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The New Cough and Cold Products for Children: Evidence is Optional and Science is Marketing

Zarbee's Helixia, Oscillococcinum

It’s the time of year where if you’re not sick, someone you know probably is. The influenza season in the Northern hemisphere started out slowly, but seems to be accelerating and hasn’t peaked yet. Add that to cold viruses circulating, and you get the peak purchasing period for cough and cold remedies. John Snyder gave a nice summary of the evidence base for the common treatments a few weeks ago. In short, despite all the advertising, there is little evidence to suggest that most of the “tried and true” products we’ve used for decades have any effect on our symptoms. One of the most sensible developments that’s occurred over the past few years has been the discontinuation or relabeling (depending on your country) of cough and cold products for children. The rationale to pull these products is compelling: Cough and cold remedies have a long history of use, and were sold without prescriptions before current regulatory standards were in place. They were effectively grandfathered onto the marketplace. When it comes to their use in children, the data are even more limited. There are few published trials and the results are complicated by different age groups, irregular dosing, lack of placebo control, and very small patient numbers. What’s even harder to believe was that doses were based mainly on expert opinion, not data, and generally didn’t consider that children don’t handle drugs the way adults do. So why withdraw them from pediatric use, but not adult use? Like most regulation, it comes down to risk and benefit. Both are troubling for pediatric use.

One of the earliest lessons you’ll gain from a pharmacokinetics course (which studies drug behavior in the body) is that children are not small adults. It’s not just their size, it’s their physiology. The stomach acidity can differ, changing how drugs are absorbed. Body-fat-proportion differences affect how drugs are distributed in the body. And the body’s pathways for metabolism are not fully mature, which means drugs can behave in different and often unpredictable ways. Given the lack of data showing how the major cough and cold ingredients behave in children, and a lack of evidence showing that they have any meaningful effects, it comes down to a question of safety. While these products had long histories of safe use, harms and deaths have been linked to cough and cold product use in children. Fatal side effects are exceptionally rare, but can occur. Risks are greater in the younger child, and particularly in infants. In light of the potential for harm and the lack of benefit, there is no justification to keep them in the market, and most regulators around the world eventually acted to reduce the risk that they will be used in children. Like many other health professionals, I was happy to see them go. Today’s treatment guidelines don’t recommend drug therapy.

The Cough Suppressant and Pharmacologic Protussive Therapy : ACCP Evidence-Based Clinical Practice Guidelines (2006) make the following recommendations about cough suppressants and expectorants:

  • In patients with acute cough due to the common cold, preparations containing zinc are not recommended. Level of evidence, good; benefit, none; grade of recommendation, D
  • In patients with acute cough due to the common cold, over the counter combination cold medications, with the exception of an older antihistamine-decongestant, are not recommended until randomized controlled trials prove that they are effective cough suppressants. Level of evidence, fair; benefit, none; grade of recommendation, D
  • In patients with cough due to URI [upper respiratory infection], central cough suppressants (i.e., codeine and dextromethorphan) have limited efficacy for symptomatic relief and are not recommended for this use. Level of evidence, good; benefit, none; grade of recommendation, D

The British Thoracic Society Cough Guideline Group in its recommendations for the assessment and management of cough in children (2007) notes the following:

  • Over-the-counter medications are as effective as placebo for acute cough with head colds in children. A systematic review of six RCTs and a further recent RCT found that over-the-counter antitussives, antihistamines and antihistamine-decongestant combinations were as effective as placebo with the potential for causing side effects.

Evidence is one thing. Reassuring parents that they don’t need to give any medication is another matter entirely – especially since many of us grew up taking cold remedies. Once these products disappeared from the shelves, their absence made my dialogue with patients easier. I could explain the rationale for no treatment, why the traditional treatments had been relabeled or removed from sale, and discuss the self-limiting nature of colds. I’d also suggest products that actually do work, like analgesics such as Tylenol, and sometimes saline (drug-free) nasal sprays for treating congestion. And that’s pretty much it. Once you break the habit of reaching for a bottle of syrup each time your kid gets sick, you adapt. Give fluids, lots of rest, and lots of TLC. And don’t worry about giving cold remedies.

