy that I’ve read to be woo or CAM (and I check).

    Have you been advised to follow a course of treatment based upon arguments from authority rather than an understanding of the evidence? Yes you have, most of the time in fact. If the U Michigan doctors could think critically and independently, there would be no integrative medicine there.

    U Michigan is no different from Harvard, Yale, Penn, UCSF, Stanford, or Hopkins. They’re all promoting woo these days.

  46. Jan Willem Nienhuys says:

    I looked into the two large trials of oscillococcinum. The first one is that of Ferley et al. (1989).

    Superficially it is OK. It scored 90 out of 100 points in the review of Kleijnen, Knipschild and ter Riet (1991). Now Kleijnen was quite liberal in handing out grades, but even Catherine Hill (of a similar survey) told me that the paper by Ferley et al. was not bad, compared to the usual homeopathy paper.

    I think it borders on the fraudulent. One can see in the paper that the researchers noted down when people were cured of their flu-like symptoms after getting to the doctor. The authors don’t give any data, and one has to use a ruler to find out how many were cured on or before 1/2 day, 1 day, 1.5 days, 2 days, and so on, until the end of a whole week.

    I give here the numbers for 1, 2, 3…7 days, top line verum, below that placebo, as I measured them from the graph:

    9 40 85 126 156 176 189 (total 228)
    7 25 68 116 151 176 185 (total 234)

    Only the data for day 2 show a ‘significant’ difference! A correct computation yield p=0.0494 (the authors goofed up on the computation too, because among others they didn’t apply the continuity correction). One might argue that being cured in two days means it wasn’t real flu. But the main thing is they selected this one result out a possible 14 results. It is implausible that the authors planned to to take ‘cured within two days’ as the primary outcome criterion. They must have known that the number of people cured within two days is not so large, so the risk of finding nothing even if there was a genuine effect would mhave been rather large.

    Anyway, this investigation was soon repeated, namely around New Yearś Day, 1991, by Papp et al..

    One might consider this as an effort to replicate the exploratory finding of Ferley et al. In this respect it failed. Examining the paper, one is struck by the different definition of ‘flu’, compared to Ferley et al. Also the definition of when a patient is considerd cured is different. Even with these adapted definition one finds: verum 188, cured in 48 hours 32, placebo 184, cured in 48 hours 25. Even without calculation one can see that this is not significant. Papp et al. don’t even give the answer, but I computed p=0.44. So one might say: exploratory result of Ferley et al. nor replicable, end iof story.

    Now this paper by Papp et al. managed to find another criterion, namely ‘considerable improvement’. With that criterion they managed to find p=0.0028.
    It took them about 6 years, namely until 1998, to find a journal willing to publish this ‘result’.

    A Cochrane review by Vickers and Smith states: ‘the data are not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndrome.’ A credulous WHO report on homeopathy (only known in concept) nonetheless claims that these Oscillococcinum investigations strengthen the claim that homeopathy is effective against flu. In surveys by homeopaths of the RCTs proving homeopathy worthwhile one usually finds these two papers mentioned.

    I.J. Good is credited with the remark ‘If you torture the data long enough, they will confess’. I think that these two papers show quite clearly how powerful after the fact reinterpretating the data can be.

  47. @ Dr Benway – “Have you been advised to follow a course of treatment based upon arguments from authority rather than an understanding of the evidence? Yes you have, most of the time in fact.”

    I don’t see how you could have enough information to make that statement truthfully. I think you are starting out with your theory and making up the “facts” to support it. Dr Benway, that makes me sad. :(

    “If the U Michigan doctors could think critically and independently, there would be no integrative medicine there.”

    So you believe that the presence of any integrative medicine center at a university hospital proves that ALL the doctors at that hospital are incapable of thinking critically and independently?

    So you believe that the 1,600 physicians, 683 medical students, 1,010 interns and residents, 503 graduate students and 482 postdoctoral research fellows, as well as the 13,000* employees, including 3,500** nurses are ALL incapable of thinking critically and independently because of the….what 13(?) physicians and other staff at the integrative medicine center?

    I don’t know whether to be appalled that you expect me to believe that or ask for some of the drugs you are on. They are obviously good.

    Dr Benway, you obviously have brilliant taste in movies, are witty bright and committed to your ideals. Your writing style has a pugnacious clarity that I genuinely admire. Let’s not fight. Let’s agree to disagree on this one.

    *Not sure if the 13,000 imcopasses some of the doctors, med students, etc.
    **numbers from wikipedia

  48. I’m probably having an ocd moment and this is clearly off topic from flu vaccines and oscilliococinum, but SE michigan has two university medical schools (UofM and Wayne State) as well as a reputable speech pathology department at Eastern Michigan. It is also (in spite of what you might hear on the news) a nice area to live, what with the lakes, the change in seasons, nice people, etc. So, it seems to me a reasonable number of medical people choose to stay in the area.

