Journal publisher retracted a study claiming poison oak could cure itching. Well done.

None of these plants will cure itching. 

Today I want to tell a positive story, where a science journal did the right thing.

I’ve written a lot over the years about bad science. A particular gripe of mine is when bogus scientific results, sometimes fraudulent, sometimes just sloppy, manage to sneak into the peer-reviewed scientific literature. This happens all too often, especially as the number of papers published each year has grown. These bad papers are then used by fraudsters and charlatans (and sometimes by innocent people who just don’t have the expertise to understand) to “prove” an unscientific claim.

Fortunately, a growing number of journals–the better ones, in general–are showing more concern than in the past, and taking actions (sometimes) to retract papers, even over the objections of the authors.

Before I get to the good news, a reminder about the most notorious scientific paper in recent memory: Andrew Wakefield’s fraudulent study in The Lancet, published in 1998, which claimed to find a link between vaccines and autism. The Lancet, to its everlasting shame, failed to retract the article until 2010, despite an avalanche of evidence that began appearing in 2002. Ten of the original 13 authors even published their own “Retraction of an Interpretation” in 2004, but The Lancet still refused to retract unless all the authors agreed. Wakefield, who was already leading the anti-vaccine movement and is now adored by anti-vaxxers, refused.

That article has probably contributed indirectly to the deaths of thousands of people from vaccine-preventable infectious diseases. And given what we knew about it by 2002, The Lancet had no excuse for delaying retraction until 12 years after publication.

But I digress. Today I want to highlight an article whose retraction I called for a few years ago, one that the journal, Scientific Reports (published by Nature Publishing Group) did indeed retract, about 9 months later.

The paper I called out was a study that claimed that an extract of poison oak can be used to treat pain. If that sounds kind of ridiculous, that’s because it is. The actual paper sounded very science-y, as I pointed out in my original column. It was titled “Ultra-diluted Toxicodendron pubescens attenuates pro-inflammatory cytokines and ROS-mediated neuropathic pain in rats.”

Toxicodendron pubescens, in case you’re wondering, is poison oak. It’s not a tree and it has nothing to do with oaks–it’s a cousin of poison ivy, and both plants contain oils that can cause extreme itching and painful rashes on contact.

How on earth could poison oak be used to treat pain? Well, it can’t. The paper was actually about a homeopathic treatment. One of the core tenets of homeopathy is that “like cures like,” as long as you dilute it sufficiently. So the poison oak paper started with the premise that since poison oak causes pain and itching, you can also use it, after you dilute it, to treat pain and itching!

Homeopathy, as I’ve written before, is a highly implausible and easily disprovable set of beliefs about medicine. I use the word “belief” intentionally here, because homeopathy really has no claim to be a type of medicine, or even a hypothesis. It’s just a 200-year-old collection of beliefs that turned out, long ago, to be wrong.

If this sounds absurd, well, selling these products is a highly profitable business. For example, check out Boericke & Tafel’s Oral Ivy Liquid ($15 for a 1-ounce bottle on Amazon.com), a homeopathic product that is made from poison ivy, poison oak, and poison sumac. It claims to be “for the prevention and temporary relief of contact dermatitis associated with poison ivy, poison oak or poison sumac.” What’s in it? Poison oak, at very low levels. (Actually this product isn’t really diluted to homeopathic levels: the packaging says it contains 0.02g of poison oak in each drop. So it might actually cause an allergic reaction–I’d stay far away from this stuff.)

Back to the study: in the paper, the authors diluted a preparation of poison oak down to levels as low as 10-30, a common practice in homeopathy. The problem is, at that level of dilution, not even a single molecule of the original substance would remain. There’s simply no possibility that such a dilution could have any therapeutic benefit, but somehow they found an effect. Hmm.

A number of scientists wrote to the journal complaining that this result was extremely implausible, and that the experiments didn’t support the conclusions. To their credit, the journal editors took the complaints seriously and investigated. The retraction notice (read it here) pointed out another major problem as well: some of the figures were duplicates! Each figure is supposed to represent a different experiment, so duplication is a big problem, added to the fundamental implausibility of the study.

As is often the case when fraud is detected, the authors did not agree with the retraction.

When I wrote my column complaining about this study, I said the “the right thing to do would be to retract this paper, because its results are simply not valid. We'll see if that happens.” Well, about 9 months later, that’s exactly what happened.

A few years ago, I was in direct contact with the Editors-in-Chief at both Scientific Reports and PLoS ONE (about different papers than the one I’m discussing above), and they expressed genuine concern about fraudulent research, as well as a determination to do better at rooting it out. When journals do the right thing, we should applaud them. So here’s to Scientific Reports, who got it right this time.

Russian homeopathy, hiding in plain sight

It turns out that Russia has its very own brand of bogus medicine:"release-active drugs," or RADs. Dozens of scientific articles have been published claiming that these substances can be used to treat or cure a remarkably broad range of illnesses, including:

"... influenza, hemorrhagic fever, meningococcal meningitis, herpes, HIV, diabetes, erectile dysfunction, sleep disorders, obesity, chronic inflammatory joint diseases, attention deficit hyperactivity disorder, ..., alcoholism, allergies, and many other health problems." 

If this sounds too good to be true, that's because it is.

Thanks to a new report published in the journal BMJ Evidence-Based Medicine (provocatively titled "Drug discovery today: no molecules required") we now know that RADs aren't drugs at all, because they don't actually contain anything. As the new study reveals,

"The problem [with RADs] is that typical dilutions of the active ingredient are so high (from 1:10²⁴ to 1:10¹⁹⁹¹) that no molecules of the initial antibodies should be present in the ‘drug’ itself."

