For those of you who have been following the past couple of posts, I am currently working my way through part of a shelf in Shoppers Drug Mart and critically evaluating some of their products.  I’ve already covered Boiron’s “Stodal” cough syrup and found it to be a combination of folk remedies and wishful-thinking.  However, their big product is the flu-remedy Oscillcoccinum.  This is among the top ten over-the-counter medicines sold in France (not surprising given their love of homeopathy), so it isn’t a “fringe” alternative medicine by any means.  Oscillococcinum (“Oscillo” for short) and Homeocoksinum (its Canadian cousin) are the same medicine marketed by two different companies, so I’m going to deal with them together.

What’s in it?

We skeptics make fun of homeopaths for using ridiculous ingredients in their remedies and then diluting them to the point where there isn’t even any ingredient left.  However, the story behind Oscillo is even more bizarre than the usual homeopath quackery.  In 1925, the French doctor Joseph Roy coined the term “Oscillococcinum” for small particles that he could see wriggling around in blood samples from sufferers of the Spanish ‘flu.  He went off and looked at the blood of patients suffering from other diseases and found that he could see the same small creatures moving in those samples, too.  He decided, based on this, that he had discovered THE causative agent of all disease.  What he probably found were small bubbles or particles of dust exhibiting Brownian motion.  We’ll probably never know…

Anyway, given his shoddy experimental observations it should come as no surprise that he immediately thought “I could make a homeopathic remedy out of this!”  He hunted down a source of oscillococci.  Now these things can be found everywhere, but he (for reasons best know to himself) chose the Muscovy duck.  This is the species of duck that French chefs used in their restaurants.  OK, you are probably thinking, perhaps some extract from the duck has some kind of medicinal properties.  Maybe it does, but not after the homeopaths have finished with it…  Oscillo is made using a 200K dilution of the liver and heart of a Muscovy duck (or “Anas Barbariae Hepatis et Cordis Extractum 200CK”, as it so helpfully says on the side of the packet).  The “K” refers to the Korsakovian method of homeopathic preparation.  Using this method, 1 part mother tincture (the full, homogenised liver/heart extract) is diluted with 99 parts alcohol or water in a bottle and then the bottle is struck against a soft but firm surface.  You then pour this away.  The theory is that what is left sticking to the sides of the beaker is around 1% of the original solution.  You then add 99 parts alcohol or water and strike again, repeating 200 times to create the Oscillo solution.  But there’s one more step!  Place a drop of this solution onto a sugar pill and let it evaporate.  Finally, sell to a customer.  In short (and to directly quote Boiron spokesperson Gina Casey), “…there’s nothing in it“.

Does it work?

The biggest surprise about Oscillo is that it is pretty much the only homeopathic medicine that has been shown to have any kind of clinical effect.  A search on PubMed yields nine results, of which four are different versions of the Cochrane Review on Oscillo as a treatment or preventative measure for influenza.  Four others are reviews of respiratory diseases in general or homeopathy.  The final paper discusses internet searches for information concerning ‘flu remedies.

• For those of you who aren’t familiar with Cochrane reviews, these are the gold standard by which clinical interventions are assessed.  Basically, a topic is chosen, a workgroup is formed and a rigorous methodology is designed to carry out a review of the literature on that topic.  The reviewers then not only write the review but also keep it updated to account for new information on the topic.  This is why there are four reviews on Oscillo.  The most recent version (Vickers and Smith, 2009) found three trials which looked at the effect of Oscillo on the prevention of ‘flu and four trials which looked at treatment of ‘flu.  There was absolutely no evidence of efficacy in preventing ‘flu but much has been made of a slightly significant effect in the treatment of symptoms.  The treatment trials suggested that Oscillo could reduce the length of a bout of ‘flu by around 0.28 days (‘flu usually lasts 7 to 10 days).  They conclude that: “Though promising, the data were not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndromes. Further research is warranted but the required sample sizes are large. Current evidence does not support a preventative effect of Oscillococcinum-like homeopathic medicines in influenza and influenza-like syndromes.”
• A review provided for primary care practitioners (Jaber, 2002, which I couldn’t access) echoes the findings of the Cochrane review: “the data on the homeopathic remedy Oscillococcinum interesting, but more studies should be performed”.
• Another of the reviews was actually just a compilation of homeopathy-related review articles (Linde et al. 2001).  They simply mention the findings of the Cochrane review.  However, they also make an interesting point that I also made concerning Stodal: “With few exceptions such as arnica for trauma or individualized homeopathy for headache, the reviews (and probably the primary research) do not cover conditions and treatment approaches which are relevant in homoeopathic practice. Self-medication with Oscillococcinum for influenza-like syndromes is popular in several countries but cannot be considered representative practice.”  Basically, Oscillo and Stodal are not really homeopathy because they are not individualised.
• The fourth review looked only at the prevention of ‘flu, at which Oscillo did not perform well (van der Woulden et al., 2005).  The authors note that Oscillo only actually featured in one of the three prevention trials in the Cochrane review, with the other two involving highly diluted virus or bacterial matter.  In contrast, this review cites vaccination as particularly effective.
• The fifth and final review (Guo et al., 2007) looked at both prevention and treatment, like the Cochrane Review, but this time included a range of complementary medicines.  They cite the same studies as the Cochrane Review for Oscillo, finding a weak but significant effect in treatment, but no effect in prevention.  The authors consider that the 0.28 day reduction in the length of ‘flu is of “debatable clinical relevance” and express concerns about the reporting of statistics in some trials.

Summary

There is some evidence that Oscillo could reduce the length of symptoms of ‘flu by a few hours.  Last year, a Boiron distributor got into trouble with the US FDA for making unsupported claims about Oscillo and avian ‘flu.  Boiron itself is more careful with its claims, stating that Oscillo “Helps rid you of the flu, from the very start.  Fever, chills, body aches, headache?  Take Oscillo and reduce the length and intensity of your flu symptoms.”  It would appear that there is moderate evidence for these claims, although it doesn’t help much…  A nice big clinical trial would be in the public’s interest, but I’m not sure Boiron will be funding any more given that the small trials that have been carried out so far provide just enough evidence for them to make their claims with impunity.

Post 1: Introduction

Post 2: Stodal, by Boiron

Post 3: Oscillococcinum and Homeocoksinum

____________________________________________________________________________

References

Guo, R., Pittler, M.H. and Ernst, E. (2007) Complementary medicine for treating or preventing influenza or influenza-like illness. The American Journal of Medicine 120: 923-929.e923.

Jaber, R. (2002) Respiratory and allergic diseases: from upper respiratory tract infections to asthma, Prim Care, 29: 231-61.

Linde, K., Hondras, M., Vickers, A., Riet, Gt., Melchart, D. (2001) Systematic reviews of complementary therapies – an annotated bibliography. Part 3: Homeopathy. BMC Complementary and Alternative Medicine 1: 4.

van der Wouden, J.C., Bueving, H.J. and Poole, P. (2005) Preventing influenza: An overview of systematic reviews. Respiratory Medicine 99: 1341-1349.

Vickers, A.J. and Smith, C. (2006) Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Database Syst Rev 3: CD001957.