world besnis plan: April 2006

My family got a little smaller today.

My dear cat, while on the surgery table, finally succumbed to cancer. Snoopy was 16 years old, and judging from the constant purr, he was the happiest cat in history. Nathalie and I had adopted him from the pound near Jamaicaway in Boston when Snoopy was only 3 or 4 weeks old, and we were still in school--playful companions for a feisty kitten. Back then Snoopy would scamper up our pants, and he always loved--even as recently as yesterday--to be picked up, mussed up, tummy-rubbed, and slid across the smooth wood floor (he always sauntered back for more). He had a gait that reminded everyone of John Wayne.

Snoopy moved with us 9 times during his life, and each time he settled in immediately, content to call it home so long as we were there. In 16 years, Snoopy cried only if the bedroom doors were closed, since his favorite place to sleep was our bed and then, in recent years, our children's beds. Surprisingly, he let the kids pull his tail and chase him around. Occasionally he brought us tributes from his expeditions (moles, birds, cicadas, mice) but he tried not to hurt them. Considerately, he never brought us fleas or ticks.

My family recalled these happy times today as we buried Snoopy beneath a freshly planted fruit tree.

If you have a feline friend at home, please give her a little extra tuna, in memory of Snoopy. If you don't have a cat (and you're not allergic) go straight to the local chapter of your ASPCA and rescue one. You'll thank me later!

Like many governments, the US tries to protect its citizens from quackery and scam. We license medical service providers, regulate clinical drug testing, and enforce disclosures of medical risks. Indeed, societies need these processes to properly assess the efficacy and dangers of new medical technologies. But when the vast majority of our population lacks a basic understanding of scientific principles, the medical safeguards fail. Con men exploit the scientifically illiterate by appealling to their hope for miracle cures, while overcoming their skepticism with confusing and intimidating jargon.
Today's blog post is inspired by one particularly egregious example of highly scalable theft -- a phenomenally successful product called Airborne, that is the number one selling cold and flu remedy in many large drug retailers. Allegedly, sales have topped $100 million after several consecutive years of doubling revenues.
The pill itself is nothing but some vitamins, some commercially tired herbs and the electrolytes you get from a swish of Gatorade. But Airborne's success springs from a remarkably shrewd and sinister campaign that employs a number of diversions to mislead the public without blatantly violating any laws. Essentially, the clever marketing messages and packaging suggest that Airborne cures the common cold, without ever actually saying so.

The Airborne Package
The convenient pocket-sized package, illustrated with cartoons of germs, displays these instructions:

For Use In: Airplanes - Restaurants - Offices - Hospitals - Schools - Health Clubs - Carpools - Theaters - Sports Arenas
Take at the FIRST sign of a cold symptom or before entering crowded environments.* 100% Guaranteed Satisfaction.
AIRBORNE PLEDGE: AIRBORNE was developed by a school teacher who was sick of catching colds in class.* The natural ingredients in AIRBORNE'S unique formulation, reflects [sic] state of the art antioxidant, electrolyte and herbal technology. WE PLEDGE to our customers to continually upgrade the AIRBORNE formula as improved technology avails itself, thereby offering the finest most effective health formula possible. Satisfaction guaranteed.
DIRECTIONS: AT THE FIRST SIGN OF A COLD SYMPTOM, SIMPLY DROP (1) AIRBORNE TABLET IN A SMALL AMOUNT OF PLAIN WATER, LET DISSOLVE ABOUT (1) MINUTE AND DRINK.* REPEAT EVERY THREE HOURS AS NECESSARY.*
EFFERVESCENT TECHNOLOGY OFFERS 100% IMMEDIATE ABSORPTION!

Without actually saying so, the package implies every which way it can that Airborne is a medicine that prevents or cures colds. But did you notice the asterisks on the four sentences containing any reference to actually treating colds? I scoured the package for clarification, but I had to literally use a magnifying glass before I could make out the footnote in fine, fine print that read:

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

In case the print is too small for you, here's a more legible version:

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

So if this product wasn't intended to treat colds, why should we take it at the first sign of cold symptoms, and why use it in airplanes, carpools etc.? What does it even mean to REPEAT EVERY THREE HOURS AS NECESSARY? Necessary to do what? It doesn't make any sense, but the manufacturer Knight McDowell Labs knows that few people will ever notice.
In fact, their CEO Elise Donahue knows better than anyone how to make claims without being pinned down. Here, ABC News reported on a Good Morning America interview with Knight McDowell Labs' CEO:

"We don't know if Airborne is a … cure for the common cold. What Airborne does is it helps your body build a healthy immune system. When you have a healthy immune system, then it allows your body, on its own, to fight off germs."
Donahue said the best proof that the product works was that 40,000 customers contact the company every year. But a number of medical experts and watchdog groups are skeptical that Airborne prevents or cures colds.
"Simply washing your hands during cold and flu season is a much more effective way of preventing colds," said David Kroll, a pharmacologist at Duke University Medical School.
Yet the Airborne box tells users to take the product at the first sign of a cold. An Airborne ad testimonial called it a miracle cold buster. And the company said in a news release Airborne would get rid of most colds in one hour.

The School Teacher Diversion
Magicians know that the best way to trick an audience is to divert their attention away from what the magician is doing with a flamboyant gesture or joke. The fraudsters at Knight McDowell Labs elevated this to an art form with an insidious diversion that turned a liability into a "viral growth" marketing engine...
You see, KNIGHT-MCDOWELL LABS is not the reputable pharmaceutical research institute from whom you'd expect to find the cure for the common cold. It is actually the recently incorporated holding company of a couple living in the beachside resort town of Carmel, California, far from any science labs. Victoria Knight, a school teacher, and Rider McDowell, an aspiring script writer, needed to overcome consumers' healthy skepticism that these two people might not have the scientific credentials to assess, let alone develop, a medication that has so far eluded armies of brilliant biochemists. But the script writer, if nothing else, understood the TV audience he hoped to entertain, and in a stroke of brilliance he turned the problem upside down: turn their complete lack of qualification into a story that drives awareness, and diverts attention from the real question of efficacy.

