There have been many cases now of big companies or organizations, or wealthy individuals, threatening to sue or actually suing a blogger for libel. The most famous case is that of Simon Singh who was sued by the British Chiropractic Association over comments he made in an article. Simon braved through the expensive and exhaustive legal process (which is especially onerous in England), but he is not just a lone blogger. He is a successful author and was writing for the Guardian. Eventually the BCA was forced to drop the case – but only after the blogging community rallied behind Simon, magnifying his criticisms of the BCA by orders of magnitude. By all accounts it was a PR disaster.

The blogging community as a whole is rather passionate about this issue. We exist on the premise of free and open public discourse about important issues. At SBM we take on many controversial issues and we don’t pull our punches when criticizing what we see as pseudoscience in medicine. So of course we take notice when a large company tries to bully a blogger to silence their legitimate criticism.

According to the BMJ this has happened yet again – this time the international homeopathy producer, Boiron, is threatening a lone Italian blogger because he dared to criticize their product, Oscillococcinum. The blogger, Samuele Riva, wrote two articles on his blog, blogzero.it, criticizing what our own Mark Crislip has called “oh-so-silly-coccinum.”  The blog is entirely in Italian, but he is maintaining a page in English with updates on the Boiron vs Blogzero affair.

Criticizing homeopathy is always fun, because it is at the extreme absurd end of the silly pseudoscience spectrum, even among some stiff competition. But now homeopathy has a corporate face in Boiron – a large multinational corporation based in France. Boiron is the largest manufacturer of homeopathic products in the world and the second largest manufacturer of over-the-counter products in France.

What they are doing to this small blogger, in my opinion, is nothing less than corporate thuggery. They are using their resources and their corporate lawyers to try to silence completely legitimate criticism of their pseudoscientific products. Of course, they will only succeed in magnifying that criticism.

For example, Riva suggested that Boiron’s oscillococcinum has no active ingredient. Well, let’s see- the company lists the active ingredient in this product as “Anas barbariae hepatis et cordis extractum 200CK HPUS.” The “200C” means that the listed ingredient was diluted with a 1:100 dilution 200 times. Serial dilution is a funny thing – a 200c dilution is the equivalent of diluting 1ml of original ingredient into a volume of water that is the size of the known universe. This is far far beyond the point where there is any reasonable chance of there being even a single molecule of original ingredient left.

So Riva was completely justified (as have many other critics) in saying that Boiron’s 200c product has no active ingredient. In fact it is deceptive to list something that has been diluted 200C as an “active ingredient.”

Not that it matters in this case, because the original ingredient is a pseudoscience unto itself. Mark Crislip gives the full details, here is his summary:

In the 1919 flu epidemic a physician who did not understand that artifacts on the slide, probably bubbles, move randomly due to Brownian motion. Looking at the tissues of flu patients with a microscope, he found what he thought was not only the cause of influenza, but the cause of all diseases: small cocci (round balls) that oscillated under the microscope. He found these wiggling bubbles in all the tissues of all the ill people he examined and thought he discovered the true cause of all disease. Sigh. Yet another cause of all illness. He is the only person, before or since, to see these oscillating cocci. Hence the name.

That’s right, oscillococcinum does not even exist – essentially Boiron takes fairy dust and then dilutes it out of (non)existence. The “anas barbariea hepatis” is basically duck liver, which is supposed to contain the most concentrated nonexistent oscillococcinum. It’s a pseudoscience trifecta.

Boiron claims that their product treats the symptoms of flu. What does the evidence show? (Yes, there is evidence – someone bothered to test whether diluted fairy dust actually works)? Well, this is yet another  interesting story. Oscillococcinum was at the center of another embarrassing controversy, this one involving the Cochrane Collaboration. They published a Cochrane review of Oscillococcinum for the flu, and the author’s concluded:

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.

This review became the poster child for what is wrong with Cochrane’s particular application of evidence-based medicine (EBM). Notice that the evidence is essentially negative, but with some positive studies – which is what we expect when studying a fancy placebo because of researcher and publication bias. But the authors concluded that the treatment is “promising” and “further research is warranted.” An SBM review of the same data would come to a very different conclusion – the data is what we would expect from an ineffective treatment. Further, the highly implausible nature of the treatment (on several levels) warrants a conclusion that it does not work, it holds no promise, and not another dime of precious research money should be wasted chasing this fantasy.

Eventually the Cochrane review was withdrawn. We interpreted this as a minor victory for SBM, although we have no way of knowing what role, if any, our criticism played in the decision to withdraw the review.

Conclusion

I hope Boiron does draw a line in the sand over their oscillococcinum product, and that it becomes the center piece of a broader public discussion about homeopathy. Most of the public does not understand what homeopathy actually is. They think it means “natural” or “herbal” medicine. They have no idea that homeopathy is about taking fanciful ingredients with a dubious connection to the symptoms in the first place, and then diluting them into oblivion, then placing a drop of the pure water that remains and placing it on a sugar pill. The resultant pill is then supposed to contain the magic vibrations of the original substance.

This rank pseudoscience, which has no place in 21st century medicine, is the business of Boiron. Let’s see them try to defend themselves and their products. Let’s see them harass bloggers and those who are just trying to expose the public to the truth. Let’s see them argue in public how air bubbles in duck liver fantastically diluted can treat the flu.

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