Homeopathic treatments for tropical disease

You are absolutely right.This type of trade of selling medicines without any principles & logic is bad for homeopathy & for the public too.

Ah, homeopathy! I like to tell the story about when I had Lyme disease. I was working with some volunteers at my place of employment. I was on antibiotics, which make me quite sick, so I was grumbling about how wretched I felt. A volunteer told me that I should purchase her homeopathic remedy, which wouldn't cause the gastric agony that antibiotics did. She then told me about when she had Lyme disease and was using her own homeopathic remedy. She was traveling at the time, and by the the time she got to the Southwest, she was so ill, she couldn't walk. Apparently the homeopathy didn't work, so she ended up going to a doctor and getting antibiotics, which actually, you know, helped her.

And that, my friends, was her sales pitch.

Revere(s), although my research on natural products takes me into the area of herbal medicines and dietary supplements, I have yet to find any convincing evidence as to the efficacy of any homeopathic treatment. I am willing to admit that we in science and medicine do not know how everything works, but it is clear that homeopathy does not work; hence, there is no mechanism worthy of study, no matter how much quantum physics and water memory is invoked by advocates.

I'd like to draw the attention of you/y'all and your readers to one of the best medical education rebuttals to homeopathy by my pharmacy school colleague, Dr Steven Pray. His paper, The Challenge to Professionalism Presented by Homeopathy, appeared in the American Journal of Pharmaceutical Education in 1998. It is a truly expert and persuasive treatise that I use to this day in teaching medical, pharmacy, and nursing students the difference between herbal medicines and homeopathy.

Oops...Pray's article is from 1996, not 98. So, I've been using it longer than I thought - long enough to be at an age where I am now experiencing memory declines.

Quackery aside, isn't there some justification for the notion that some medicines may have stronger effects or perhaps different effects at high dilutions?
Hormesis?
For example, I seem to remember that opiods have paradoxical effects on pain at extremely low dilutions...

Let's not conflate a) homeopathy, b) herbal remedies, and c) nutritional supplements. These are different substances, and there are different issues.

Among my fellow geeks, there is much use of nutritional supplements and pharmaceuticals for keeping our brains in good shape. Vitamin B complex is the most common, there are some other supplements that are highly popular also (these are not stimulants or related to stimulants, and some of them have peer reviewed findings supporting their use for "maintaining normal cognitive functioning with increasing age"), and there are some prescription meds as well (similar, e.g. preserving memory functioning). (I'm not naming names of compounds here, that is deliberate.)

However, most thoughtful geeks also have the common sense to not self-medicate under conditions where calling an MD is prudent. Also we are quite aware of drug interaction risks and we behave accordingly (e.g. recently I had a life-threatening development that landed me in the hospital and resulted in a prescription for a medication that *might* interact with one of my nutritionals; hence I discontinued the latter until such time as an MD can advise further). We are aware of other risks, and good vs. bad practices, for example around proper vs. improper use of antibiotics (e.g. always finish the entire course). Generally speaking, we have a decent grasp of scientific method, we're prudent, and we tend to err on the side of caution.

Though, there is reasonable room for reasonable people to differ. I know one fellow geek whose approach to minor colds & allergies includes the use of homeopathic remedies. Y'all here might consider him a fool for "wasting his money" on "that stuff." Yet he would not take OTC "cold relief" meds that merely suppress symptoms; if he felt he had worse than a simple cold he would go from the homeopathics directly to an appointment with an MD. (And he would not use homeopathics for e.g. malaria.)

If there's a moral to this story, it's that people with reasonable smarts can take care of themselves, and can engage alternative and conventional health care practices on a prudent basis. We do not need, do not want, and will revolt against, any attempts at a regulatory regime that is based on protecting idiots from the worst sorts of idiocy at the expense of denying the right of informed individuals to make informed choices. More information is better than less; and informed choices are better than a lack of information or a lack of choice. In short, trust people to use their heads.

I would agree with g510, if choosing homeopathy were a legitimate choice, but it's a little bit like saying consumers should have the right to chose to participate in a Ponzi scheme.