In other words, RADs are simply homeopathy by another name. As I've written many times before, homeopathy is one of the most patently absurd forms of pseudoscience, and although it's been debunked countless times, it remains popular due in part to commercial interests that profit handsomely from selling ineffective but expensive sugar pills.

RADs are produced by a single Russian company, with the odd name "OOO NPF Materia Medica Holding." The papers promoting the benefits of RADs are authored by a variety of Russian authors, but they are nearly all co-authored by or associated with one person, Oleg Epstein, who is also the company's founder.

Epstein and his Russian compatriots have been very clever about disguising the fact that their "release-active drugs" aren't drugs at all. Their papers are full of scientific jargon, which has no doubt helped them get their work past reviewers who (as every scientist who has published papers knows) can sometimes be a bit lazy.

They've also taken advantage of–one might say abused–the U.S. clinical trials system, ClinicalTrials.gov, by registering 22 studies of RADs there, such as this one.

The authors of the BMJ report (Alexander Panchin, Nikita Khromov-Borisov, and Evgenia Dueva, all Russian, though Dueva is based in Canada) are unsparingly blunt in revealing how Epstein has manipulated the scientific system in Russia to gain approval (and lucrative sales) of his so-called drugs. For example, Epstein has published 90 papers on RADs in a single journal, including 48 in a special issue that he edited himself.

Panchin and colleagues also took a closer look at 6 papers about RADs that were published in English-language journals, all co-authored by Epstein. They report that

"the articles contained misleading descriptions of active substance concentrations, severe flaws in study design and methodology, as well as concealed conflict of interests.... the authors did not mention that MMH manufactures and sells RADs and holds the corresponding patents. Epstein was not mentioned as the founder and CEO of MMH."

They contacted all of these journals, and only one journal, PLoS ONE, went so far as to retract the bogus science on RADs. Kudos to PLoS ONE for doing so. The other journals, some of them published by reputable scientific publishers including Elsevier, Wiley, and Springer, either didn't respond or refused to take action.

Fortunately for consumers, RADs haven't yet spread into U.S. and European markets, although their manufacturers are trying. In a recent letter published in a the Journal of Medical Virology, Epstein and his co-authors write that

"Currently we are in the process of approving evaluation requirements for our products, taking into account their peculiarities and allowing their potential authorization in the USA and Europe."

Buyer beware. The Russian quacks are coming.

A dubious homeopathy study made its way into a scientific journal. Will it be retracted?

Homeopaths did it again–they snuck a dubious study into a respectable journal. Well, sort of. Let's quickly look at the study, and then look at the journal that published it.

The paper has a very science-y sounding title, which likely helped it sneak under the radar: "Ultra-diluted Toxicodendron pubescens attenuates pro-inflammatory cytokines and ROS-mediated neuropathic pain in rats." It seems they were studying pain in rats, but what else is hiding inside this title?

The first warning here is the phrase "ultra-diluted." In the world of homeopathy, substances are diluted until there is literally nothing left, not a single molecule. Some of the dilutions in this paper were indeed extremely dilute, down to 10^-30, which means that they were just water. So they can't possibly have any therapeutic effect, at least no more effect than plain water.

You might also be wondering what Toxicodendron pubescens is. That's poison oak! Here's what homeopaths claim about poison oak: that if you dilute it down sufficiently, it reduces itching and pain. This is one of the basic principals of homeopathy, that "like cures like"–that if you want to treat a symptom, using a substance that causes the same symptom, only dilute it way down. Feeling itchy? Rub some poison oak on that! I'm not kidding–here's a link to a product you can buy that really makes this claim.

Of course this is utter nonsense, as I and many others have written before. Homeopathy doesn't work for anything at all, as a massive Australian study concluded back in 2015.

Now let's look at where this dubious study appeared: in a journal called Scientific Reports. Scientific Reports is a mega-journal that publishes 25,000 papers per year, making it the largest journal in the world. What's also interesting is that it is published by the Nature publishing group, which also publishes the highly prestigious journal Nature and many other related, high-quality journals. (Full disclosure: I've published many papers in those journals.) PLoS ONE was the first mega-journal, and it was so successful (i.e., it made so much money for its publishers) that Nature decided to imitate it. They've managed to steal a lot of the "customers" from PLoS ONE because the Nature brand is, apparently, more appealing to many authors.

It's tempting to argue that everything in Scientific Reports is just low-quality stuff, so one more bad paper doesn't mean anything. But it's not so simple. Scientific Reports is trying to be a decent journal, one that has a very high acceptance rate (59%, according to their website) but that nonetheless publishes only valid science. Last year I was involved in a kerfuffle with them over a plagiarized paper, and after lots of pressure, we did get them to retract the paper. It wasn't easy, but the Editor in Chief corresponded with me at the time, and he really does seem to be trying to enforce some decent standards.

When you publish 25,000 papers a year, though, some garbage is going to slip through. To their credit, Scientific Reports has now issued a note of concern on this homeopathy paper, as reported by the alert team at Retraction Watch. Here's the note in its entirety:

"Editors’ Note: Readers are alerted that the conclusions of this paper are subject to criticisms that are being considered by the editors. Appropriate editorial action will be taken once this matter is resolved."

The right thing to do would be to retract this paper, because its results are simply not valid. We'll see if that happens.

