I can hear you, just barely hear you, I can just barely hear you

I have tinnitus in my left ear. At least, I think that's what I have; my attempts to get the condition diagnosed have generally been unsatisfying. For me, it manifests as a static sound, accompanied by a feeling of movement or pressure or something in my ear canal. It comes and goes, and it usually accompanies sounds, but not with any particular pattern I've been able to discern. Naturally, it never seems to happen when I'm getting tested, so I'm sure that's contributed to the vagueness of my diagnoses. It's a nuisance, more than anything, but I'd certainly like to be rid of it.

So, recently I've heard this commercial on my local Air America affiliate. It starts with some overly dramatic voices--"Do you hear it?" "I hear it all the time!" "It's annoying." "It keeps me awake at night."--and so forth. There's an annoying sound in the background, which rises in intensity as the voices rise in desperation, and if that portion of the commercial were to escalate any further, I'd expect it to head for some desperate Lovecraftian or Poeian declaration of insanity--"'TIS THE BEATING OF HIS HIDEOUS HEART!" or something.

Cue the soothing sales pitch, saying that you can "hear the silence" with Quietus, an all-natural herbal remedy for tinnitus. My first reaction was one of sardonic literary geekery: yes, I imagine that quietus is a cure for a great many ailments. All of them, in fact. I just wonder if they make it with a bare bodkin.

That lame English major joke would have been the end of this post, but that "all-natural herbal" tagline in the commercial seemed like an opening for copious amounts of woo, so I dug a little deeper. Lo and behold, when I found their website (such as it is--it's just a one-page ad with no information about the composition), the woo ran hot and cold like pure water:

That's right, it's homeopathic. For the two of you who don't know, homeopathy is a pseudoscientific alternative medicine modality based around the "Law of Similars"--that if you have some symptom, the way to cure it is by taking small amounts of substances that cause that symptom. In order to achieve those small amounts, one part of the allegedly curative substance is diluted in ten or one hundred parts of water, which is then shaken in a particular way. This procedure may be repeated several times, giving incredibly dilute solutions. And by "incredibly dilute," I mean "well beyond Avogadro's Number, so diluted that none of the solute remains in the solution." This is okay, because the water has memory, and shaking it causes something about the vibrations of the substance to yadda yadda. The point being that if it worked the way homeopaths claim, it would require us to completely rewrite the laws of physics. Thankfully for the physicists, homeopathic remedies consistently fail all well-designed tests of efficacy.

Now, it's possible that Quietus uses one of the more potent dilutions--1X, for instance, would be a 1/10 dilution, which is quite potent for some substances. I don't know, because the website doesn't include any information on the product.

But what the website does have is a phone number. I decided that this blog fodder was too rich to pass up, especially since it hit so close to home. So I gave them a call. I stayed on hold for awhile, jotting down the questions I wanted to make sure to ask. Eventually a representative picked up--we'll call him Dane--and asked me basic information about my name and condition. I was completely honest, describing my symptoms just as I did above, and mentioning that I've had them since about sixth grade or so.

He explained that Quietus is a chewable tablet that you take twice a day; over the course of the conversation, he further explained that most people show an effect in seven to ten days, and that you should wean yourself off of it once your symptoms are gone. But he was also careful to note that this isn't a cure for tinnitus, but it will cause the symptoms to go away, or it will cause you to stop noticing the symptoms--that much wasn't entirely clear.

Dane mentioned in the early part of the call that Quietus is a proprietary mix of various herbal remedies "proven" to relieve the buzzing, ringing, etc., associated with tinnitus. He also noted that it was "certified effective by the FDA Homeopathic Pharmacopoeia." When I could, I asked if he'd be able to tell me the ingredients--I wouldn't want to risk an allergic reaction, after all. He listed off a bunch of ingredients: Potassium blends, sodium, salicylic acid, iodide, and something called "cenosha" or "senosha" bark. I've tried looking up the latter on Google in a variety of spellings, but I can't find anything even close. After each substance, he mentioned that it has been "proved" to be effective on tinnitus symptoms.

I then moved on to the only question I had to really play dumb for: "You mentioned it's certified effective by the FDA Homeopathic...what did you say? I've heard of homeopathic stuff before, what is it?" Dane explained that it was the branch of the FDA in charge of vitamins and supplements. I understand what he meant, but he really wasn't answering anything even remotely like the question I asked. It was also clear that he either didn't know what homeopathy was, or really didn't want to say--and I suspect the former.