The more basic point is that selling of many homeopathic and herbal remedies is essentially fraud. They are offering a cure or treatment that no clinical trial has ever proven beneficial. Selling somebody something under the pretext that it will cure something that it won't is fraud, plain and simple. The only reason that they avoid being regulated as drugs are is that these supplements are considered "foods" not drugs, and they avoid describing the so-called benefits on the box or label to avoid truth in labelling violations.

I'm having trouble seeing different between fraudelently offering someone a cure for a potentially deadly disease like malaria, and offering an ineffective treatment for a runny nose. Granted, the harm from one is worse than the other, but the deception is the same.

Here's a quiz: Who is more self-deceived?

A. Someone who believes that a homeopathic remedy will cure them even though there is no clinical evidence it will;
B. Someone who believes that pharmaceutical corporations and the money and influence they wield have zero impact on our understanding that their pills are effective and that homeopathy isn't;
C. Someone who believes that all truth regarding healing can be divined through randomized controlled trials.

And the correct answer is: D. George Bush.

I fully agree with g510. Let people make up their own minds. Many pharmaceuticals are based on naturally occurring substances (cf. tamiflu and star anise), but these aren't patentable and thus we are subjected to the side-effects of the synthetic substances they come packaged with in order to make money off them. Big pharma would love to see natural remedies regulated into oblivion, as their stranglehold on the healthcare market would be complete.

As for fraud in prescribing something that doesn't work: SSRIs (increase the dosage) versus L-tryptophan/5-HTP and diet (address the deficit) has to be one of the biggest crimes in recent medical history. Who wins out of that? Go figure.

Re. Quitter:

I should preface this by reiterating that I'm personally skeptical (open-minded skeptical) about homeopathy and don't use homeopathic products myself. However there is a larger issue at work here that needs to be addressed.

If you want to go after consumer products that fraudulently imply medical benefits, then you ought to start with the Hummer, which is sold as a male potency aid, sixty thousand bucks' worth. It's even named after the very act that got a President impeached. Buy a Hummer and your sweetie will give you a Hummer. Right.

In fact the entire SUV industry is founded on the same promise: masculine potency, thus the implicit promise of bigger better boners. Last time I checked, that was a medical claim for a couple of medicines whose names will probably trigger a spam filter here.

You should also go after the perfume industry, since the promise offered by perfume is to induce an altered state of consciousness, which, according to the FDA, is a medical claim (anything purporting to "affect human performance..."). Television also induces ASCs, including changes in EEG that are reliable, repeatable, and blatantly characteristic of being in a trance state. And perhaps worst of all are the sugar-overdosed cereals marketed to children with pictures of cartoony characters with wide bugged-out eyes and other overtly hyperactive traits that make them uniformly look like speed freaks cranked up on meth. Talk about making a pharmacological claim!, my God!, this crap is creating the meth addicts of tomorrow!

As for plain ordinary wastes of money, start with the real estate bubble. After all there is no simpler technology in the world than the roof. Any two of us can build one with common tools and materials. Yet the price of roofs has skyrocketed in recent years, and they are apparently in a chronic artificial shortage, characterized by the constant complaint on the part of working people about how hard it is to keep one over their heads. Perhaps someone is stealing roofs from over peoples' heads while they sleep; someone should investigate! And of course this lack of roofs is also a chronic public health problem, as people who don't have roofs to sleep under are also at high risk not only of being infected with various things themselves, for example multi-drug resistant tuberculosis, but being vectors for those diseases in the community-at-large.

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So, Quitter, I have a question for you: Who owns your body, and more specifically, who owns your brain? Do you? Or does the state, via its regulatory agencies? Because the moment you allow someone else to dictate what you can and cannot do with your own body and your own brain, they own you. And we have a word for that. It's called slavery.

So, g510, do you ever eat at restaurants? Do you do your own private health inspections beforehand? Or are you a slave of the health department?

Homeopathy is a VERY effective method, but ONLY if the right remedy, and to a lesser extent the right potency and dosing schedule, are used. Relatively simple principles that are often very difficult to put into practice, especially consistently. However, once you have experienced it personally, you know it is real and it doesn't matter any more that it doesn't make sense.