Meanwhile, when reading the paper, I noticed that no less than eight of its references are to a journal called Homeopathy, published by Elsevier, one of the biggest and most profitable academic publishers in the world. Unlike Scientific Reports, Homeopathy is not even trying to publish valid science; its entire existence is premised on a nonsensical set of beliefs.

The good folks over at Retraction Watch wrote about this journal two years ago, in an article called "Does a journal of homeopathy belong in science?" Spoiler alert: it doesn't. As Ivan Oransky and Adam Marcus wrote then:

"the issue is that science publishers, even legitimate global corporations like Elsevier, will accept something patently unscientific if it might make them money."

So while Nature does deserve criticism for letting bad science slip into its mega-journal, Elsevier has a lot more explaining to do. At least Nature is trying.

Sniffle. It's allergy season again. Do those shots work?

Ah, spring is in the air. The flowers are blooming and the trees are bursting into leaf.

For many of us, this time of year means one thing: allergies. The price of going outside for any length of time is sneezing and itchy eyes that last for many hours, even after we return indoors. Rather than going out and enjoying the warm air and colorful vegetation, we close the doors and windows and stock up on antihistamines and eye drops. Studies show that 20–40% of people in the U.S. have allergies.

Your local pharmacy has shelf after shelf of allergy treatments, ranging from mildly effective (Zyrtec and its equivalents) to laughably ineffective (anything homeopathic). But even the best pills have side effects, and they only serve to suppress the symptoms. As one study put it:

"Patients struggle to alleviate their misery, frequently self-adjusting their treatment regimen of over-the-counter and prescription medications because of lack of efficacy, deterioration of efficacy, lack of 24-hour relief, and bothersome side effects."

Isn't there a way to tell your body to just stop it already? After all, pollen is not a pathogen. Our misery is caused by our own immune system's over-reaction: it ramps up in response to the foreign particles (pollen) in our eyes and airways and creates a histamine reaction, which is simply not necessary.

None of the over-the-counter pills prevent this reaction, but they can dampen it–hence the term "antihistamine." However, what if there were a way to tell your body to simply chill out and ignore the pollen?

Well, maybe. You can get allergy shots. This is a surprisingly simple procedure: your doctor takes a small, diluted amount of the allergen (pollen, cat dander, etc.) and injects it into your arm. Over the course of many months, your doctor will very gradually increase the amount being injected. You have to go for the shots every week, and continue them for several years.

The question is, do they work? The answer is a qualified yes.

NIH and the Agency for Healthcare Research and Quality (AHRQ) have put together a long explainer of the evidence for and against allergy shots, which you can find at PubMed Health. The NIH study looked at 74 clinical studies of allergy shots. To save you some time, I'll cut to the chase: the evidence is quite good that shots work. Or, as the AHRQ study put it,

"we found high grade evidence that subcutaneous immunotherapy reduces rhinitis/rhinoconjunctivitis symptoms."

This might seem like pseudoscience, but it's not: what's happening is that your immune system is being de-sensitized to the allergen. It doesn't work for everyone, but in many people, this gradual de-sensitization trains their immune system not to react so badly. It's not necessarily permanent, either: after stopping the shots, allergies might re-appear after a few years.

So if you're looking out your window at the beautiful spring weather with a box of tissues by your side, maybe you have a way out. Talk to your doctor or visit the AAAAI site to find an allergy specialist. Don't expect miracles or a quick fix, but allergy shots are the best we've got, for now.

Here's $142M we'll be wasting on pseudoscience in the new US Budget

After much unnecessary drama and 6 months late, Congress finally passed a budget last week funding the government for the fiscal year that started in October 2017. While much of the news is good, or at least not too bad, the 2,232 page budget contains lots of goodies for special interests.

I downloaded the whole thing so you don't have to.

One of the worst pieces of wasteful spending is tucked away on page 934: $142,184,000 for the National Center for Complementary and Integrative Health. Incredibly, this is a 9% increase over the NCCIH's 2017 budget of $130.5 million. Is this because they've discovered new and effective treatments? Alas, no.

NIH has been spending money on so-called alternative medicine since 1992. Over the years, the budget has increased from just $2 million to the very hefty $142 million this year. NIH has now spent a total of $2.366 billion dollars on its alternative medicine center.

The NCCIH started as an "office," funded by a $2 million earmark by former Senator Tom Harkin, who later elevated it to a National Center called NCCAM. On Harkin's retirement in 2015, his buddies renamed it as NCCIH, adopting the buzzword "integrative" as a jazzier word than "alternative." It's a classic (and sad) example of how once something gets started by Congress, it grows relentlessly, creating its own constituency of people and industries who consume the funding and clamor incessantly for more.

What have we learned for our $2.4 billion? Have new cures been developed, new medicines been discovered? Has NIH provided good scientific evidence that any of the "alternative" methods–which include acupuncture, homeopathy, naturopathy, Ayurveda, therapeutic touch, reiki, aromatherapy, and others–actually work? The answer to all these questions is no.

On the other hand, the real work of biomedical research, funded by the rest of NIH, has yielded tremendous progress on a wide range of diseases. These include cures that we could only have dreamed about 10 or 20 years ago, such as this amazing stem cell cure of a 7-year-old boy with a devastating skin disorder, or this leukemia treatment reported in 2013.

After 26 years and $2.3 billion spent trying–and failing–to prove that alternative medicine works, it's long past time to end this nonsense and shut down NCCIH, as I and many other scientists have been saying for years. That $142 million could be used far more effectively studying real treatments for real diseases, rather than imaginary treatments that have failed, time and again, to prove their merits.

