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:
I suppose it'd cause quietus if you drank enough of it.
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.

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22 Responses to I can hear you, just barely hear you, I can just barely hear you

  1. Techskeptic says:

    the funny part is that Quietus is the name of the euthanasia drug in "children of men" (awesome movie). Its a mass drowning procedure in the book.

  2. Bronze Dog says:

    I think it was "Cinchona bark" you were looking for. Sometimes called Quinine Bark (like quinine water), according to a quick Bing.Funny story, it contains a useful antimalarial drug, but the big reason why you'd never, ever want to take it in raw herbal form is that it also contains a variety of carcinogenic compounds as well.

  3. GDad says:

    Salicylic acid is used for acne treatment and wart treatment, and its relative, acetylsalicylic acid is aspirin.So you will probably not have any acne in your esophagus, at least.And I love the Quietus remark.

  4. Anatoli says:

    Heh, I am so going to mess with my pharmacy workers.

  5. Akusai says:

    This reminds me of the woo-meisters I was planning on fisking, turning in to the FDA, and reporting on the results. Maybe I'll do that after I get back from TAM.

  6. Anatoli says:

    Well, the pharmacy was a bit of a disappointment. I guess things aren't as bad here in Israel. We asked to see the 'holistic medicine' aisle, and were told that they didn't have one.Not to say there wasn't a whole section of dietary herbal supplements all saying the same one thing on the box, "Natural herbs are good for you," with not the tiniest implication of what it is exactly that the specific herb is good for and why I should pay the equivalent of 5 boxes of Aspirin for it.The one homeopathic remedy we could find was an X5 Bach Flower extract. I was really hoping we could find something under Avogadro's limit. :It ended up being a hoot still, though. I bugged her about how that low a concentration could be effective, "Well, that must be all you need.""But how does it work?"-"Through mechanisms as of yet unknown to science.""Then how do we know it has an effect?"-"Oh, there are studies proving it.""Then why hasn't the active ingredient been isolated? And why am I being charged so much for it? And why does the more dilute solution cost more?"-"What are you talking about?""Okay okay, can I see those studies, could you refer me to them?"-"Oh, it's not like I have these studies here. All you need to know is that its been proved to work.""Yeah right, lady."Having my lads laughing it up in the background was a nice touch.

  7. stuart says:

    I am writing this post to all atheists who have a vested interest in debunking the myth of Jesus Christ. I am sorry if it bothers anyone that I am not continue the discussions that are going on your blog. Please contact me at the email address below and I promise I will never post on your blog again.Here's what's up. A number of fundamentalist Christian blogs have come out swinging against a new book by Stephan Huller called the Real Messiah. The most recent being:http://atheistwatch.blogspot.com/But there are many others. The only allies he seems to have on the web are a bunch of Jewish bloggers who like him because his mother was a Frankist (see wikipedia for more about this sect).In any event Huller's book presents evidence that a two thousand year old throne in Venice proves that Jesus was not and never claimed to be the messiah. Huller is going to appear on CNN in two weeks as part of his promotion of the book. As a big fan of his work I wanted to alert my fellow bloggers about this interview and have as many of us who have read the book to direct questions which challenge the existence of God and the whole Christian-fascist paradigm. If you are interested in getting more information about his appearance please contact me at mastersonstuart@yahoo.com. If you haven't read the book here is a blog posting to familiarize yourself with his basic points when you do the phone in show:http://therealmessiahbook.blogspot.comThanks againStuart

  8. Genewitch says:

    Just out of curiosity in regards to trials (double blind or otherwise):Couldn't the homeopaths claim victory if the control group gets better at the same or slightly lower rate with the water dilutions?I think it's quite safe to assume that every "drop" of water on the planet has at one point been in contact with every substance on the planet possible. Wouldn't, then, the "water memory" allow even the control group's water to have the memory of … iodine or whatever that the experimental group's water also has? And isn't the idea "the more dilute the more better(sic)"?This is something that has really bothered me about the whole homeopathic movement – to listen to them, TAP WATER is the most powerful medicine in the world.Am i wrong, here, or what?

  9. It's that whole succussion thing, Genewitch. The magical water needs to be shaken vigorously, or it won't work!

  10. Aronaya says:

    So, when you hear the ringing in your left ear, are there any inner or outer conditions that correlate? Any patterns? How does the rest of your body feel when you hear the tinnitus?

  11. Michael says:

    As someone who writes a great deal about evidence-based medicine, is a skeptic and has tinnitus (alas, more severe than yours), I loved your post. I figured it would be herbal remedy. But homeopathy, too! Wow.Keep up the great work

  12. MUSE923 says:

    I loved your post, it really did all the "leg work" for me. I too have tinnitus, in both ears, and have started hearing ads for this product on the radio station I listen to most often, which clearly cares not a whit about the truth of the ads they carry. This is right up there with most of the ads for weight loss products. As I have been to doctors and audiologists and been told that there is really no effective treatment for tinnitus, I would LOVE to learn about something, anything, that offers some hope for relief. This, apparently, is not it. Just another way to separate the desperate and credulous from their money. Thank you for your "research" into this product.