Guiding principles 2 and 3 above are not correct. (A rant against homeopathy really should start with accurate statements.) Remedies do not have to be in very low doses (although they often are), but they do have to be energized. It isn't a "single remedy for every illness", it is a single remedy for the totality of the individual person's symptoms. There may be dozens of remedies for what you might consider an "illness".

A basic problem with the treat yourself approach via OTC homeopathic remedies is that most people don't understand how to make the selection. With self study, it is within the grasp of the layperson to manage acute conditions homeopathically, but chronic conditions should almost always be left to the trained homeopath to prescribe. The malaria example is unfortunate, bound to fail.

By the way, homeopathic remedies, unlike herbal products, ARE regulated as drugs, by the FDA, since the 1930s.

I would rather we have the opportunity to take responsibility for ourselves than to have our options curtailed by regulation. There will always be folk medicine. Homeopathic remedies are among the most benign out there, and if used intelligently, the most effective.

Brooks: As I say, I'm a tolerant person. However, vanishingly small quantities are definitely a bedrock of homeopathy. I took that from a homeopathic site, but I know from my own reading in the history of homeopathy that this is so. Now you can redefine homeopathy if you wish and conflate it with herbalims or botanicalism or whatever you want, but small quantities are definitely required.

That aside, I am not a wholehearted advocate of each and every thing "conventional" medical practice does. It is capable of much harm and a great deal of it isn't any better founded, scientifically, than homeopathy. But most of it is and very little (if any) homeopathy is well grounded, scientifically.

Maybe some of it works. I know many people who say they derive great benefit from chiropracters, even though there is no scientific basis for what they do. And pleny of people say they derive benefit from religion. Fine with me, as long as you don't make me take your medicine, homeopathic, religious or chiropractic and don't hurt people by depriving them of treatment that could help them (consider Christian Science).

g510, quitter, et al....simple solution: homeopathic and herbal remedies should all be required to state on their label in big bold letters that there is no scientific proof these products have any of the benefits they claim to have, although there may be some anecdotal evidence to support them. It's a buyer beware. You are allowed to choose what to believe, what to spend your money on. Alot of people have been cured by placebos, because they simply believed they would be. Sometimes I think alot of conventional medicine works largely the same way. Essentially, in many cases, we cure ourselves, and an MD helps us to do so.

Actually, there have been quite a few published clinical trials showing homeopathy is effective. If you are interested, the information is out there, but you'll have to do your own searches.

The dilutions were necessary because the first remedies to be evaluated were all very toxic in their material form - stuff like arsenic and mercury. However, homeopathic remedies start at 10% material ingredient, indicated as "1X" - the "X" being the decimal scale and "1X" meaning it has undergone one dilution of 1 part to 9 parts, but then also succussed (shaken, energized). 10% isn't teensy by any means, probably more than many allopathic medicines contain. From there, depending on the condition, it may be greatly diluted, but that isn't what makes it homeopathic, only what makes it less toxic and more powerful. More powerful is not always indicated, sometimes contraindicated, for a particular situation.

I'm not sure what you mean by "conflate it with herbalims or botanicalism". I wouldn't do that - they have nothing in common. They may work together, as conventional and homeopathic treatments can as well, and an informed and unbiased doctor would do just that.

My cat recently had surgery, and I controlled her post-operative pain just fine using only homeopathy, and with absolutely no side effects (which were a mainstay of the pain medicine my vet gave me for her and was sure she would need). Hardly a placebo if it works in an animal. It was clear from her behavior when she needed something, and she responded within moments of receiving the remedy (the pharma would have taken longer). I kept the pharma painkiller on hand for her, in case I was unsuccessful, but it was simply never necessary. Overall, her recovery was much faster and much gentler as a result of homeopathy. It's a shame it isn't used more often, but it does take knowledge and experience to use it effectively.

There has certainly been some work. As with conventional therapies, there are both positive and negative results. Here is an interesting one from a journal I *can* get access to:
Witt et al., 2005.

