Date Last Updated: 26/07/04

Homoeopathic oscillococcinum for the prevention and treatment of influenza

Overview

The flu (influenza) is a highly infectious viral disease. Homoeopathic preparations, such as oscillococcinum or similar products, are often prescribed by homoeopaths for the prevention and treatment of the flu. This evidence summary identified one systematic review and seven clinical trials (with a total of 3,459 patients) on the use of homoeopathic oscillococcinum for the prevention and treatment of the flu. In three clinical trials (involving 2,265 people) homoeopathic oscillococcinum taken on a regular basis did not prevent the flu, although the development of fever and muscle aches and pain was reduced slightly. In four clinical trials (involving 1,194 people) taking homoeopathic oscillococcinum once the flu was contracted shortened the duration of the illness by about a quarter of a day (on average) and reduced the severity of some of the symptoms experienced. Mild but reversible side effects (such as headache or skin rash) can occur when taking homoeopathic oscillococcinum. Some people also experience tiredness, dizziness, diarrhoea or a temporary worsening of symptoms when using homoeopathic remedies. No serious side effects have been reported with the use of homoeopathic oscillococcinum.

Background

Influenza
Influenza (commonly called ‘the flu’) is a highly infectious disease caused by a virus, and is particularly common in winter. Influenza is spread from person to person through the coughing and sneezing of infected people¹. Symptoms of influenza include cough, sore throat, fever, a feeling of bodily discomfort (malaise), muscle aches and pain (myalgia), headache, and a runny nose (rhinitis)¹. Collectively these symptoms are referred to as “influenza-like syndrome”. Influenza typically lasts for three to seven days, although cough and malaise may persist for more than two weeks¹. For certain people, influenza can lead to pneumonia and can cause certain medical conditions (such as heart or lung disease) to become worse¹. The risk of complications, hospitalizations and death from influenza is highest amongst people aged 65 years and over, young children, and in people with heart and lung problems.

Homoeopathy
Homoeopathy aims to stimulate the body’s own healing responses and is based upon three main principles, namely the principle of “similars”, the use of dilutions called “potencies”, and the totality of symptoms or “holism”^{2, 3}. The principle of “similars” is the theory of treating like with like, in that people with particular signs and symptoms can be cured if given a drug that produces the same signs and symptoms in a healthy individual. The principle of “potencies” is the idea that remedies retain biological activity if they are repeatedly diluted and shaken². The principle of “holism” is that preparations are most effective when all symptoms are considered and not just the disease as a whole. For example, two people presenting with a cold but different symptoms would receive a different homoeopathic treatment³.

Homoeopathic preparations for the prevention and treatment of influenza tend to be derived from influenza virus, influenza vaccine or bird liver. Homoeopathic oscillococcinum, a commercially available patented medicine (“Oscillo” produced by a company called Boiron) derived from the heart and liver of wild ducks, is also used⁴. Preparation of homoeopathic products involves a method called “potentisation” (stepwise dilution), combined with “succussion” (vigorous shaking)⁵. In assessing the patient, homoeopaths often take into account a range of physical, emotional and lifestyle factors in order to identify the best homoeopathic preparation (or “simile’). Many homoeopaths also recommend changes to diet and lifestyle⁶.

The practice of homoeopathy is not currently regulated by legislation in New Zealand. Many homoeopaths are affiliated with a self-regulating professional body (such as the New Zealand Council of Homoeopaths).

Evidence reviewed in this summary

Efficacy information

Systematic reviews: One systematic review on this topic was identified for this evidence summary⁴. This review was conducted by the Cochrane Acute Respiratory Infections Group and was last updated on the 6th August 2003.
Clinical trials: The above review identified seven randomised, double-blind, placebo-controlled clinical trials^7-13 representing 3,459 patients. Three of the seven trials were written in English^{8, 12, 13} and two trials were unpublished^{9, 10}. Only two trials reported full details on the trial design and results^{8, 13}. Since this review was last updated, no further trials have been published on this topic. No clinical trials of homoeopathic treatments for influenza are known to be currently underway (see www.controlled-trials.com).
Case-control studies/Cohort studies/Case studies: Given the extensive coverage of the above systematic review, no case-control, cohort or case studies were assessed for this evidence summary.

