Friday, March 12, 2010

Falsehood in advertising pays

I was at the drugstore today and while waiting for the pharmacist to bring out the medicines I saw on one of shelves behind the counter a dark green box labeled "Coldease." Well, that caught my attention because I remember a Coldease in the US that's being sold as a homeopathic cure for, well, colds. Unfortunately, it isn't homeopathic, meaning that the amount of active ingredients in the preparation is nowhere close to infinitesimal. In fact there's enough of the zinc compound to cause adverse effects, loss of smell being one of the more notorious ones.

When the pharmacist returned I asked if I could take a look at the green box. Closer examination revealed this Coldease probably isn't homeopathic at all. The pharmacist told me it's actually an herbal remedy--meaning there is an appreciable amount of the active ingredient in it and the ingredient is of course plant-based. And sure enough it is. The description said it contains, among other things, Echinacea, a plant touted, for Zeus knows how many centuries, as a treatment for colds.

I googled Coldease the moment I got home and turns out my memory was--as is usually the case--on the blink. The American "homeopathic" remedy is "Cold-Eeze," and it was through James Randi that I first heard of it. Coldease on the other hand is a brand by the Philippine pharmaceutical company United Laboratories (Unilab). I couldn't find this product on their website. Instead I found the following Coldease TV ad uploaded by Unilab on their Youtube channel. According to the info they provide the ad was produced in late 2009. In the video Unilab boasts Coldease can "help stop a cold before it starts." But can Echinacea--presumably the major active ingredient in Coldease--in fact stop a cold before it occurs?

Studies, systematic reviews and meta-analyes of trials have come to conflicting conclusions. The National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) tells us:
Study results are mixed on whether echinacea effectively treats colds or flu. For example, two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults. However, other studies have shown that echinacea may be beneficial in treating upper respiratory infections.

Most studies to date indicate that echinacea does not appear to prevent colds or other infections.

On the other hand, a 2007 meta-analysis by Shah et al. published in the British medical journal Lancet found that "Echinacea decreased the odds of developing the common cold by 58% and the duration of a cold by 1.4 days."  However, in June 2008, Craig Coleman, one of the authors of the meta-analysis, in reply to a letter, wrote in the Lancet:
I agree with Andreas von Maxen and Peter Schoenhoefer that the studies on echinacea included in our meta-analysis are heterogeneous in their methodological quality. We attempted to cast a broad net to see whether or not a difference in the incidence or duration of cold was evident when the whole of the literature on echinacea was summarised, but as described in our paper's conclusions, we too suggest caution in over-emphasising the results before they can be confirmed with more rigorous, larger randomised controlled trials.

Meanwhile, a 2007 Cochrane Collaboration systematic review by Barrett el al. concluded,
Echinacea preparations tested in clinical trials differ greatly. There is some evidence that preparations based on the aerial parts of E. purpurea might be effective for the early treatment of colds in adults but the results are not fully consistent. Beneficial effects of other Echinacea preparations, and Echinacea used for preventative purposes might exist but have not been shown in independently replicated, rigorous RCTs.

That such large studies and reviews come out with contradictory and cautionary results may imply that the effect size of echinacea is very small or nonexistent--that is, its therapeutic efficacy over placebo may be zero to minimal. Whatever the reason for the differences in conclusions, however, it is inadvisable to tout echinacea as effective against colds or in preventing it when the jury is still out on the matter and no definitive evidence is at hand to support a claim to efficacy.

Unilab and others who promote and market echinacea as a cold remedy are, to say the least, jumping the gun. Why not wait until there is firm, conclusive evidence that it is effective? Because when it comes to profit the end justifies the means.

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