There is a bit of a double standard going on here--the legal and financial incentives make it difficult to justify randomized clincial trials for alternative remedies that are already legal cash cows. I think there has been some movement, particularly by Tom Harkin (D, IA), to regulate these treatments--but it takes doctors to convince legislators, and most doctors just like to make jokes about alternative medicine [like revere's homeopathic birth control joke] as if ALL of it is quackery.

We have five NHS Homeopathic Hospitals in the UK, in London, Tunbridge Wells, Bristol, Liverpool and Glasgow.
http://www.trusthomeopathy.org/csArticles/articles/000000/000066.htm

Here are some fairly straightforward standards:

1) Test and label for purity and potency.

2) Any health claims should be backed by peer reviewed publications.

3) If potential adverse consequences are confined to the individual consenting adult who chooses to use a substance or technique, no regulation beyond prohibition of overtly toxic substances.

4) If the potential adverse consequences have a reasonable probability of also affecting individuals who are not consenting adults who choose to use a substance or technique, then require printed label statements to the effect that the compound in question has not been proven effective and should not be taken under such-and-such conditions. Also reserve the power to ban products in the event of egregious claims, e.g. "Dr. Bob's Chicken Pills cure avian flu in three days or your money back!"

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The issue of belief: Science tends over time toward convergence, but there are always areas in which controversy remains, and these are largely matters of a-priori belief systems. For example Hubble's Big Bang theory was originally rejected by mainstream astrophysicists essentially on the basis that since Hubble was a Catholic priest, his theory was an attempt to sneak God in via the back door, and since God was taboo (I use that word deliberately and with full intent of its implications) in science, Hubble's theory must be rejected. For example, disbelief in human impacts on global climate, though presently a dwindling minority position, is largely grounded in financial vested interests. For example, the very existence of near-death experiences (NOT the same issue as whether their content reflects an actual afterlife or an abnormal brain condition) was initially rejected altogether (as in "no, that did not happen to you, you are making it up") because they also have potential religious implications. And on the flipside, we have 1/3 of people in the US believing that evolution and natural selection are false, and instead believing in a Biblical version of creation as literally true.

What we must do, MUST do, as a pluralistic society, is allow room for freedom of belief and action, so long as one individual does no harm to another. The concept of freedom of religion was born at a time when religion was considered the primary arbiter of fundamental truth. Today we consider science as the primary arbiter of fundamental truth (OK, most of us here do, anyway). Yet even issues of basic methodology differ between the physical sciences, the biological sciences, and the social sciences.

In some cases these differences are not large, but they lead to substantially different beliefs and paradigms among individuals in the various disciplines. Within disciplines there are often ferocious differences of opinion and belief about methodological issues, for example how to operationalize variables, what threshold of significance constitutes support for a hypothesis, and so on. Overall this picture bears much resemblance to the differences between denominations within a given religion, and in some cases bears resemblance to the differences between different religions entirely.

But the bottom line is, we are a pluralistic society, and the idea of enforced orthodoxy of belief is not only alien to, but inimical to, our core traditions. This is subtly but significantly different from the idea that scientific methods and findings should inform public policy. The former is the realm of the private and personal; the latter is the realm of the commons; and only the worst sorts of tyrants would attempt to drag the private into the public by way of such excuses as interstate commerce.

Homeopathy has worked for my family. While, as a biologist, I would never take it for life threatening symptoms, I have found it very helpful for allergies. I suffered from a reaction to molds and my doctor put me on cortisone but I wanted to find a system that allowed me to respond in a timely manner to my bodies over-reactions. I come from a family that has had intensive association with the medical community and I find that their atomic answer for everything disturbing. I also have seen the devastating effects of the over prescibed meds that have become a way of life. I call it a gentle coaxing for my body in the right direction. This allows me to listen to my body rather than run rough shod over my symptoms. Do cold medications work- no they only hide the symptoms while you go to work and get sicker. A tolerance for a combination of conventional medicine and holistic approach to your body would find you in better health.
In the world you are predicting, fleeing doctors in the event of a flu epidemic, I suggest you prepare and then have a back-up system- homeopathy is mine. I am testing it's limits while I still have the opportunity.