  13. Anonymous says:

    I too have heard the Quietus ads on Air America. Love my Air America station, but hate the commercials they carry for quack medical treatments and weight-loss compounds. I hope everyone listening to Air America is smart enough not to take the bait.RE GDad: "Salicylic acid is used for acne treatment and wart treatment, and its relative, acetylsalicylic acid is aspirin."And aspirin can cause or worsen tinnitus. So can Pepto-Bismol, which contains bismuth subsalicylate.I suppose under the irrational logic of homeopathy, that's why salicylic acid is in Quietus–because it causes the problem it's trying to cure.The only reason I mention this is to say that I hope anyone with tinnitus avoids both aspirin and Pepto-Bismol-type medicines.

  14. Anonymous says:

    This is the worst article I have ever read… you wrote so much crap just to be repeating your complete biased thoughts.. I am 23 yr old musician and suffered an ear injury when I was 12 I have had "tinnitus" for almost a year.. All i did was change my diet, wear ear plugs at loud events and stay away from alcohol and my tinnitus diminished with help of some herbal supplements… This article goes right with all the snake oil products everyone seems to be selling to take advantage of desperate people looking for a "cure".

  15. Doubting Tom says:

    This is the worst article I have ever read… Then I encourage you to read more, because you've either read very few articles, or what you've read has been very high quality. I mean, at the very least, I've got proper grammar and punctuation, plus a Shakespeare reference! At the very least, that puts this above anything on WorldNetDaily. you wrote so much crap just to be repeating your complete biased thoughts..How are my thoughts biased? I did a quick investigation of the claims made in an advertisement. My only previous thoughts going into it were the well-established case against homeopathy and some knowledge about how science, medicine, and human thought work. I am 23 yr old musician and suffered an ear injury when I was 12 I have had "tinnitus" for almost a year..Why do you mention those two things together, as though they're connected? Do you have good reason to think that an ear injury caused tinnitus ten years after the fact? All i did was change my diet, wear ear plugs at loud events and stay away from alcohol and my tinnitus diminished with help of some herbal supplements…This is hilarious. "I did four things, and credit my recovery to only one of them." How do you know that the herbal supplements did anything? I would suspect that wearing earplugs (which would guard against future damage) and staying away from things which are known to exacerbate the condition would have more effect than unregulated, untested herbal supplements. This article goes right with all the snake oil products everyone seems to be selling to take advantage of desperate people looking for a "cure".I'm not sure what you're trying to say here. My post here is about those snake oil products designed to take advantage of desperate people. Homeopathy doesn't work, and that almost certainly includes Quietus. I don't recommend buying any herbal supplement for any condition, and I recommend strongly that no one buy homeopathic "remedies" for anything. This stuff is snake oil sold to the gullible and the desperate. So, is that last statement unclear, or did you just not read my post before commenting?

  16. Mike Toreno says:

    From your conversation it doesn't sound like the thing is really homeopathic – maybe they don't really know what homeopathic means? How would the "law of similars" apply to tinnitus anyway, no one knows exactly what causes it. And how can a chewable tablet be homeopathic, where's the water?Sounds more like some kind of herbal mixture they put together, and if that's true it's not impossible that it works. The fact that there haven't been any trials doesn't prove it doesn't work. Doesn't prove it does, of course, but doesn't prove it doesn't either. I mean, a drug that's proven effective in trials was effective before the trials were done. If they'll give you some free up front I'd try it, if I could establish that it wasn't harmful.I use this thing called Uricinex for gout, before I started taking it, I had terrible problems for months. After I started taking it, something happened. I did other stuff too, when I have an attack I take some baking soda solution, which is supposed to make your blood more basic, thereby increasing its capacity to absorb the acid crystals that are the source of the gout attack.I've had a much much easier time for 2 years, and I am unwilling to state conclusively that the Uricinex had nothing to do with it. It seems harmless enough, and, while it is effective as a wallet lightener, it doesn't lighten my wallet to such an extent as to cause a financial burden.Could be the same with Quietus (unless it's really homeopathic, in which case it is, of course, useless). It could work, and if it's harmless, seems to work, and is cheap enough, maybe it's worth taking.

  17. Mike Toreno says:

    OK, I should have read more comments before commenting myself, if it has salicylic acid, and salicylic acid makes tinnitus worse, per anonymous on 11/4, it's something to stay away from.