    My original point was that this means the area is well supplied with health care staff so that we have some choices when selecting a doctor or health care center. This is not true of some rural areas or areas distant from hospitals. It was certainly not true of my father, who lived in Mississippi an hour away from a very small hospital and 1.5 hours from New Orleans.

    I had no intention of commenting on the relative quality of ANY of the medical schools/hospitals in the area or in the country. I’ll leave that to someone more knowledgeable in that area.

  49. Dr Benway says:

    So you believe that the presence of any integrative medicine center at a university hospital proves that ALL the doctors at that hospital are incapable of thinking critically and independently?

    Most doctors rely upon arguments from authority because they have to. There aren’t enough hours in the day to critically review all the evidence for or against some treatment, and there are countless treatments.

    It is reasonable to accept the homework of others as one’s own provided there is a solid system of criticism and peer review in place. But how do we judge if peer review is working?

    A functioning system of criticism should filter out really crazy ideas –e.g., treating polio with magic– without trouble. Ergo, any obvious idiocy in a reputable publication like the NEJM or at one of our leading medical schools ought to worry us.

    No doubt the U Michigan doctors capable of seeing the problems with anthroposophic medicine and other forms of spellcasting and superstition are just very busy right now, else they’d visit us here at SBM with a few stories.

  50. sheldon101 says:

    Oscillo is also an historical artifact. A lot of work went into discovering the cause of the Spanish flu. A number of researchers decided it was caused by a bacteria, usually the bacteria now named Hib after its so called causation of influenza. Others argued that it was a non-filterable bacteria (which we now call a virus). In the early 1930s, it was definitively proven that influenza was caused by a virus. So on top of all the other impossibilities of oscillo, we have being designed for a bacteria that did not exist, one that caused influenza. Ooops.

  51. ckmw says:

    I haven’t posted here before, but read regularly and have been grappling a bit with my own emerging skepticism as someone who has used CAM quite a bit.
    My journey into CAM happened as I would bet it does for many people, as someone who spent a decade with all kinds of chronic illness that was attributed to everything from viral infection to psychiatric problems. I figured I had nothing to lose since I was ready to throw in the towel so I put my skepticism aside and jumped head first into chiropractic, homeopathy and some other stuff I am just too embarassed to mention. 2 years ago I found out that my symptoms had a bizarre and mysterious source- multiple sclerosis. Ta Da.
    The discussion reminds me of a recent neurologist visit where I asked the NP for mental health referrals to someone competent in dealing with an MS patient having cognitive issues and depression. She mused on how great something like that would be, and said that she did not. I then asked if there was any advice on the training and background of who I should be looking for- an MD in psychiatry, a Psy-D specializing in “neuro- biology” (is that a real thing? because I see it advertised). She said “no, not really.” And then she suggested I try exercise because she thought there were lots of studies showing it helped people with depression.
    Do I need to expound on this forum how idiotic that statement is? And that was basically the end of the conversation.
    So while my specialist doesn’t promote or participate with any CAM approaches to treating MS, would it really be so far out there to have referrals to mental health providers? To stop for a moment and address “wholistically” my total health picture? I wasn’t asking for crystal healing.
    So my big confession is that I am still going to the accupuncturist regularly. Even though I have read a lot on this and other blogs that makes me really wonder what the heck I’m doing exactly, and the reason is that despite being pretty sure I would not have any results, going seems to have correlated with feeling a lot better. Placebo? Wishful thinking? I have no explination because I fully recognize that the science isn’t there. I also take MS medication, but it does nothing for the day to day symptoms and even if it is only my imagination, it seems worth the money and time to go to the TCM provider. I wonder sometimes if somewhere along the way and MD had taken the time to really address the disease I had if my relationship to healthcare as a whole would have been different.

  52. Dr Benway “No doubt the U Michigan doctors capable of seeing the problems with anthroposophic medicine and other forms of spellcasting and superstition are just very busy right now, else they’d visit us here at SBM with a few stories.”

    Yup, perhaps they are too busy implementing safety measures. According to Leapfrog Group, U of M is one of the top hospitals in the nation for quality and safety, along with Detroit Receiving, DMC and Huron Valley-Sinai…All of which are within a 40 mile radius from my home. Which, I think illustrates my (should have been passing but much disputed) comment that I am lucky to have good access to health care.

    As the parent of a child that will be having at least two more inpatient surgeries and an good number of outpatient surgeries and/or tests, I evaluate a hospital based on experience in the needed specialty, safety and quality of care; not based on some guilty by association to CAM or whether or not their participating physicians vent, snark or make informative posts on blogs opposing CAM.

    If the later two are your criteria for a good hospital as prescribed by your glorious fight against CAM, you can leave me out. I am not interested.

  53. Enkidu says:

    I saw a tv commercial for Oscillococcinum last night… and this was during the evening news, not during some cable channel 876 late night program.

  54. Gabor Hrasko says:

    Hi,

    The Oscillococcinum review had really disappeared from the search engine results on the Cochrane reviews page, but it still can be found:

    http://www2.cochrane.org/reviews/en/ab001957.html

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