$142 million. To those who argue that it's only a small percentage of the NIH budget, I would point out that a typical NIH research grant is under $500K. This means we could fund at least 300 additional biomedical research projects every year if we got rid of this giant special-interest earmark that has utterly failed to produce anything useful.

Instead, someone in Congress managed to sneak in the largest budget increase that NCCIH has seen in 15 years. What a waste.

FTC steps in where FDA fears to tread - on homeopathy

Here's a label that the FDA should require.

The federal government is probably wincing right now from the after-effects of the election, but one agency deserves a robust round of applause: the Federal Trade Commission. This week, the FTC announced, in a strongly-worded report on homeopathic advertising, that homeopathic drugs should "be held to the same truth-in-advertising standards as other products claiming health benefits."

The FTC can't prevent homeopathic marketers from selling their products; only the FDA could do that. But starting very soon, they will require that homeopathic products include statements that:

• There is no scientific evidence backing homeopathic health claims
• Homeopathic claims are based only on theories from the 1700s that are not accepted by modern medical experts.

Admittedly, this might not effect sales very much. Over at Slate, Alan Levinovitz argues that these claims might even backfire, because some users of homeopathic drugs don't trust modern medicine, or because they might belief that hey, if it's been around that long, it must work. But old medicine is not good medicine. (And in the FTC's defense, they also recommended that the FDA "subject homeopathic drugs to the same regulatory requirements as other drug products," but they can't force the FDA to act.)

But wait: does this mean homeopathic drug makers didn't have to be truthful in the past? Well, yes. As the FTC report explains, in 1988 the FDA–the agency in charge of regulating drugs in the U.S–basically struck a deal where they agreed that homeopaths could be self-regulating, as long as they included a disclaimer that their claims haven't been evaluated by the FDA. To put this more bluntly: the FDA's agreement with homeopaths (you can read it here) is basically a license to lie.*

For example, the widely-sold homeopathic product Oscillococcinum, which is nothing more than a sugar pill, says on its packaging that it "Temporarily relieves flu-like symptoms such as body aches, headache, fever, chills and fatigue."

Helpful hint to potential victims customers: Oscilloco doesn't do anything of the sort. Oscilloco escapes having to prove their claims by a tiny asterisk, which (after much digging through the website) is attached to a disclaimer that '*these “Uses” have not been evaluated by the Food and Drug Administration.' Interesting how they place the word "uses" in quotation marks.

Homeopathy is the most obviously fake alternative medicine you're likely to see in your local pharmacy. This may seem like a pretty strong statement, but look at what homeopathy claims:

• That infinite dilutions of a substance, to the point where not a single molecule remains, have a medical benefit
• That water "remembers" the substances that were in it in the past
• That a substance that causes a symptom will, when diluted, cure that same symptom. Thus (for example) poison ivy can cure itching.

These claims violate basic principles of physics, chemistry, and biology. The idea that water remembers what was in it is so confused that it's not even wrong–and it also implies that every sip of water you take "remembers" virtually every substance on the planet, although homeopaths appear not to recognize this. Yet homeopathic "drugs" are a multi-billion dollar business today; the FDA estimated that consumers spent $2.9 billion on homeopathic remedies in 2007, the last year for which they reported numbers.

The FDA held a public hearing last March, and the FTC held their public workshop in September. They solicited and received over 500 comments, both pro and con. Most of the pro-homeopathy comments boil down to "it worked for me" or "people have been using this stuff for years"; in other words, anecdotes and testimonials. The con-homeopathy comments described scientific studies showing that homeopathy simply doesn't work. These include a thorough review conducted by the Australian government last year, which concluded:

"There are no health conditions for which there is reliable evidence that homeopathy is effective."

Despite Alan Levinovitz's concerns that warning labels won't help, I'm with the FTC here. If the FDA won't (or can't) stop homeopaths from selling their modern snake oil, at least we can slap labels on them saying they don't work. If consumers want to buy a product that the government says doesn't work, well, it's their money.

*Well, they're not really lying if they include a disclaimer, are they? So I'm not really calling them liars.

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.

Allergy sufferers beware! These eyedrops are a scam.

Spring allergy season is upon us, and plants are bursting into leaf and bloom, spreading pollen everywhere. For some of us, this otherwise beautiful season is a time to stock up on antihistamines and tissues, and we try our best to stay indoors.

When pollen causes red, itchy eyes, we look for eyedrops to provide some relief. The American Academy of Allergy, Asthma, and Immunology and has a list of eyedrops here that includes products such as Zaditor®, Alaway®, and others. These eyedrops contain real medicine that can soothe itchy eyes and reduce your allergy symptoms.

So I was in the pharmacy section of my local grocery store, Giant, looking for eye relief, but they were sold out of Zaditor. Right next to the empty slot, though, I saw a row of other eyedrops from a company called Similisan®, and I took the picture shown here.

Homeopathic eye drops at Giant Foods in Baltimore.

Looks legitimate, right? Each box has a cross on it (apparently intended to resemble the logo of the Red Cross), and they are in the pharmacy section. I picked up the box labeled "Allergy Eye Relief" to take a closer look, though, and saw the word "homeopathic" near the bottom of the box.