The shelves didn’t stay bare for too long. As John Snyder pointed out, a stunning 10% of children are given a cough and cold remedy every week. The demand is huge. That’s an enormous market that manufacturers couldn’t ignore. There are several new remedies that you’ll see on the shelf – most of them marketed at infants and children, and they’re advertised as “natural” products that really work. The enabler is weak regulation. In the USA, it’s the Dietary Supplement Health and Education Act (DSHEA). In Canada, it’s the Natural Health Products Regulations. Different regulatory frameworks, but with the same intent – to allow “natural” products and supplements to be sold without actually requiring those products to be backed by good evidence of safety or effectiveness. It’s the easiest way for a new product to be approved – describe it as “natural” (if you’re in Canada) or a supplement (in the USA), and you bypass the strict regulatory requirements required if you called it a “drug” instead. It’s simply not possible to keep up with all of the new products appearing – here’s the evidence for some of the products that I’ve seen appear on pharmacy shelves:

Homeopathic remedies

The first products that appeared after the traditional cough and cold products disappeared were the homeopathic remedies. Even pharmacies that don’t tend to sell much homeopathy now seem to offer homeopathy for children, suggesting pharmacies are prioritizing sales ahead of scientific evidence – because as pseudoscience goes, there is no product so demonstrably useless as homeopathy. Based on the idea that “like cures like” (which is magical thinking) and the concept that water has a memory (also magical thinking), homeopathic remedies look like medicine – but don’t have any medicine in them. Various substances are taken and diluted – not just herbs but products like “Berlin Wall”, “Stonehenge” and even “Rabbit Anus” are considered potential “remedies”. The net effect is that while there are hundreds of homeopathic products sold, it’s effectively all the same thing – an inert placebo. The granddaddy of the homeopathic cold remedies is Oscillococcinum, a product of fermented duck’s heart and liver that has been diluted so dramatically (1 part in 100, 200 times in a row), that in order to consume even a single molecule of the original fermented duck, you would have to swallow a volume of tablets greater that the mass of the entire universe. The chance of effectiveness or side effects with this product is equally remote. Boiron, the manufacturer, has several other cough and cold products, including Stodal, a “toxin-free” homeopathic cough syrup without any demonstrated evidence of efficacy, either. There are other manufacturers on the market now, directly targeting the children’s market. Homeocan now has an entire line of “cough and cold” “remedies” that are marketed under the banner “Kids 0-9 All Natural Medicine” which were created by “a pharmacist and professional homeopath”. The cough and cold product is labelled “Helps relieve dry cough, congestion, mucus build-up and reduce pain and fever.” when the bottle actually contains no medicinal ingredients. There’s also NatraBio, which is advertised to be useful in children as young as 4 months, and it’s claimed:

Treating children with homeopathy utilizes nature’s medicines to gently relieve symptoms and promote healing. Homeopathic medicine is a safe treatment for most minor ailments. Precise levels of homeopathic ingredients work safely and without side effects.

  • All natural ingredients
  • No side effects
  • No sugar
  • No drowsiness
  • Made in accordance with the U.S. Homeopathic Pharmacopoeia.

If you didn’t know better, you could easily be fooled into thinking Natrabio is a product with medicine in it. The ingredient list, like all homeopathic remedies, is deliberately deceiving:

Active Ingredients: Aconitum Napellus (Monkshood) 3X, 6X, 12X, 30X (Aconite), Echinacea Angustifolia (Coneflower) 3x (Coneflower), Allium Cepa (Red Onion) 6X (Red Onion), Hydrastis Canadensis 6X (Golden Seal), Euphrasia Officinalis (Eyebright) 6X (Eyebright), Gelsemium Sempervirens 6X (Yellow Jessamine), Sanguinaria Canadensis (Blood Root) (Blood Root), Sticta Pulmonaria (Lungwort) 6X (Lungwort)

3X is a 1:1000 dilution. 6X is a 1:1,000,000 dilution. While there may be a few molecules of monkshood or red onion in the final dilution, it is all for intents and purposes inert, as these ingredients would not have any medicinal effects.