Finally, I asked, since it had been certified effective by the FDA, if there were any clinical trials. He answered that they had been proved effective, and that it had been proved for five years to be safe and effective. I asked if the results would be published anywhere, and if that information was available; Dane said that the literature that would be included with the pills would have testimonials and such. I may have cut him off a bit there; "I was thinking more like medical journals or something like that." He replied that he was pretty much just a salesman, and wasn't sure about anything like that. Obviously, I understood that.

Given that, I said that I wasn't sure if he'd be able to answer the other question--"What mechanism it works through, like the biochemistry of it?" He really didn't know, and I didn't blame him. At one point he'd said that the remedies enter the body and cause the brain (or ear) to no longer recognize the noise, but it was unclear how this happened.

Dane realized at that point that he hadn't even told me how much it cost--$59.95 for one bottle of 64 pills (I think that was the number), and discounts for more bottles, plus a 100% money-back guarantee if I'm not satisfied. I explained that I'd have to do a little more research first, and that I'd call him back. I realized the call wouldn't end there, because I'm sure he gets paid on commission. He asked whether it was a cost issue, or if I was just skeptical about whether or not it worked; I answered that it was a little of both. Dane suggested that the best way to find out if it works is to try it yourself, and I really held back the torrent that that Doggerel could unleash. I said "sure," and Dane said that everyone was different, so even if you look at all the trials, it won't tell whether or not it'll work for you. I agreed, but said that I know there are also cognitive biases that I wouldn't want to fall into, and so I'd like to do a little more research before I make a decision. Dane said that he thought we could both agree that the best idea would be to do some more research, look at the information, and try it myself. I chuckled a little and said that I agreed, and I figured I'd do the first step and call him back for the second. I thanked him for the information, and he more or less hung up.

I don't want to say anything disparaging about Dane, he was a nice guy, not really pushy at all, and I only wish he was a little more knowledgeable about the product. I feel a little bad for him; I wasn't going to be dropping $60 on homeopathic pills, regardless of the dosage, and so I did kind of waste his time. It's not his fault that homeopathy is bunk; he's just the guy answering the phones, and he wasn't prepared for some skeptic blogger to call and bother him for twenty minutes. Then again, that wouldn't be a concern if his employers weren't peddling pseudoscience as real treatment. Thinking back, I would have liked to have asked him about the dilution, but that would have tipped my hand as someone who knew a thing or two about homeopathy. I also would have liked to know if there were any expected side effects, and I'm kicking myself a little for not thinking of that in the first place.

I want to hit on that "proved" word which kept coming up in the conversation. Now, if it were a normal drug, then I would expect that word to refer to a multi-phase series of clinical trials, the results of which would be published in medical journals and available to anyone with the appropriate subscription. What "proving" means, apparently, in homeopathy is "homeopaths showing that a given substance causes a given symptom at some dosage." I don't know that this is what Dane meant in particular (and I don't know if he'd have known either), but I do find the repetition of that particular word to be interesting, since it does have such significance in homeopathy. In any case, the fact that it's in the Homeopathic Pharmacopoeia really doesn't mean anything to me; the FDA's regulations governing homeopathy are almost nonexistent, a problem exposed most recently by the Zicam scandal. If Quietus went through tests to demonstrate safety, as Dane suggested, then it went above and beyond what's necessary under FDA guidelines.

What all this comes down to is that tinnitus is really the perfect woo-friendly ailment. The symptoms are entirely subjective, which opens the door to some significant psychological effects. At least in my case, the symptoms also come and go irregularly and unpredictably, and I'd be a little surprised if even chronic tinnitus didn't wax and wane in severity over time. Not only does this open the door to confirmation bias, post hoc ergo propter hoc thinking, and regression fallacies, but it explicitly suggests that the latter is to be expected as a normal effect of treatment. Quietus isn't a cure, and Dane specifically recommended keeping some pills on-hand in case symptoms recurred. Therefore, any improvement in symptoms--even if that improvement is just normal, expected regression to the mean--would be attributed to the pills' effectiveness, and any restoration of symptoms has already been explained away as normal, expected, and reason to use more pills. I think the only fault in this scheme is the relatively small pool of sufferers--which I think accounts for the $60 bottles, as opposed to a more Zicam-esque $15 or so--but even then, since there is no actual cure, they've got a chance of snagging quite a large portion of those sufferers.

I can't say, without knowing a little more, whether or not this is a scam. After all, it might have therapeutic dosages of the substances in question, and they might be effective. What I can say that there's not a chance that I'll be dropping $60 on tinnitus remedies anytime soon, and that "try it for yourself" is about the last method I'd choose to evaluate the efficacy of such a drug.