Safety information

Systematic reviews/Clinical trials: The above systematic review⁴ reported information on side effects associated with the use of homoeopathically-derived oscillococcinum. However, only three^8,12-13 of the seven clinical trials^7-13 identified by the review provided actual data on side effects. Two additional systematic reviews on the safety of homoeopathic medicines in general were identified^14,16. One review focused on homoeopathy aggravations (the temporary worsening of symptoms), and identified 25 relevant randomised placebo-controlled trials, involving 3,437 people¹⁴. The second review summarised all adverse effects related to homoeopathy published in English from 1970 to 1995, and identified 53 relevant studies¹⁵.
Other studies: A general survey involving 1,025 users of homoeopathy across six European countries was identified that also provided details on side effects¹⁵. Given the comprehensive information provided by the above studies, no further information on side effects was sought.

Evidence on efficacy

Prevention of influenza
Evidence on the use of homoeopathically-derived oscillococcinum or similar products for the prevention of influenza is available from three trials (with a total of 2,265 patients)^{9, 11, 12}. The trials ranged in size from 200 to 1,595 patients. Although the scientific quality of the trials was generally poor, two trials were considered to be of better quality than the third^{11, 12}. Overall, results from these studies indicated that, compared to a placebo:

Homoeopathic oscillococcinum did not help prevent the overall occurrence of influenza-like syndrome^{9, 12}.
Homoeopathic oscillococcinum had no effect on the average number of symptoms experienced or the development of headaches¹¹.
The occurrence of fever associated with influenza was reduced by 8% in people taking homoeopathic oscillococcinum¹¹.
The development of muscle aches and pain (myalgia) was reduced by almost 7% in people taking homoeopathic oscillococcinum¹¹.

Treatment of influenza
Evidence on the use of homoeopathically-derived oscillococcinum or similar products for the treatment of influenza is available from four trials (with a total of 1,194 patients)^{7, 8, 10, 13}. The trials ranged in size from 100 to 487 patients. Although the scientific quality of the trials was generally poor, two trials were considered to be of better quality than the others^{8, 13}. Results from these trials indicated that, compared to a placebo:

Oscillococcinum reduced the duration of influenza by about a quarter of a day (0.26 days)^{8, 13}.
Oscillococcinum enabled a return to work about half a day earlier after the flu^{8, 13}.
The chance of still experiencing fever and two or more other flu-like symptoms after 48 hours was reduced by almost 6% in people taking homoeopathic oscillococcinum^{8, 13}.
The chance of experiencing no improvement in symptoms after 48 hours was reduced by almost 13% in people taking homoeopathic oscillococcinum¹³.
Back ache and side pain was reduced by almost 10% in people taking homoeopathic oscillococcinum¹³.
The use of medication for pain or fever was reduced by just over 9% in people taking homoeopathic oscillococcinum⁸.
The above trials reported no significant difference between homoeopathy and placebo for sore throat¹³, headache¹³, spinal pain¹³, cough¹³, use of medication for cough or sore throat⁸, use of antibiotics⁸, or use of any other medication during the trial period¹³.

Combined results from all trials with relevant data showed no significant differences between homoeopathy and placebo for fever, runny nose (rhinitis), or aches^{7, 10, 13}. Compared to a placebo, homoeopathic oscillococcinum had a significant effect on the following outcomes:

The occurrence of chills was reduced by just over 18%^{7, 10, 13}.
The average temperature was reduced by 0.39 degrees^{10, 13}.
The occurrence of coughing during the day was reduced by just over 20%⁷.
Patient assessment of treatment being a success was increased by just over 10%^{7, 8, 13}.

There were insufficient data available to determine the effects of homoeopathic oscillococcinum on groups particularly prone to the flu (such as the elderly or children) or the effect of different homoeopathic doses. One trial reported a better recovery within 48 hours in the homoeopathically treated group, for people aged between 12 and 29 years compared to people aged 30 years and over⁸.

Evidence on safety

Findings from the one systematic review⁴ and the three clinical trials^8,12-13 reviewed for this summary, indicate that:

Side effects associated with the use of homoeopathic oscillococcinum tend to be mild and reversible, and include headaches or allergic reactions.
In one clinical trial almost 10% of participants taking homoeopathic oscillococcinum for the prevention of influenza experienced a mild side effect (such as a headache or skin rash), compared to 2% of people taking a placebo¹².
In another trial, 3.2% of all participants experienced side effects, with no difference observed in the number of side effects reported by people taking the placebo compared to the treatment^4,8.
No serious side effects associated with the use of homoeopathic oscillococcinum were reported by any of the trials⁴.