Zarbee’s

Not all the new cough and cold remedies are completely inert. Pediatrician Zack Zarbock created the honey-based cough syrup Zarbee’s, which is marketed as claiming it “maintains immune function” but actually contains:

Per teaspoon (5mL)

  • Honey 4.15 mL
  • Vitamin C 34 mg
  • Zinc 1.65 mg

Zarbee’s is effectively diluted honey, with a few vitamins added. Zarbee’s claims it is “clinically proven” but there are no trials in Pubmed using the product or its combination of ingredients. There are a few trials that show plain honey may be equivalent or superior to dextromethorphan (which is more than likely ineffective) and may be better than placebo or no treatment. So while it’s possible that pure honey may offer a modest effect on cough, the same can’t be said (with certainty) for Zarbee’s, as there are no studies with this particular product. Moreover, there is no evidence that vitamin C provides any meaningful effects in children with coughs and cold. And while there is some promising but conflicting evidence studying zinc lozenges for colds in adults, its use in children has not been established as effective. And there’s no evidence at all to suggest that zinc supplied as a syrup has any meaningful effects. The bottom line is that Zarbee’s doesn’t offer any demonstrable advantage over pure honey. Zarbee’s also markets a cough syrup for infants (aged 2-12 months) that contains agave nectar instead of honey. There is no published evidence to suggest that agave is effective for the treatment of cough in infants. And Zarbee’s also markets a “mucus relief” version which is honey and ivy (Hedera helix), the evidence for which is summarized below.

Helixia

Helixia is a new (to North America) line of cough and cold remedies that are marketed for children as young as 1-year old (and younger, “with consultation”). The active ingredient is English ivy leaf extract (Hedera helix). Leaves are purported to have expectorant and antispasmodic properties owing to irritation of the gastric mucosa, a mechanism of action which is unproven. The manufacturer claims the product is “clinically proven” but there’s no information on the website to support this claim. An enquiry to the manufacturer (Pendopharm) for evidence resulted in a link to Fazio S et al., “Tolerance, safety and efficacy of Hedera helix extract in inflammatory bronchial diseases under clinical practice conditions: a prospective, open, multicenter postmarketing study in 9657 patients“. The title tells you all you need to know about this study’s quality – it was an open label survey that asked about effectiveness and safety in children with inflammatory lung disease – not colds. When I pressed the manufacturer further, they provided me with the citation “Efficacy and tolerability of ivy-containing cough remedies, a study in children with recurrent obstructive airway disease”. It’s published in a German journal, dated 1996, and doesn’t appear to be in Pubmed or available online. It’s poorly written and missing most of the signs of a quality study. The researchers looks at airway function in children aged 6-15 with obstructive airway disease (not children with the common cold) and reported improvements in pulmonary function – not measures related to colds. Another irrelevant study. A search on my own was more instructive:

Systematic Review of Clinical Trials Assessing the Effectiveness of Ivy Leaf (Hedera helix) for Acute Upper Respiratory Tract Infections” seems to provide the best overview, which is probably why the manufacturer was reluctant to provide it or mention it. Most of the relevant trials were published in Germany which makes reviewing the original trials difficult. Of the ten trials published, the authors noted that only one was considered high quality, and that trial excluded children from the study. The authors did not identify any trials that compared ivy leaf alone (the composition of Helixia Prospan) with placebo, which is the comparison we’re looking for. The authors concluded:

Although all studies report that ivy extracts are effective to reduce symptoms of URTI, there is no convincing evidence due to serious methodological flaws and lack of placebo controls. The combination of ivy and thyme might be more effective but needs confirmation.