G510: Gosh, I've taken Dr. Bob's Chicken Pills for over a year now with no ill effects. LOL.

Did you see the recent article on cinnamaldehyde? Isolated from Guizhi-Tang, a traditional Chinese medical formula used to treat flu. (Note: if you read the abstract, PGE2 is a largely pro-inflammatory prostglandin.)

I'm too am "a western physician who believes strongly in modern medical science".

However I don't think we should let our enthusiastic condemnation of "alternative" medicine obscure the fact that large parts of "our" medicine are disctinctly dubious, non-evidence-based and frankly fraudulent. I suspect at least 10,000 times as many people have died from corrupted scientific procedures involving Vioxx, SSRI antidepressants and several other drugs than have died from taking diluted water as malaria prophylaxis.

I should know. Anyone who harbours any illusions about our "science" versus their undoubted "nonsense", and that approval of drugs by the FDA is in any way secure should take a careful look at what is happening in pharmaceutical medicine right now. We are not talking about the uncertainties of science - we are talking about fraud, and the collusion of government in the corruption of science.

My blog and the "allopathic" shenanigans involving Procter and Gamble in Sheffield
http://www.scientific-misconduct.blogspot.com

And as some random examples

Lawmakers say fda should clean up its act
http://www.scoop.co.nz/stories/HL0608/S00229.htm

More about the Fall of the FDA
http://www.seedmagazine.com/news/2006/07/the_fda_is_a_cauldron_of_disco…

Why pharmaceutical companies need to be prevented from researching clinical aspects of their own drugs
http://scientific-misconduct.blogspot.com/2006/08/why-pharmaceutical-co…

Experts Fault New FDA Drug Label Changes
http://health.msn.com/healthnews/articlepage.aspx?cp-documentid=1001371…

Aubrey: I presume your comments were directed to others as I expressed much the same sentiments as did you. The malaria example seems quite egregious, however, and the homeopathic establishment was condemning it.

Homeopathy as a clinical practice seems to be quite "plastic" regarding its definition. Many people consider it a generic kind alternative medicine or a type of herbalism. Homeopathy, strictly speaking, is neither, and in its purer forms makes little sense to me. Whtether some remedies that go under the name homeopathic work better than a placebo is an empirical question, which needs to be considered case by case. The same is true for conventional medical therapies.

11dogs, if I understand you correctly, the potential unavailability of medical or pharmaceutical assistance in the event of a h5n1 pandemic is one of the main reasons I am expanding my understanding of homeopathy. I am quite confident that it can match up favorably against conventional medicine in treatment of flu, but it isn't something I would advise someone with no experience with homeopathy to rely on. So I am also "testing its limits while I still have the opportunity".

revere, if I didn't make myself clear, I generally share your sentiment about the malaria example. While there may be homeopathic prophylactic options for malaria and there are definitely treatments, that isn't the way to apply them with any confidence.

What no one here seems to have mentioned are the execrable claims of some in the homeopathic community to have successfully treated victims of the 1918 flu, and thus their claims to already have an effective treatment for H5N1.

If there's an outbreak, people like this will be the death of thousands, particularly if it causes the deluded souls who believe this nonsense to avoid some widely available treatment that might be scientifically verified as effective (such as, say, tamiflu, or statins, or a vaccine, should we ever get there).

booboy,
tamiflu and statins(?!?!?!) scientifically verified human H5N1 treatments?
Not yet.
How many shares of Pfizer stock do you own?

boojieboy, if the symptoms of the h5n1 pandemic strain are comparable to the 1918 symptoms, then the current homeopathic arsenal of remedies already noted for influenza WILL be capable of treating h5n1. Unlike 1918, the internet will make it possible to widely disseminate the name of the "genus epidemicus" - the remedy or two that has proven most effective in treatment. However, we won't know for sure until it has started. Meanwhile, there have been enough corollaries made between h5n1 and 1918 that 1918 at least is a guide about what remedies might be worth stocking.

http://www.herbaltherapeutics.net/Favorite_Remedies.pdf

Interesting that you linked to Sandra Perko's book - an outstanding homeopathic textbook on treating flu and how to choose the right remedy.