Uh oh. It turns out that these products are little more than very, very expensive bottles of sterile water. For $9.99 you get 10 ml of water that contains several extracts–in vanishingly small amounts–for which there is no evidence whatsoever that they have any effect on allergies. Similisan's allergy relief bottle contains:

• Honeybee
• Eyebright (a plant)
• Sabadilla lily (another plant)

Yes, that's right: they grind up honeybees and put them in the eyedrops. The (wacky) idea is that because bee stings cause allergic reactions, a tiny bit of ground-up bee in solution will prevent those reactions. This flawed principle is the basis for all of homeopathy, which has stuck around for 200 years despite the complete absence of evidence that it works.

As I've written before, homeopathic drugs get a free pass on regulation, thanks to Congress. Homeopaths will tell you that their drugs are regulated by the FDA (they often make this claim in the comments on my articles - just watch), but they're not. All the FDA can do is check to see if the products contain the ingredients listed on the label. Unlike real drugs, though, the FDA does not and cannot require that these "drugs" have any effect whatsoever.

I don't think I need to say more about ground-up bees, but what about those other two ingredients? Eyebright is a plant that has "little or no evidence of efficacy" for eye infections. Its use dates back to the ancient Greeks, and has an interesting history:

"Eyebright was used as early as Theophrastus and Dioscorides, who prescribed infusions for topical application in the treatment of eye infections. This in large part was due to the similarity of the “bloodshot” petals to irritated eyes."

That's right: the flower petals look like irritated eyes, and this was enough to get the early Greeks to try them out as a treatment. Needless to say, the physical appearance of a plant has nothing to do with its efficacy as a medicine. (But try telling that to a homeopath.)

Sabadilla, the third ingredient, is a plant extract used as an insecticide, with an active ingredient called veratrine. As Laura Pottorff from Colorado State University explains, "its dust can be highly irritating to the eyes." Therein lies the homeopath's motivation for using sabadilla in eyedrops: homeopaths believe that a substance that irritates the eyes will somehow soothe the eyes if it is sufficiently diluted.

Similisan claims that their 3 homeopathic eyedrops will relieve itching, burning, watering, and redness in your eyes. The box just says it's "manufactured according to homeopathic principles," but doesn't explain that it hasn't been shown to be effective. You have to go to their website to discover that

"The uses of our products are in compliance with official Homeopathic Compendia. They were not the subject of approved applications reviewed by the Food and Drug Administration prior to marketing." 

In other words, they've never presented any evidence that these things actually work.

One can only hope that the sabadilla in Similisan's eye drops is sufficiently diluted; if not, you're putting insecticide in your eyes. The package says that all three ingredients are at 6X dilution, which in homeopathic jargon means 1 part in 1 million. The problem is that homeopathic substances have no real standards, so we don't know how much of the active ingredients were in the original mixture before dilution.

I was curious to see if Whole Foods Market sold the same stuff, and not surprisingly they do, in their special section devoted to homeopathy. (I've written about WFM and their love affair with homeopathy before.) The only difference is that Similisan costs more at Whole Foods, $11.99 to $14.99 depending on which flavor you buy (check out the photo below).

Homeopathic eye drops at Whole Foods Market. How much

money do you want to waste on a tiny water bottle?

Homeopathic eye drops are nothing more than really, really expensive water. At $10 for 10 ml, that works out to $1000 per liter. Similisan proudly states that it's sold at a wide variety of U.S. retailers and pharmacies, including CVS, Kroger, Publix, RiteAid, Safeway, Target, Walgreens, Walmart, and Wegmans. Seems like they're doing quite a good business selling their $1000/liter water.

Consumers beware: the eyedrops you're looking at, even in the Pharmacy section of the store, might be expensive, ineffective make-believe medicine. Make sure to read the package closely; the fake medicine is sometimes right next to the real stuff, and the packaging is designed to fool you.

Get your wolfsbane here! Cures headaches, only $16 a bottle

Homeopathic drugs contain some pretty strange ingredients. These drugs (or perhaps I should call them potions) come in ordinary-looking packages, apparently designed to look just like real medicine, but they are not. Inside the bottles are concoctions of a wide variety of plant extracts and other substances, almost none of them effective for what’s written on the package.

This week I was browing the headache remedies at CVS, and I encountered a treatment I hadn’t seen before: Nova Headache Complex. It’s an expensive homeopathic remedy, advertised at $16.29 for a 50-ml bottle.

Because homeopaths and their treaments are unregulated, Nova can sell this stuff without having to prove that it has any effect at all on headaches. We can thank Congress for that: ever since 1938, when a homeopathic member of Congress passed the first law protecting them, homeopathic manufacturers have been allowed to forgo any testing to show that their products are safe and effective. And who decides what is homeopathic? The homeopaths themselves.

So: what does Nova’s Headache Complex contain? According to the package, it contains Aconitum Napellus 12X, Bryonia 12X, Cactus Grandiflorus 4X, Chelidonium Majus 6X, Cimicifuga Racemosa 6X, Sanguinaria Canadensis 6X, Spigelis Anthelmia 6X, Thuja Occidentalis 6X. Let's look at just the first of these.

Wolfsbane flowers

Aconitum napellus is a lovely flowering plant, commonly known as monk’s hood or wolfsbane. If that sounds ominous, it should: wolfsbane contains several highly poisonous compounds. It's listed at #3 in the top 10 deadliest plants at Zitbits, which explains:

"When ingested, an intense burning feeling in the limbs and abdomen is immediately felt. In large doses, death can occur in as little as 2-6 hours. Only 20ml of pseudaconitine is needed to kill an adult human. Its name comes the mythology that it was thought to keep away werewolves, hence ‘wolfsbane’."