That’s the conclusion that other groups have reached. The Natural Medicines Comprehensive Database says there is insufficient evidence to evaluate the effectiveness or safety of ivy. The Natural Standard, another publication, gives it a “C” (unclear or conflicting) rating for childhood asthma and obstructive lung disease, and no rating at all for coughs and colds. The manufacturer claims there are no drug interactions, but there is no evidence this has been systematically studied. In short, Helixa Cough Prospan is a poorly studied herbal remedy with no convincing evidence of effectiveness for the treatment of coughs or colds, in either adults or children.

Conclusion

It’s not possible to keep up with all of the new cough and cold products for children appearing on the market. But it is easy to understand the current state of the evidence, and the current treatment guidelines. There is little convincing evidence that the marketed cough and cold products for children have meaningful effects. Consequently, medicating children is generally unnecessary and sometimes inadvisable. It needs to be emphasized that coughs and colds are self-limiting illnesses – children will recover, with or without treatment. Manufacturers of cough and cold remedies are actively trying to convince consumers otherwise, and they’ve been aided by weak regulatory standards that are permitting products to be sold, often without any convincing evidence that they work. The result is a marketplace that’s  reminiscent of where we were, with ineffective and unnecessary treatments crowding pharmacy shelves.

Posted in: Herbs & Supplements, Science and Medicine

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28 thoughts on “The New Cough and Cold Products for Children: Evidence is Optional and Science is Marketing

  1. windriven says:

    “” in order to consume even a single molecule of the original fermented duck, you would have to swallow a volume of tablets greater that the mass of the entire universe. ”

    Now wait, Scott. I’m in total agreement on the stupidity of homeopathy but I choked on this assertion. What is the molecular formula for fermented duck’s liver? H2C8Q4O6 where Q is the chemical symbol for quack? ;-)

    1. Frederick says:

      fermented duck liver… yeurk. I’m gonna be sick just thinking about it. So basically can can use only one liver to produce trillions of pills. talk about low production cost! :-)

      So to absorb a ll that you need to be a black hole, right?

  2. goodnightirene says:

    I am upset to read previously (Snyder), and now from you, that codeine is ineffective for cough. I’ve always used it in severe cases with myself and the kids. After thinking about it, I realized that I never thought it treated the actual cough (well, actually I DID think it depressed the cough reflex), but rather, puts the sufferer to sleep deeply enough that s(he) quits coughing long enough to get some much needed sleep. Does that fly?

    On the plus side, I’ve never purchased any other cold or flu remedy other than Vapo Rub, which I never thought of as a real treatment, just part of TLC. But, I’m old and the practices of younger parents are radically different. I’d speculate that the difference is intense marketing and working Moms who are desperate to get the kids well enough to go to daycare.

    1. Andrey Pavlov says:

      It is known that opiates do indeed blunt actual pain responses (nociception) as well a some higher order pain perception (a la Melzack). But at least some significant part of their effect basically boils down to making us not care that we are in pain. They also tend to interfere at least somewhat in memory formation so we forget how much pain we actually experienced. So it stands to reason that part of the effect could be that you simply don’t care you are coughing and then afterwards forget how much you coughed.

      As for making you sleep more soundly such that you don’t cough… I honestly don’t know but would speculate not likely. Particularly codeine is a less potent narcotic and you’d have to have a reasonably high dose to really knock you out to that level. But it does make you more drowsy such that you will more easily and quickly fall back to sleep from being woken by coughs and then you forget some of how much you actually woke up and fell asleep again. Combined with perhaps a bit of actual cough suppression in that the trigger to get you to cough is probably at a higher threshold in sleep in general and even a tetch higher with a narcotic on board and that could likely explain the majority if not all of the effect.

      Not to say that such things wouldn’t make a cold more bearable, but it does have risks associated with it which may or may not be justifiable in light knowing that we are not really helping the cough, but just snowing you so you don’t care or remember as much.

    2. mousethatroared says:

      I too am pretty stunned about cough medicine with codeine not working better than placebo. I remember having horrible coughs when I was younger and as an adult that settled right down with that medication….and I have tried other medications, without near the results. Any chance that it works for a particular subgroup? I have asthma…would it help an asthma cough, but not others?