And so the package, the web site, and the advertisements lead with the Amazing Fact that Airborne was CREATED BY A SCHOOL TEACHER! As any confidence artist knows, disclosing unflattering facts up front wins the target's trust.

"Created by a school teacher? Can you imagine? Really? Who'd have thought a school teacher would invent the miraculous cure for the common cold? How amazing!"

These are the comments I heard bounced around among people I know on the that first day I heard about this miracle cure. The school teacher story was so far-fetched that it actually accelerated brand awareness!
And sure enough, each consumer convinced himself or herself that Airborne works, based on selective anecdotal data. "I used it last week and I didn't get sick!" "I took it too late to stop my last cold--next time I'll take it sooner." "Everyone says it works."

Clinical Results
So I examined the product they gave me. Nothing on the package (especially the inventor's credentials) impressed me, but I did become hopeful when I read the words

"See Clinical Results on our Web Site www.AirborneHealth.com"

I did check out the site and here's what I found (in tiny hard-to-read print):

WHY AIRBORNE?
The FAA estimates 600 MILLION PEOPLE pass through American airports each year. A recent government survey identified “unhealthy air” and nausea as the leading concerns of airline customers.

Workers within our highly technological society now spend close to 90% of their time indoors. The U.S. Environmental Protection Agency (EPA) estimates that our exposure to pollution may be as much as five times greater indoors than outdoors! Best selling Airborne formula was created by a second grade school teacher. 100% satisfaction guaranteed.

Wha?? What's the connection between the US EPA's report and the school teacher? Evidently, plenty of readers seem to miss the non sequitur, inferring from the proximity of the sentences that the school teacher's invention cures these plagues of pollution and airline nausea.
It is much easier to read the print on the order form for the growing product line, including the AIRBORNE Gummi Lozenges, the AIRBORNE Junior 3-Pack, and the Airborne SUPER DUPER COMBO FREQUENT FLYER Pack. And whether or not the stuff works, I've got to admit I find value-priced lemon-lime candies much more appealling than exercise and good diet.
Of course, the most convincing reason to trust Airborne is prominently positioned at the top of the home page:

“Look, Airborne is great. I wouldn't go on a movie set without it; it's on my plane and in my house.” -Kevin Costner, Hollywood, CA
Now really, how can 40,000 consumers, and Kevin Costner, be wrong? But still I wanted to see those clinical results and I just couldn't find any. I used the Contact form to ask for a pointer to the clinical data, and here is the reply I received:

From: Consumer Support [mailto:consumersupport@airbornehealth.com]
Sent: Mon 3/20/2006 5:25 AM
To: David Cowan
Subject: RE: Comments from the web site

Thank you for your inquiry. The 2003 trial was a small study conducted for what was then a small company. While it yielded very strong results, we feel that the methodology (protocol) employed is not consistent with our current product usage recommendations. Therefore, we no longer make it available to the public. Thank you for your interest in Airborne. Please
us know if you have additional questions.

Have a great day and stay healthy!

A small study for a small company? Are Airborne users really so naive as to buy the claim that companies with more revenue must conduct larger studies to be valid? And which usage recommendation was inconsistent with the "methodology (protocol)" -- perhaps the instruction to use it at the first sign of cold, or was it the instruction to Repeat Every Three Hours As Necessary? So much for those "very strong results" the package promised me.
According to the ABC News Good Morning America interview story:

Airborne said that a double-blind, placebo-controlled study was conducted with "care and professionalism" by a company specializing in clinical trial management, GNG Pharmaceutical Services.
GNG is actually a two-man operation started up just to do the Airborne study. There was no clinic, no scientists and no doctors. The man who ran things said he had lots of clinical trial experience. He added that he had a degree from Indiana University, but the school says he never graduated.
"I would not define that then as a clinical trial," Kroll [a pharmacologist at Duke University Medical School] said.
Airborne insists the results are valid, but the company is removing all references to the study from its Web site and packaging.
"We found that it confused consumers," Donahue said. "Consumers are really not scientifically minded enough to be able to understand a clinical study."

And there it is--Knight McDowell Labs' strategy summed up by its CEO on Good Morning America. We consumers just aren't smart enough to follow all that science mumbo jumbo anyway. Who needs it?

No Miracle Cure
Airborne is obviously not the only healthcare scam out there. (For an excellent rundown of homeopathy, reflexology, faith-healers, holistic therapy, diet fads, alternative cancer treatments, etc., read The Health Robbers: A Close Look at Quackery in America or check out the blogroll on Quack Files.) The FDA can rigorously enforce scientific standards and disclosures, but when Americans fail to comprehend the basic principles of the scientific method, the FDA cannot protect them from snake oil salesmen.
Simply chasing down false claims by liars like Knight McDowell Labs is a quick fix that ultimately fails. The packaging and web sites adapt to each demand, without a hitch in sales.
Unfortunately, curing this disease requires far more slow and expensive therapy--namely, better science education. (Hmm, now I wonder who might not want our children to think like scientists?) I'm not even talking about chemistry and physics. I mean a simple, new curriculum that introduces high school students to why and how science works--every day of our lives.
In other words, the real cure to the disease of quackery truly will be created by a school teacher!
Updates: Scientific American features this blog post in an article submitted as evidence of deceptive advertising against Airborne, leading to a $23m judgment against the company!

Blogged with Flock