Wolfsbane has been used as a poison for thousands of years, going back to Roman times. Many young readers will remember it as the main ingredient in a deadly potion in the Harry Potter books. Coincidentally, exactly one year ago, a gardener in England died after accidentally brushing against some wolfsbane flowers.

Yikes! How can they sell this stuff? Well, luckily for consumers, the 12X refers to an extreme dilution, in this instance equal to 10 raised to the 12th power, or 1 part in 1 trillion. The only reason people don’t die when they take Nova's Headache Complex is that there’s essentially no wolfsbane in it.

Fortunately, most homeopathic “drugs” don’t contain any measurable amount of their active ingredients. That’s because homeopaths think that the more you dilute a substance–even to the point where not a single molecule remains–the more potent it is. This laughably foolish notion flies in the face of modern chemistry, biology, and physics, but homeopaths believe it anyway.

What about the other ingredients? All of them are plant extracts, several of them also poisonous (including black cohosh and bloodroot). To avoid extending this discussion for many more pages, suffice it to say that none of these plants have been shown scientifically to cure headaches.

Nova Headache Complex does contain one real ingredient: 20% alcohol. That’s quite a lot, much stronger than beer or wine. Slate.com's Yvette d'Entremont demonstrated on YouTube how one can easily get drunk from a few bottles of these homeopathic products. (She used CVS's homeopathic constipation cure, which fortunately has no effect at all on constipation.) This revelation prompted NBC4 in Los Angeles to investigate why CVS was selling alcohol to minors.

Back to our headache "cure": fortunately, over-the-counter medicines such as ibuprofen, aspirin, and acetaminophen work very well for most people. If none of these work for you, drinking an alcohol solution laced with wolfsbane (or, to be more accurate, laced with nothing) won’t help either.

The FDA is currently considering whether or not to modernize its regulation of homeopathic remedies. They’ve held a hearing and solicited public comments. Interesting, the Federal Trade Commission weighed in, arguing that the FDA's current lax rules “may harm consumers and create confusion for advertisers.” I’m skeptical that the FDA will step in any time soon, but one can always hope.

Meanwhile, CVS will sell you wolfsbane for headache pain, but I hope that none of the bottles contain the deadly poisons listed on the label. If nothing else, at least you get a shot of overpriced alcohol.

The top five cold remedies that do not work

A cure for the cold, from ThadGuy.com

One of my daughters caught a cold last week, and now she's given it to me. We’re giving ourselves the best treatment known to science: rest. But to judge from the products offered at our pharmacies, you’d think there were dozens of options to treat a cold. In local pharmacies and in the medicines aisle at my local grocery store, I’ve found row after row of colorful packages, claiming to relieve cold symptoms, shorten the duration of the common cold,” and more. 

Some of these medications actually do treat symptoms, but none of them cure a cold. But mixed among them—sometimes side-by-side with real medicines—I found several products that don’t work at all. 

How can a drug manufacturer get away with this? Simple: the products that don’t work are either supplements or homeopathic products. The manufacturers of both these types of “medicines” have successfully lobbied Congress to pass laws that exempt them from FDA regulation. Supposedly they aren’t allowed to make direct claims to cure or treat disease, but unless you read the wording on their packages very carefully, you’d never notice. (Note to older adults: bring your reading glasses to the pharmacy section!) 

Most important for consumers: if a treatment says it’s homeopathic, then its ingredients do not have to be shown effective. “Homeopathic” simply means that the ingredients are listed on the Homeopathic Pharmacopoeia, a list maintained by homeopaths themselves. And if it contains supplements or vitamins, they too are exempted from regulation by the FDA, under a law known as DSHEA. 

So next time you go searching for something to take for your cold, or for your child’s cold, here are the top 5 cold remedies you should not buy:

1. Zicam is a zinc-based remedy. Zinc is tricky, because there is some evidence to suggest that taking zinc right at the onset of a cold might shorten its duration a little bit, from 7 days to 6. But as Dr. Terence Davidson from UC San Diego explained, if you look at the more rigorous studies, the effect vanishes. Zinc turns out to have some worrisome side effects, too. Zicam's nasal spray and gel versions were linked to a serious loss of the sense of smell (anosmia), which led the FDA to issue a warning letter in 2009. Zicam responded by withdrawing the product for a time, but their website now says “A clinical link between the Zicam® products and anosmia was not established.“ Strictly speaking, this is correct, but there have been published reports suggesting a link, such as this one from 2009.*

Zicam’s website makes the misleading claim that “All of our Zicam® products are regulated by the FDA.” This is a common ploy of homeopathic drugmakers, claiming the FDA regulates them because the FDA could step in (as they've already done with Zicam) if consumers are being harmed. Unlike real drugs, though, Zicam has not been evaluated by the FDA for effectiveness or safety.

2. Airborne. You can find this in the cold remedy section many pharmacies (I did), but Airborne doesn’t cure anything. It’s a cleverly marketed vitamin supplement with no scientific support for any health benefits. How do they get away with it? Actually, Airborne paid $23 million back in 2008 to settle a class-action lawsuit over its advertising. They had been calling Airborne a “miracle cold buster.” According to the Center for Science in the Public Interest’s David Schardt, 

“Airborne is basically an overpriced, run-of-the-mill vitamin pill that’s been cleverly, but deceptively, marketed.”

After the lawsuit, Airborne modified their packaging, which now claims only that it “helps support your immune system.” This is one of those vague claims that supplement makers love, because it doesn't really mean anything. Airborne's products also now include a disclaimer that

 “These products are not intended to diagnose, treat, cure, or prevent any disease.”  