      I don’t know…luckily now I have an inhaler that works, so I don’t typically need other medication for a cough.

      1. Frederick says:

        Don’t forget that Codeine do not work in like 10-15% of people. human can absorb it, so it need a enzyme to transform it in morphine ( or morphine like, my knowledge of biochemistry are rudimentary). it is My case,, 2 years ago i broke my pill and the Doc gave me some emtec 30mg, pop 2 of those, did not feel anything, my wife take one, and she was drugged. So a there probably a lack of efficiency for that too. So i had no pain medicine for that wrist. Nest time i ask directly for morphine. :-)

        1. Frederick says:

          Ah turn out is 6 to 10 % of Caucasian, that’s me.

          http://www.worstpills.org/public/page.cfm?op_id=414

          don’t know the reliability of the source, but it is the best explanation i found :-) ok lot of you already know that, since there is a lot of Doc in here :-) but i like to learn hehe

          1. Sawyer says:

            I’ve tried numerous times to figure out if WorstPills is a reliable source and have never made a decision. I’m curious how others feel about it.

            1. Andrey Pavlov says:

              I’ve never heard of it before and I just perused the site. At first blush it seems quite fine. However, a few things caught my eye and I wanted to investigate further. However, they require a paid subscription to view the content that I could not get around. Things like “Hormone Replacement Therapy: Use at the Lowest Dose for the Shortest Amount of Time” and “Life-Threatening Liver Toxicity Linked to Supplement ” and “Unproven Laxative Widely Used for Childhood Constipation ” seem quite reasonable.

              But then you’ve got “All Sleeping Pills Are Still Risky, But Safer Alternatives Exist ” which could be reasonable, but sounds like it takes a much more negative slant than warranted, though I can’t tell without being to read the actual article. And “Human Papilloma Virus Vaccine: Get the Facts
              (November 2013)
              Read about the benefits and risks of this vaccine for women, as well as the doubts about its usefulness for men.” Which lifts a big eyebrow for me as potentially anti-vax, but once again I can’t tell without reading the article.

              Overall I’d say the site is a little too suss for me, especially since it requires a paid subscription and seems to be run and managed by the same person for the last few decades so some sort of agenda is a little more likely. I can’t say definitely one way or another, and I certainly wouldn’t discount out of hand if someone referenced it to me, but I would definitely read each reference carefully and am a bit skeptical of the site.

              Certainly not as strange as <a href="http://chewthatpill.com/disclaimer/"Chew That Pill which I stumbled across somehow. ;-)

    3. MadisonMD says:

      @MTR:

      Any chance that it works for a particular subgroup?

      Sure there is a chance. But a more parsimonious explanation is the placebo effect. Brilliant SBM acolytes are not exempt.

      1. mousethatroared says:

        MadisonMD – How about not so brilliant acolytes, can I be exempt? ;) Sure it could be placebo response. I’m just confused why other cough medicines would elicit less or no response from me*.

        Thinking about it last night, I would guess that another explaination might be timing. When I get a severe cough after a cold, it usually gets increasing worse, then gets really horrible for 2-3 nights, then gets better (unless the asthma kicks in). It’s possible that I was trying other cough medicines first, as the cough developed, and just visiting the doctor at the peak of my cough severity and mistaking the improvement for drug effectiveness.

        I have to say, I’m not 100% convinced of the lack of effectiveness, but given the potential danger of having codeine products in the home and the strong question of effectiveness, I am onboard with not prescibing it for coughs.

        * I suspect that I fall into the camp that thinks actual symptom relief from placebo is not powerful. That most of the positive placebo results are reporting bias, regression to the mean, etc.

      2. MadisonMD says:

        I’m just confused why other cough medicines would elicit less or no response from me

        I think that timing, as you say, could explain it. The placebo could explain it if your expectations were greater for particular cough medicines.

