How to treat the flu: a shopping guide

Flu season is upon us, and your local pharmacy may feature special displays with products claiming to cure or treat the flu (which is caused by the influenza virus). The array of products, and the claims featured on their packaging, can be bewildering. Which of them should you buy? Here is a quick guide. (Spoiler: if you want to know what really works, skip to the end.)

This photo from a local RiteAid shows their display of "alternative" treatments. Let's consider a few of them.
Alternative pills that claim to treat the flu. 
1. Across the top we have vitamin C drops, helpfully labelled "Defense" in large letters. You might think these would defend you against the flu virus, but you'd be wrong. Vitamin C has no effect whatsoever on the flu, and it doesn't prevent colds either. People have been taking it for decades, but popularity is no substitute for evidence.

2. The shelves include 11 different formulations of Airborne, with the phrase "helps support your immune system" prominently displayed. Does this product help your immune system fight off the flu? Not even a tiny bit. Airborne is nothing more than an overpriced vitamin supplement (including vitamin C), and it's on the shelf because of clever and misleading marketing. Back in 2008, Airborne settled a $23.3 million lawsuit over false advertising, which was filed because they called their product a "miracle cold buster." After the lawsuit, they simply re-labeled it as an "immune booster," which is vague enough that they've been getting away with this claim ever since. Save your money.
3. Several of the products here, notably Zicam, are basically sugar pills supplemented with zinc. Some time ago, there was preliminary evidence that zinc might reduce the duration of a cold, but there was never any evidence that it could work for the flu. (Aside: colds are caused by completely different viruses.) Once scientists looked at it a little harder, they discovered that zinc doesn't work for colds either, as I explained in a 2012 column. Zicam is marketed as homeopathic, a clever ploy that allows it to escape government regulation. Their marketing constantly dances around what is permitted, usually by claiming it provides "immune support." Sound familiar?
Very expensive sugar pills.
4. On the bottom shelf you might notice Oscillococcinum, a homeopathic remedy that is just a sugar pill. Oscillo's claims to treat anything are almost laughably ridiculous: its "active" ingredient is supposed to be an extract from the heart and liver of a duck, which is then diluted until even that ingredient is no longer present.  As you can see in the close-up picture here, it's not cheap: $31 for 30 pills.
The box also claims that it "reduces duration and severity of flu symptoms," a completely false claim. The FDA has issued warning letters about this before, pointing out that "These products have not been approved or otherwise authorized by FDA for use in the diagnosis, mitigation, prevention, treatment (including treatment of symptoms), or cure of the H1N1 Flu Virus." Apparently the manufacturers of Oscillo (and the numerous places that sell it) are just ignoring the FDA.

These are just the "alternative" treatments. Most pharmacies have an even larger selection of flu treatments with real medicine in them. Here's a photo from the same RiteAid, right next to the alt-med selections.  
Medicines that try to treat the flu.
The selection here includes pills and liquids in many shapes and sizes, and all of them have active ingredients that do indeed have some effects. But they don't actually treat the flu itself: instead, they treat some of the symptoms, such as pain and congestion. None of them work very well, although those that contain ibuprofen or acetaminophen do help reduce pain.

So what does work? The latest medical science offers only two options:
1. Vaccination. Get your flu shot! The flu vaccine isn't perfect, and it varies in efficacy from year to year, but it usually provides some protection. In the best years it can reduce your chance of getting the flu by 75% or more. It's far better to avoid getting the flu in the first place.

2. Oseltamavir (Tamiflu), available only by prescription, is the only anti-viral medication that has been shown to have some effectiveness against the flu. It's not great, but it can reduce the severity of symptoms and maybe shorten the duration of the illness by about 1 day. You have to see a doctor to get it, which means taking your (sick) child or self to a doctor's office and exposing other people to the flu. 

The bottom line: none of the treatments that you can buy without a prescription will cure the flu. The "alternative" treatments are completely useless, and the real medicines might help a little bit with symptom control. 

Your best choice, by far, is the flu vaccine. Unfortunately, the internet is filled with misinformation such as claims that the vaccine doesn't work, or that it can give you the flu, or (worst of all) the utterly discredited notion that preservatives in the vaccine cause autism. Some of the anti-vaccine nonsense has even been promoted by presidential candidates, namely Donald Trump, Ben Carson, and Jill Stein. By spreading these false stories, Trump and Stein are doing real harm to the public health.

Flu advice from a future doctor.
Finally, I want to give props to RiteAid for trying to get people vaccinated. In front of the same store at which I took these pictures were two large signs saying "Get your flu shot today." Inside the store, they had a special table with science-based information about the flu vaccine, which featured artwork from local children (one of them shown here) encouraging other kids to get vaccinated. Well done.

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