In terms of side effects associated with the use of homoeopathy in general, a systematic review identified 12 relevant placebo-controlled clinical trials¹⁵. Results from these trials showed that three in every 100 people taking a homoeopathic medication experienced at least one side effect. However, the review reported that both the people taking garlic and those taking placebos experienced similar types of side effects. Side effects were minor and short-lived, and included headaches, tiredness, skin eruptions, dizziness, diarrhoea, and/or the temporary worsening of symptoms (often referred to as “homoeopathic aggravation”)¹⁵. A survey of 1,025 people receiving homoeopathy (of any type) found that 7.8% reported a “significant aggravation” and 25.4% reported a “slight aggravation” of their symptoms (which homoeopaths believe is a positive sign that the correct remedy has been given – referred to as “proving”)¹⁶. However, results from a systematic review that specifically looked at homoeopathic aggravations found no difference in the proportion of aggravations reported by people taking placebo compared to those taking a homoeopathic treatment¹⁴.

Cited references

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Bridges CB, Harper SA, Fukuda K, Uyeki TM, Cox NK, Singleton JA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbidity and Mortality Weekly Report 2003;52(RR-8):1-36.
Linde K, Clausius N, Ramirez G, Melchart D, Eitel N, Hedges LV, et al. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997;350(9081):834-843.
Jonas WB, Kaptchuk TJ, Linde K. A critical overview of homeopathy. Annals of Internal Medicine 2003;138(5):393-399.
Vickers AJ, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. The Cochrane Library, 2003;2.
Ernst E, Pilter M, Stevinson C, White A. The desktop guide to complementary and alternative medicine: an evidence-based approach. London: Mosby; 2001.
Vickers A, Zollman C. ABC of complementary medicine. Homoeopathy.[comment]. British Medical Journal 1999;319(7217):1115-1118.
Casanova P. Homeopathie, syndrome grippal et double insu. Tonus 1984:25-26.
Ferley JP, Zimirou D, D'Adhemar D, Balducci F. A controlled evaluation of a homoeopathic preparation in the treatment of influenza-like syndromes. British Journal of Clinical Pharmacology 1989;27(3):329-335.
Nollevaux MA. Klinische studie van mucococcinum 200K als preventieve behandeling van griepachtige aandoeningen: een dubbelblinde test tegenover placebo. Unpublished 1990.
Casanova P, Gerard R. Bilan de 3 annes d'etudes randomisees multicentriques oscillococcinum / placebo. Unpublished: Oscillicoccinum - rassegna della letterature internationale 1992.
Rottey EE, Verleye GB, Liagre RL. Het effect van een homeopathische bereiding van micro-organismen bij de preventie van griepsymptomen. Een gerandomiseerd dubbel-blind onderzoek in de huisartspraktijk. Tijdschrift voor Integrale Geneeskunde 1995;11(1):54-58.
Attena F, Toscano G, Agozzino E, Del Giudice N. A randomized trial in the prevention of influenza-like syndromes by homeopathic management. Revue d Epidemiologie et de Sante Publique 1995;43(4):380-382.
Papp R, Schuback G, Beck E, Burkard G, Bengel J, Lehrl S, et al. Oscillococcinum in patients with influenza-like syndromes: a placebo-controlled double-blind evaluation. British Homeopathic Journal 1998;87(2):69-76.
Grabia S, Ernst E. Homeopathic aggravations: a systematic review of randomised, placebo-controlled clinical trials. Homeopathy: the Journal of the Faculty of Homeopathy 2003;92(2):92-98.
Dantas F, Rampes H. Do homeopathic medicines provoke adverse effects? A systematic review. British Homeopathic Journal 2000; 89 (Suppl 1): S35- S38.
Anelli M, Scheepers L, Sermeus G, Van Wassenhoven M. Homeopathy and health related Quality of Life: a survey in six European countries. Homeopathy: the Journal of the Faculty of Homeopathy 2002;91(1):18-21

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