        Of course, cannot rule out that it works in limited situations. To test if it truly works for you, try the following:
        (a) Purchase colorless cough syrup that you think works.
        (b) Enlist a friend to label 8 opaque bottles A thru H and make a key.
        (c) Friend should randomly select four, and fill with 25 whisky; the others fill with 20 ml whiskey + 5 ml cough syrup. [Could blind another way, but Whisky should mask the flavor]
        (d) Friend labels key and keeps it.
        (e) As you develop cough the next eight times, drink fluid from bottles A-H in order, keep a record of how well each worked for you and whether you think it had medicine.

        I’d have to crunch the #’s but I imagine if you get at least 6 right, then we could conclude it works for you.
        ————
        If it truly does work for you, that would be brilliant… but I can give you that already.

        1. mousethatroared says:

          I like it, makes sense. But the logistics would be challenging – getting the cough syrup with codiene prescribed, keeping all the bottles ready for the amount of time it takes to get eight colds with cough and resisting the temptation to raid the trial bottles when we run out of whiskey.

          Can I continue being slightly uncertain, drink the whiskey for pleasure and use my inhaler for the bad coughs like I have been?

          1. MadisonmD says:

            Yes, your plan is more sensible!

  3. Kov says:

    It’s a known fact that the liquor that results from distilling fermented muscovy duck liver makes an excellent hot toddy, which anyone will tell you is the best treatment for URTI. i.e. drink something soothingly warm and tasty that gets you tipsy.

  4. Kiiri says:

    I remember grape flavored dimetap that my mom used to give us for coughs/colds. It was like candy in a bottle and you didn’t mind taking that when you got sick! My little man (2 y/o) just finished his only real illness of his short life (he’s not in daycare) and that was miserable for all parties concerned. I admit that I felt dismay that there was no cough syrup for toddlers on the shelf at the local drug store, mainly as after two nights in a row of coughing snot boy waking up every hour to hour and half, I was desperate for anything that might help him sleep a few hours straight. I might not have been so desperate if hubby wasn’t also sick and therefore not rotating the night duty as per normal. That being said, I did finally find a honey cough syrup (just honey I read the label thoroughly) so gave him some of that. Before that I was giving him honey off a spoon which he enjoyed at least. I don’t think either actually helped the coughing. The research apparently says we need a better cough syrup for adults and children!

  5. Lizzy says:

    Holy crap I had no idea the Zarbees I bought was homeopathy crap! I got it from the cold/flu aisle because it was on sale. Dang. Sneaky homeopathy

    1. WilliamLawrenceUtridge says:

      More like “shitty pharmacy”.

      1. rhea Luna says:

        True. I am 27 and surrounded with gullible new agey types who buy anything that advertises itself as homeopathic and new aged.
        I know that cough and cold medicine does little but I like Nyquil and cough suppressants for my husband because he at least sleeps. My own body fights off the common cold so quickly it might as well be a minor nuisance. I’ve never had a cold go on for more than 2 days and at the amazement of my anti science junkies who tell me on a regular basis I make poor food choices (which are rich in fruits vegetables and all the shit on the pyramid) they claim because my fruits have some kind of thing in them or are conventionally grown or I eat gluten and occasionally a little Debbie I’ve got to be the sickest person. I am the healthiest among them and have zero allergies, never contracted the flu, and have 3 kids who please their doctors with their protein and iron levels. But these anti sscience anti vaccines gullible types try to ensure me I will have an array of health issues soon enough. Meanwhile my doctor disagrees with their assessment of mine and my children’s health.
        People today are insane and lack critical thinking abilities.
        /endrant

  6. Frederick says:

    I had a cold last month and i had 7 bad night of half sleep because of the coughing, imagine on a poor kid. That’s why those medicine are so popular, you want them to work, and they might a little ( placebo or the little efficiency they have for once work). i always though that they had some efficiency, I used buckley pill for day and nyquil for night. but then i read the article that was post here. and did a little experiement, 2 day with medicine, 2 days without. Of course my personal experience is not in itself a rigorous proof, but i felt not difference, except for the dizziness of nyquil that can at least have the effect of helping you sleep. So i decided to stop those except for tylenol/Motrin ( i mixed them one pill of each, for headache and everything) for when i have headache and muscle pain. Oh yeah one thing that work are extra strong fisherman friend’s lozenges, for sore, Coughing and congestion at least for the time there are in you mouth. and the effect last couple of minute afterwards.

