Osucksy … no, Olycocks … damn!, Oscillococcinum!?

Every year it’s the same story: when people around us start coughing and sneezing and complaining of catching the flu, we see commercials for the unpronounceable product pop up on our TV screen. Oscillococcinum is back in town! This cold and flu season we saw some interesting developments with regards to this homeopathic drug; interesting from a sceptical point of view, of course.

In the Netherlands we were treated to a hilarious documentary made by the Keuringsdienst van Waarde, a critical consumer programme. They set out to find the Canard de Barbarie, a duck, which is used in the preparation of Oscillococcinum: you take out the heart and liver and let these rot for 40 days in a bottle together with a mixture of pancreatic juice and glucose. And after that, you dilute this stuff to an absurd level, 200K. To be reasonably sure that you could find at least one molecule of the original mixture, you would need to have the equivalent amount of molecules of what would be available in a gazillion extra universes. Oh well, let’s not exagerate: in fact it’s only a googol googol googol extra universes like our own. Many people have had a good laugh about the documentary, but I doubt that sales plummeted after the broadcast.

More influential are probably the court cases, which have started overseas. In last couple of years at least five lawsuits have been filed in the US against Boiron, producer of Oscillococcinum. In Canada a Class Action Lawsuite has been filed against Boiron and Shoppers Drug Mart. In most cases the plaintiffs claim that the marketing of Oscillococcinum violates various consumer protection acts and is misrepresenting effectiveness of the product.

Reasonable people of course know that Oscillococcinum can’t work. Oops, can I say that without getting into legal trouble? In 2011, Italian blogger Samuele Riva was threatened by Boiron because of a critical blog on homeopathy in which he used Oscillococcinum as an example. In the end Boiron backed off, but only after their actions backfired due to the ‘Streisand effect‘.
In the Netherlands the chairman of the Antiquackery Association was once sued by the company of a homeopathic product, which he had called worthless. Outcome of this courtcase (1996) was a bit annoying: you are allowed to say that homeopathy in general doesn’t work and that it is a shame that such a product is sold. But you are not allowed to claim that the product doesn’t work without having experimental data to support this claim. The judge seemed to think that the fact that there is no scientific proof for homeopathy somehow equals the ‘fact’ that there also is no proof that it doesn’t work. Scientifically this stance is silly, of course. Someone who makes a claim which undermines all established theories on chemistry and physics should present convincing evidence for that claim; it’s not up to his opponents to prove that he is wrong.

So what can be said about the claims for effectiveness of Oscilliococcinum? Is there such convincing evidence? Boiron points to two Randomized Controlled Trials, published in peer-reviewed journals. These seem allright at first sight: A controlled evaluation of a homoeopathic preparation in the treatment of influenza-like syndromes by Ferly et al.(1989) and Oscillococcinum in patients with influenza-like syndromes: a placebo-controlled double-blind evaluation by Papp et al. (1998). Jan Willem Nienhuys, secretary of Dutch sceptical foundation Skepsis, found out, however, that these studies have serious flaws. In particular the applied statistical analysis looks fishy in both cases.

The study by Ferly showed a significant difference in favor of Oscillicoccinum (a close call though p=0.0494, if only they had applied the correct test). They noted down how many patients were ‘cured’ after 0.5, 1, 1.5, 2, … , 6.5 and 7 days and saw that if you look at the scores at day 2, there is this significant difference. However, on the other moments there is no significant difference! So out of 14 possible outcome measures they just took the one which fitted their agenda. And to make it more difficult to spot this, they presented the figures in a graph only, no table included. Nienhuys had to use a ruler to find out what the numbers were on the other moments.

It’s eay to find ‘significant’ relations after collecting your data (cartoon:xkcd)

The Papp study was set up to replicate this find. In principle an honourable inititiative, if done in a fair way. However, if they would have stuck to the same outcome measure Ferly used, they would have had to report that there was no significant difference (p=0.4). For some reason this is not mentioned in the article; another outcome measure was considered more important. They didn’t consider just ‘free of flu-like symptoms after 48 hours‘, but tell us that  the Krauth test showed a clear improvement in health in the Oscillococcinum group (p=0.0028).
That sounds quite impressive until one tries to find out what it actually means. This Krauth test is quite a rare animal in the world of statistical tests and probably the authors meant something called a Configural Frequency Analysis. If you use this carefully you can detect a difference in a set of symptoms. But it’s easy to get false positive results, if you don’t apply the correct Bonferroni-adjustments. Also the test assumes that the symptoms are indepent, which is clearly not the case when one of them is “general feeling of illness”. None of this is mentioned in the article. It looks like Papp et al. just fed their data blindly into one statistical test after another until they found one which gave a p-value lower than 0.05.

In general I’m an adherent of Hanlon’s Razor, “Never attribute to malice that which is adequately explained by stupidity.”, but in this case it probably only applies to the reviewers of the articles. In both cases the researchers had to bend over backwards to find something they could present as a positive result. And in my opinion to such levels that this cannot be explained by stupidity alone.

Oscillococcinum is for sissies, anyway; tough guys take diluted Tyrannosaurus Rex.

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