So what the heck are they doing in the “cold medicines” section of the store?

3. Coldcalm is a homeopathic preparation sold by Boiron, one of the world’s largest manufacturers of homeopathic remedies (including Oscillococcinum, an almost laughably ineffective flu remedy). It claims on the package to relieve cold symptoms. What’s in it? A dog’s breakfast of homeopathic ingredients, including belladonna, about which NIH says, 

“Belladonna is UNSAFE when taken by mouth. It contains chemicals that can be toxic.” 

Another ingredient is pulsatilla, which “is highly toxic, and produces cardiogenic toxins and oxytoxins which slow the heart in humans.” Neither belladonna nor pulsatilla relieves cold symptoms.

Being homeopathic, these ingredients are highly dilute, but I think I’ll pass on Coldcalm.

4. Umcka. Umcka is another homeopathic preparation that claims to “shorten the duration of common cold” and “reduce severity of cold symptoms.” Sounds pretty good—if only it were true. Umcka’s active ingredient is a plant extract called pelargonium sidoides, an African geranium. Interestingly, there have been a few experiments on this extract, some of which showed a small positive effect. However, a review of these studies reported that their quality was “very low," that all of them were conducted by Umcka itself, and that all of them were conducted in the same region of Russia. And remember: homeopathic preparations are so dilute that they contain little, and sometimes none, of the active ingredient.

5. Antibiotics. Okay, these are real medicine, and you can’t buy them over the counter at your pharmacy. But Americans take them in huge quantities to treat the common cold. The problem is, antibiotics don’t work for colds.

When my daughter told her friends she had a cold, they wanted to know why she didn’t go to the doctor. Of course, doctors can’t do anything about a cold, and going to a doctor’s office just puts other patients at risk. My daughter knows this. But her friends were astonished to hear that we never take her to the doctor for a cold. It turns out that most of them had been to doctors many times for colds, often coming away with a prescription for antibiotics. 

Antibiotics treat bacterial infections, not viruses. Taking antibiotics unnecessarily can be bad for you: besides wiping out your gut flora, it increases the risk that bacteria will develop drug resistance. Perhaps if we changed the name to "antibacterials," doctors would stop prescribing them for viruses.

I found Zicam, Airborne, Umcka, and Coldcalm for sale at Walgreens and Walmart. CVS and RiteAid don’t carry Umcka (good for them!) but do sell the others.

When you get a cold, you develop immunity to it and you won’t catch it again.We keep getting colds because they're caused by more than 100 different viruses, most of them nasty little buggers that continually circulate in our population. Each time you catch a cold, you’re getting a brand new one. The only consolation is that once you’re over it, you won’t get that one again.

So if you get a cold this winter, save your money. Stay home, rest and drink plenty of fluids. And I have it on good authority that there is one treatment for the common cold that’s inexpensive, widely available, and really, really works: chicken soup.

*In response to my inquiry, Zicam's manufacturer, Matrixx Initiatives, sent me some additional information. They pointed out that subsequent studies have not supported a link between Zicam and anosmia (loss of the sense of smell), and also that they permanently discontinued Zicam intranasal gel products ("Cold Remedy Nasal Gel and Cold Remedy Gel Swabs) in 2009, "despite the absence of any credible scientific data pointing to a potential link." They also argue that "the efficacy of zinc-based formulations is primarily a function of bioavailable dose" and that "Zicam products are formulated to ensure availability of the zinc." Arguing in favor of Zicam's benefits, they pointed to several studies that I'd already read, and I remain unconvinced and, as I pointed out above, Matrixx does not have to prove efficacy to the FDA because they are selling Zicam as a homeopathic preparation, which allows them to avoid FDA regulation.

The 3 Dumbest Products Sold By Whole Foods Market

Whole Foods "Whole Body" products.

I have a love-hate relationship with Whole Foods Market. On the one hand, I love their fresh produce, their baked goods, and many other food choices there. On the other hand, they seem to have embraced anti-science positions in the interest of keeping everything “natural.”

Before describing what they do wrong, let’s start with some things they get right. Their seafood sustainability policy supports fishing practices that allow wild fish populations to survive. This is a shining example that other stores would do well to follow, if we want to preserve remaining stocks of wild salmon, tuna, swordfish, and other fish. Whole Foods stores now mark each fish with a sustainability rating shown as a bright-colored label next to each fish. Bravo!

Whole Foods also offers chicken and beef that was raised humanely, following animal welfare standards that they clearly describe on their website and in their stores. For those who care about the way farm animals are treated, this is a valuable option.

But in some areas of the store, especially their “health” section, Whole Foods wades deep into pseudoscience,  So here are the three of the most egregious examples.

1. Whole Foods sells homeopathic medicines that are little more than snake oil. They make claims for health benefits, both on their shelves and on their website, that are based on little more than magical thinking. For example, they sell “homeopathic flu remedies” claiming that “when taken at the first sign of sickness, these can provide temporary relief of symptoms including fever, chills, and body aches.” This is simply false: no homeopathic treatment has ever been shown to be effective at treating flu symptoms. (I’ve written about homeopathy in more detail here and here.)

It’s ironic that on the one hand, Whole Foods proclaims “We've long believed that consumers have a right to know what's in your food”. But when it comes to homeopathic remedies, they neglect to inform consumers that these remedies do not contain the ingredients on the bottle at all. That's because homeopathic preparations are so diluted that not a single molecule of the original substance remains. Even more absurd, though, is that even if they weren't diluted to nothing, most homeopathic ingredients have never been shown to have any health benefits to begin with.