Until your "widely available" conventional treatments are just that, it might be worth looking into some alternatives.

Now this is an interesting thread: the issue of evidence supporting or otherwise, for various treatments including homeopathy, in relation to avian flu. It appears to be leading toward a proposal, or at least an idea that could be put to use.

Before going there, I'll state a bias up front, which is that I believe the planet is overpopulated with humans by a factor of three, so quite frankly, I believe we're in for a dieoff one way or another, and attempting to put it off will only make it worse. If I wanted to moralize about it, I would say we *deserve it* for our hubricious breeding & consuming behaviors, and perhaps it will lead to some kind of behavioral evolution after it's over.

That being said, I see no reason why people shouldn't be able to "guinea pig" (here I'm using the word as a verb) for the sake of empirical data collection. With the internet this should be relatively easy. Develop a project design, recruit volunteers, and see what happens. Strictly speaking, doing this under anything less than controlled conditions would produce only anecdotal data, no more or less valuable than the results of a survey. But it would be a start, and of course it would be even more interesting if a couple of major universities made an advance commitment to do follow-up studies in the event any positive findings come in for unorthodox health practices.

The worst that can happen is for individuals to become asymptomatic contagious carriers as a result of their self-treatments. This risk could be contained somewhat by having them go into self-quarantine. Aside from that, the worst that could happen would be for a bunch of consenting adults to drop dead. But keep in mind: a) they would be consenting adults, and b) there are 4-plus billion too many of us on earth anyway, and c) we might discover something interesting along the way.

The premise behind homeopathy, at least as I understand it, is laughable. Tell me if I have this right:

1. Start with a substance that induces symptoms similar to the illness to be treated. Why? Magic, apparently. 'Principle of Similars' or somesuch.

2. Dilute the substance repeatedly by factors of 5 or 10, often to absurd levels. Don't worry that the chance of even one molecule of your substance remaining may be infinitesimal.

3. Be sure the shake in a special way after each dilution, to 'energize' everything. This makes it actually get stronger at each step, right?

It amazes me that a rational person could believe in that.

Yet I accept the possibility that some so-called homeopathic remedies may have real effects (beyond the placebo effect). Brooks notes that some preparations are not highly diluted, and might contain 10% of the supposed active substance. Such preparations could very well have beneficial physiological effects, but there is nothing to distinguishe them from other, non-homeopathic natural remedies. That certainly doesn't validate the principles of homeopathy.

It is indisputable that some natural substances have medicinal value. I expect that at least some 'natural' remedies, and even some homeopathic remedies (if not overly diluted), include useful active ingredients. But if so, they act according to normal physical and pharmacological principles. There is no magic involved, no special 'energy' or other such woo.

And yet, I fully agree with g510's post at 7:10AM on 9/1. People should generally be free to do as they please, and that includes the freedom to care for themselves as they think best. The ideas behind homeopathy may be ludicrous, but if that's what some people choose to believe and apply to themselves, who am I to say they can't?

(Of course, things get more difficult in areas like infectious disease, or treating severly ill children, but that's another matter.)

P.S. to g510: you don't seriously think the Hummer is named for a sex act, right? That whole post was rather wild-eyed and over-reactive, so I can't be sure.

qetzal, the overriding reason why I use homeopathy is because it works, with no side effects, often much faster than the allopathic analog (if there even is one), and has the potential to cure while the allopathic analog may only suppress.

Homeopathy is an energy medicine. Discussion of material physiological effect is therefore irrelevant.

I was as skeptical as you until, out of desperation, I went to a homeopath. Since then, it has been a fascination and I have soaked up what I could about first aid and acute situations because learning about those are within reach of the layperson.

"Homeopathy is an energy medicine. Discussion of material physiological effect is therefore irrelevant."