  7. PharmZA says:

    “Oh yeah one thing that work are extra strong fisherman friend’s lozenges”

    This is not a commercial plug for this product, but I have also found that F.Friend’s loz work better than other more expensive options. As an aside, I have read that this product is still manufactured by a family-owned concern and that the matriarch of the family is the second wealthiest female in Britain, after the Queen.

  8. Xplodyncow says:

    Is it possible that products labeled as “homeopathic” are actually not homeopathic? We’re assuming that they don’t have any active ingredients, but what’s to stop a manufacturer from throwing a few random chemicals together and calling the result “homeopathic”? It seems easier/cheaper to mix stuff together than to continually dilute something a specific number of times.

    1. mousethatroared says:

      @Xplodyncow – It’s not only possible, it’s true that not all homeopathic remedies contain zero ingredient. Some are more herbal or chemical remedies than homeopathic. One way you can tell (although not for certain, given the laxity of inspection and regulation) is to look the the dilutions. For instance arnica gel (topical use) contains arnica.

      My Google fu has failed me. I can’t find a good guide to dilutions.

    2. WilliamLawrenceUtridge says:

      Quality control in the manufacture of homeopathic products is actually a pretty big problem. Several factories have been repeatedly inspected and fined for shoddy production lines, including the homeopathic liquid not actual landing in the right places, broken glass in the mix, etc. And since there is no way of verifying if a product is homeopathic or not, contains the right ingredient or not, then you have no way of being able to tell if what you’re getting is the “right” thing. Not that it matters.

      In fact, basically the only way you could tell if a homeopathic product is “real” would be to test it for anything but lactose (what those little pills are made of). If you find anything but milk sugar, then the product should be sent back and the manufacturer fined.

      The idiocy of it all makes my brain hurt.

  9. Vicki says:

    There were cases several years ago of a so-called “homeopathic” remedy that contained enough zinc to damage patients’ senses of smell. Something labeled as “1X” or “2X” could contain a significant amount of the ingredient in question: “1X Substance 500 mg” would mean each dose contained 50 mg of the substance.

    On the other hand, just putting X ml of distilled water into a bottle, or making pure sugar pills, would be cheaper than either diluting as claimed or including actual active ingredients.

    1. Calli Arcale says:

      I seem to recall there was a Russian homeopath who found a great improvement on Hahnemann’s original methods. It worked just as well, but removed a lot of the tedious dilution and succussion steps.

      1. Create your “mother tincture” by diluting your substance in water or alcohol.
      2. Strike the solution.
      3. Dump it down the drain.
      4. Refill with fresh water/alcohol.

      Done! Saves a lot of trouble. Amusing that he still kept the first two steps, though. He did come under criticism from other homeopaths, but one can’t deny that his process was a lot easier. And, as we all know, every bit as good. ;-)

      1. Sarah A says:

        Oh yes, the Korsakovian method – I looked it up once when I was wondering why homeopathic oscillococcinum pills were labeled “200CK.” Apparently its based on the assumption that if you fill a container and then dump it out, about 1% of the original mixture will be left in the vessel. Re-fill the vessel and – viola! – a 1:100 dilution without all that tedious measuring business.

  10. Jo5ef says:

    Here in Australia you can get a natural remedy from the pharmacist “Senegal and ammonia”. I usually get some when I have a cough on the principle that anything that tastes that bad must be good medicine, but I suppose that is as ineffective as everything else. Oh well there’s always hot toddy ie whiskey boiling water lemon and honey, sign me up for the clinical trial!

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