The Science Behind Profits

Science is the only compass we have to guide the efficacy of new discoveries and treatments.  But we should continue to be skeptics even when something is “double-blind placebo controlled”. 

Herpes labialis or “cold sores” are common lesions of the oral mucosa that are prevalent in our population (as many as 1.6 cases per 1000 people).

First let’s learn some virology! Herpes simplex virus 1 or "HSV1", is the virus responsible for those annoying lesions. It is a type of DNA virus, that after infecting the host, causes the painful sore (in the case of HSV1 in the oral mucosa) to help shed itself. Then it runs away to the neural ganglia to “hide” from the immune system. And then it waits. During periods of stress, such as illness or life events, our immune system is compromised and the virus migrates from its hiding spot back to the oral mucosa and BAM! you get another cold sore. Lather, rinse, repeat. Those painful lesions reoccur in one of every three sufferers. [1]

The most frustrating thing about this little virus is that we don’t have a good way of treating it. For example, doconasol commonly known as “Abreva” only reduces the effects of the virus by a whooping 18 hours! [2]

“The median time to healing in the 370 docosanol-treated patients was 4.1 days, 18 hours shorter than observed in the 367 placebo-treated patients (P =.008; 95% confidence interval [CI]: 2, 22).”

The reason the docosanol is not more effective, is because it prevents attachment of the virus to the host cell. Once the virus is inside the cell, then the virus is safe. By the time you begin to feel symptoms, the virus is likely already reproducing inside the cell. You are only preventing more viruses from infecting more adjacent cells. Secondly, by using such a poor mechanism of inhibition, you are selecting for viral particles that are resistant to docosanol. And when they come out of hiding the treatment will be even less effective. Talk about evolutionary mechanisms of survival!

Now, no one is disputing that those are significant results. They were achieved because the number of people treated did benefit from the treatment over placebo. And just like everything science can be motivated by money. Imagine, hundreds of hours spent in labs, millions of dollars spent in trials and product development. There has to be some profit somewhere. 

We can see this biased interpretation of scientific results in many places, from food science to nutraceutical science and it turns out that evidence-based medicine is not absolved. The problem is that companies can wordsmith scientific data to make results look better than they actually are.  They advertised docosanol as being “able to cut healing time in half”

The papers and the studies are out there for you to interpret, and if you think that applying a cream every two hours and shortening the infection time by 6.4% is worth the price; then go for it!

The advertisers for doconasol, said it was. And it worked, To the tune of $3,420 per pound of docosanol

1. Opstelten W, Neven AK, Eekhof J. Treatment and prevention of herpes labialis. Can Fam Physician. 2008;54(12):1683-7.

2. Sacks SL, Thisted RA, Jones TM, et al. Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial. J Am Acad Dermatol. 2001;45(2):222-30.