With respect, Brooks, I think that's hooey. I am unaware of any evidence for 'energy medicines.' If homeopathy works for you, I suggest it's most likely the placebo effect. The other alternative is conventional pharmacology, if you take remedies that aren't highly diluted.

The reason those explanations are preferred is that we know both of those things really exist. I've seen no demonstration that the 'energizing' step has any value whatsoever, or that 10^50 dilutions of anything can magically retain activity.

Of course, if you know of any good evidence to the contrary, feel free to post a link. (Not anecdote, please, evidence.)

Homeopathy is just one of the energy medicines. Chiropractic and acupunture, done right, are other examples.

Placebo is a universal enough phenomenon, but no more an explanation of homeopathy than for anything else. (Take two people with home medicine cabinets. The western medicine devotee takes something from his cabinet, is pleased with the results and knows that is the reason he feels better. Ditto for the homeopathic devotee. But the western medicine devotee, if a homeopathy skeptic, will completely discredit any sense of real benefit by the homeopathic practitioner without having any sense of the massive hubris behind that opinion.)

You can get at some of the proof you requested through the link Solitaire provided.

Brooks, have any of these homeopathic remedies of yours been put to the test? i.e., a randomized clinical trial. I, for one, would be very interested in seeing the results.

The current subtypes in Indonesia by the way are substantially more virulent that the 1918 H1N1 subtypes.

I reviewed the evidence for statins, and although promising, found it a bit lacking (see below). However, Fedson's review in Clin Infect Dis this summer was a bit more positive.

[Statins, a class of drugs which were originally designed as HMG-CoA reductase inhibitors to lower cholesterol levels have been recently suggested as potential immunomodulators for the hypercytokinemia induced by avian influenza (34), although evidence to support this possibility is still limited. For example, prior statin therapy was found to decrease the rate of severe sepsis and admission to intensive care (35), and reduce the 30-day mortality of patients with community-acquired pneumonia (36). Also during the flu epidemics between 1996 and 2003 in the Netherlands, out of a population sample of 60 000, patients who had at least two statin prescriptions over the previous 12 months had a 26% lower risk of pneumonia and severe respiratory problems (34).

Less is known about the immunomodulatory properties of statins than steroids. In a very small study of patients (N = 16), randomly allocated to a diet (control) or diet + simvastatin (treated), the treated group had significant decreases in monocyte expression of TNF-α and IL-1β (37). In another study, Swiss researchers demonstrated that statins inhibit induction of MHC-II expression by IFNγ, thus acting to repress MHC-II-mediated T cell activation and halt recruitment of other cells to become MHC-II positive (38). Constitutive MHC-II expression was unaffected under these conditions, which makes statins unusual immunomodulators in this respect.

At present, we do not believe the evidence is sufficient to warrant a recommendation of statins as a possible class of drug for use in the therapy of severe cases of avian influenza, although we do not find contraindications to their use in such cases. In addition, even though the U.S. Food and Drug Administration has so far denied applications for lovastatin and prevastatin, the British government permitted over-the-counter sales of simvastatin (39), which might possibly lead to its use as a prophylactic by the general public.

References
34. Enserink M. Old drugs losing effectiveness against flu; Could statins fill gap? Science 2005; 309: 1976-1977.
35. Almog Y, Shefer A, Novack V, et al. Prior statin therapy is associated with a decreased rate of severe sepsis. Circulation 2004; 110: 880-885.
36. Mortensen EM, Restrepo MI, Anzueto A, Pugh J. The effect of prior statin use on 30-day mortality for patients hospitalized with community-acquired pneumonia. Respir Res 2005 Jul 25; 6:82.
37.Ferro D, Parrotto S, Basili S, Violi F. Simvastatin inhibits the monocyte expression of proinflammatory cytokines in patients with hypercholesterolemia. J Am Coll Cardiol 2000; 36: 427-431.
38. Kwak B, Mulhaupt F, Myit S, Mach F. Statins as a newly recognized type of immunomodulator. Nat Med 2000; 6: 1399-1402.
39. Choudhry NK, Avorn J. Over-the-counter statins. Ann Intern Med 2005; 142: 910-913.]