This week, Dr. Sydney Spiesel discusses the herbal remedy Airborne and the power of belief, how to prevent kidney stones, and whether 30 million more kids should get a flu shot each year.
Airborne: Why it really does work.
Product: For more than 10 years, the herbal remedy Airborne was marketed as a cold-fighting treatment by CEO Elise Donahue, a former second-grade teacher who created and marketed the product herself, working her way up to an Oprah endorsement. Donahue's company claimed that it had been tested, with remarkable success, in a "double-blind, placebo-controlled clinical trial of 120 patients" in the early stages of a head cold. About half the patients treated with Airborne reportedly didn't develop a full-blown cold, compared with 77 percent of placebo-treated patients who did.
Law suit: But then two years ago ABC News reported that the testing laboratory, GNG Pharmaceutical Services, was a two-man operation with "no clinic, no scientists, and no doctors," started up to generate the Airborne study. A class-action suit for false advertising followed, and the company just agreed to pay more than $23 million to settle it. Besides its lack of demonstrable efficacy (a little problem shared by virtually all cold medicines), there is the additional concern that Airborne might contain an unsafe amount of vitamin A.
Regulation: Why isn't some government entity, like the Food and Drug Administration, keeping track of products like this? The answer is simple: Basically, we don't want them to. In 1994, Congress passed the Dietary Supplement Health and Education Act, which essentially set aside the FDA's oversight of products marketed as dietary supplements or the ingredients of dietary supplements. The FDA can pull such products from the market if they carry a significant risk of injury or if they are advertised to "prevent," "cure," or "treat" some illness, but, otherwise, they are to be left alone. The legislation was enacted to satisfy people who believe in these products and manufacturers who want to sell them. Neither constituency thinks these products should be subject to the pre-market safety and efficacy testing required of real medications—and, frankly, the true believers probably wouldn't heed the results, anyway.
Question: Are people deluded, or do products like this work? My answer, surprisingly, is that they do work—but only if you believe and thus deceive yourself. When you take the medicine you believe in, you won't notice when your nose runs anyway, and if you forget to take it before flying, you won't remember that your trip ended in perfect health. That's why it is so important that real studies of efficacy and safety include both the medication under evaluation and a placebo that looks, smells, and tastes just like it.
Findings: A very nice recent piece of research illustrates both the powerful effect of expectations and the subtle forces that influence them. The research group offered the experimental subjects a "new pain-relieving drug"—actually a placebo—and measured how well it relieved the pain of an electric shock. The subjects were divided into two groups. Both were given the same placebo pills and both were exposed to the same painful shocks, but one group was told that the pills cost $2.50 each and the other group was told that the pills were discounted to 10 cents. (I suppose because no one in their right mind would believe that a real pharmaceutical manufacturer would sell something so cheaply.) Both pills worked to reduce pain, but the $2.50 pill worked a lot better than the cheaper one.
Conclusion: I'm betting that even though Airborne's settlement includes an offer of refunds to disappointed buyers, the company won't have to pay a lot of them. It's awfully hard to unbelieve.
Kidney stones and germ prevention?
Condition: Kidney stones are hard, usually minerallike objects made of a poorly soluble salt, calcium oxalate. Between 5 percent and 15 percent of the population has them at some point. Because they often cause severe pain, kidney stones frequently send sufferers to the hospital. The annual economic impact of those admissions in the United States has been estimated at about $2 billion. Preventing them could lead to savings of $2,500 per patient.