2. Whole Foods has an anti-GMO policy, adopted across all their stores, that ignores the science of GMOs. They announced last year that they would label all products in their stores to indicate whether they contained Genetical Modified Organisms. They also have announced that they are trying to eliminate GMOs from their shelves. 

Why is Whole Foods opposed to all GMOs? Their answer is simply: 

“Crops are currently modified to survive herbicide treatment, produce their own pesticides and resist certain diseases.“

This answer is a true statement, though it does not describe all GMOs, nor does it explain why we should avoid them. For example, golden rice is a form of rice that’s been modified to contain more vitamin A than regular rice - a modification that is designed to prevent blindness in children, particularly in poor, rural regions where rice constitutes a major part of the diet. Golden rice has even been blessed by the Pope. Is Whole Foods opposed to this form of GMO?

And what’s wrong with engineering a crop to resist disease? Some foods would basically disappear from our shelves if we didn’t have disease-resistant versions. For example, the Hawaiian papaya was nearly wiped out by a virus until, in one of the first uses ever of genetic modification, plant scientists created a resistant variety. This saved the industry, and the papaya itself has exactly the same nutritional value it had before.

I suspect that Whole Foods (and many anti-GMO types) are mostly opposed to Monsanto’s Roundup Ready GMO crops, which are modified to allow farmers to use more of Monsanto’s herbicides. I can sympathize with that position - but not with opposing all uses of GMO technology. That’s throwing the baby out with the bathwater.

3. Whole Foods won’t sell the pain relievers aspirin and ibuprofen, because they’re not “natural." Instead, their Whole Body department sells a wide range of nutritional supplements, for which they make claims such as this: 

“Not sure which supplement to choose? Grab a full-spectrum wellness or immune support formula. These combinations of herbs, vitamins, minerals and antioxidants are specifically designed to effectively improve overall wellbeing and enhance immune support.“ 

That’s just gobbledygook, but it's carefully worded to avoid FDA regulations. The phrase "enhance immune support" is a common go-to phrase for supplement makers, because it sounds science-y. Not only are supplements mostly useless, but taking megadoses can actually harm you. And there’s no scientific reason to think that “natural” products are better for you. After all, snake venom is 100% natural.

In contrast, ibuprofen and aspirin really work - but you can't buy them at Whole Foods. I continue to shop at Whole Foods for their many excellent food selections. But for anything medical, I shop elsewhere.

Dr. House Was Right

I’m a big fan of the show House, which ran on the Fox TV network for 8 years and is now on Netflix. Gregory House, masterfully played by actor Hugh Laurie, is an brilliant doctor who diagnoses patients whose bewildering symptoms have stymied other doctors. He’s also unbelievably rude: he insults and harrasses his patients and his fellow doctors alike, but they tolerate him - usually - because he’s almost always right.

I doubt that any real doctor is as rude as House. But like any group of professionals, doctors vary widely in their people skills. Recently, though, Medicare has started using patient satisfaction as a component of how it pays hospitals. In response, some doctors now try harder to give patients what they want, rather than what they need, as described last year by Kai Falkenberg at Forbes.  On Medscape recently, William Sonnenberg wrote that “patient satisfaction is overrated” and said of Press Ganey, a company that runs patient satisfaction surveys:

“Press Ganey has become a bigger threat to the practice of good medicine than trial lawyers.”

You can find Medicare's hospital survey online. Dr. House would fail, big time.

What’s wrong with giving patients what they want? It turns out that patient satisfaction is tied to higher costs and, even worse, a higher death rate. A large survey covering 52,000 patients, published by a team led by Joshua Fenton at the University of California-Davis  found that the most satisfied patients not only spent about 9% more than average, but had a 26% higher death rate. From the study: “The most satisfied patients had statistically significantly greater mortality risk compared with the least satisfied patients.”

For patients who think a nice doctor is a good doctor, this might come as very disappointing news. Was the effect due to patients already in poor health, who might be more inclined to like their doctors? No: when the researchers excluded the sickest patients and looked only at the healthier ones, the risk of dying was even higher. (It’s important to note here that this is relative risk; only 3.8% of patients died during the six-year followup to the study.)

Over at The Daily Beast last week, Daniela Drake summarized this trend as “You can’t Yelp your doctor.” (Not that Yelp isn’t useful for finding a good pizza place.) And yet, as Scott Hensley reported on the NPR blog Shots, online ratings of doctors are becoming very popular, even though they don’t measure how good a doctor is at diagnosing and treating illness.

This study has implications for so-called “alternative medicine” as well. Patients who frequent alternative providers such as acupuncturists, homeopaths, and naturopaths often report high levels of satisfaction, as if satisfaction correlated with better care. Now we have a large study showing that this is simply not the case.

It makes sense that patient satisfaction is related to cost: patients often demand treatments that they don’t need, and “Patient requests have also been shown to have a powerful influence on physician prescribing behavior”, as Fenton and colleagues reported. It is less clear why the most satisfied patients died at higher rates.

Obviously, doctors don’t need to act like Dr. House to be effective. But doctors need to be able to tell patients things they don’t want to hear. Just because you want an antibiotic for your sore throat or your child’s ear ache doesn’t mean you should get one.  The UC Davis study demonstrates that using patient satisfaction surveys to adjust reimbursement rates, as Medicare is currently doing, is a recipe for higher costs and lower quality of care.

Given a choice between a friendly doctor who gives me what I want and a brilliant doctor who gives me what I need, I’ll take Dr. House.