  18. Doubting Tom says:

    And how can a chewable tablet be homeopathic, where's the water?While I'm not familiar with homeopathic remedies in chewable tablets specifically, I know that it's fairly standard practice for homeopathic remedies to be sold in tablets. Apparently they take the properly succussed homeopathic solution and put a drop of it onto a sugar pill. It's like they're flaunting its uselessness. And I suppose if it's a sugar pill, it doesn't much matter if it's chewed or swallowed. Sounds more like some kind of herbal mixture they put together, and if that's true it's not impossible that it works. The fact that there haven't been any trials doesn't prove it doesn't work. Doesn't prove it does, of course, but doesn't prove it doesn't either.Agreed. But that still leaves "don't use it" as the most reasonable–and most safe–choice. Until it has been demonstrated safe and effective through the scientific process, the null hypothesis would be that it doesn't work. Further, while there are lots of herbs with medicinal properties, one of the results of medical testing is isolating the effective ingredients, purifying them, and developing a specific, appropriate, precisely-controlled dosage. This isn't true for herbal remedies; even if the chemical is effective, there's no telling how much of it you'll get–or even if you'll get any. I'll take aspirin over willow bark any day. If they'll give you some free up front I'd try it, if I could establish that it wasn't harmful.And I wouldn't, because of the other problem: personal biases. If I start taking some supplement, I open myself up to making all manner of fallacies (which I listed in the original post) of thought and observation, which may lead me to false conclusions about the effectiveness of the supplement. I did other stuff too, when I have an attack I take some baking soda solution, which is supposed to make your blood more basic, thereby increasing its capacity to absorb the acid crystals that are the source of the gout attack.I'm actually more curious about the baking soda thing. Blood is a buffered solution, with chemicals designed to balance out the pH if it gets too high or low. A pH as acidic as 6.8 or as basic as 7.8 can be deadly. The blood typically stays around a pH of 7.4, which means there's not a whole lot of room for it to get more basic. I hope you've either consulted a doctor or gotten the biology wrong on that process. Regardless, a little baking soda won't do anyone any harm; I just doubt that it'll have as much effect on the bloodstream as it does on, say, the stomach acid. I am unwilling to state conclusively that the Uricinex had nothing to do with it. It seems harmless enough, and, while it is effective as a wallet lightener, it doesn't lighten my wallet to such an extent as to cause a financial burden.You could always conduct a personal placebo test, but you'd have to draft a partner to do the blinding and recording. It'd take some time, effort, and interest, but it might end up making your wallet a little heavier in the end. OK, I should have read more comments before commenting myself, if it has salicylic acid, and salicylic acid makes tinnitus worse, per anonymous on 11/4, it's something to stay away from.Right, but according to the Law of Infinitesimals, if you avoid it altogether, you might overdose!

  19. Mike Toreno says:

    It says on the box how much baking soda you're supposed to take (that is, the maximum you should be taking). It's pretty well known as a remedy for stomach upset and I guess a number of people take it for that. I'm not concerned with it making my blood too basic, I figure the dosage on the box is way way to little for that. I'm more concerned about the sodium, so I took about half the dose on the box.I went to the doctor 3 times over the years for gout, I got some Vioxx(!) the first time (worked great, but expensive, plus the other problems that emerged later.) Then the next couple times after Vioxx was off the market, I got indomethicin, which didn't really work that great. The various remedies I found on the intertubes, though, do seem to work although I admit I can't tease out what's going on, whether it's just getting better by itself, whether it's the baking soda, the milk, the uricinex, or what.I know it isn't any kind of placebo effect, I'm too suspicious for a placebo to work, I think, plus placebos aren't that great on swelling or any other visible condition, I think. My milk plus baking soda in the middle of the night I saw more as a forlorn hope than anything else but damn, I got better all day Saturday. Now, the getting-better-by-itself effect, that's a different issue and could have been the cause. But milk's cheap and doesn't hurt you, baking soda's cheap and doesn't hurt you if you don't exceed the dosage on the box and don't take it for more than a couple days.With something as subjective as tinnitus, if the stuff was really homeopathic, and was cheap (which it isn't) I'd take it. It might work, and if it works, and is safe (which homeopathic remedies are, being essentially nothing) who cares if it works for a real reason.I did find some machine on the tubes that you can get, it's sort of a trainer or something, it plays countering sounds or something like that and you supposedly get to where you don't notice the tinnitus. It ain't cheap, and I can't remember whether it's medically recognized or not. A quick search just now didn't find it.

  20. Anonymous says:

    I have tried Quietus. It does not work! Don't waste your money or time. PREVAL, the company selling Quietus, promises a full refund. Not true. You can get a full refund of the purchase price of $119.00 60 days after you return the unused product by mail, but NOT the shipping and handling charge of $15.00. They keep that – there is NO FULL REFUND. Another refund option they offered me was they would credit $60 back to my credit card immediately and I keep the rest of the product (which doesn't work). This is a scam. Don't get sucked in like I did. Oh, another thing, they will also sign you up for legal advice and a buyers service for $19.95 a month each, even though you tell them you don't want it. I've cancelled that too but I'm still waiting to see the credit against my credit card.I would advise NOT doing business with this shady group of snake oil salesmen. They are preying on people, like myself, who are looking for some peace and quiet. Again, this is a scam.I've learned my lesson and still have tinnitus.

  21. Maria says:

    Hi, I am The editor/writer with medicine-worldwide.net. I really liked your site and i am interested in building a relationship with your site. We want to spread public awareness. I hope you can help me out. Your site is a very useful resource.Please email me back with your URL in subject line to take a step ahead and also to avoid spam.Thank you,Maria Jones maria.medicineworld@gmail.comwww.medicine-worldwide.net

  22. dancilhoney says:

    Be sure to drink plenty of water or fluids to flush out the uric acids. Gout really Is a hassle. But if you know how to counter attack it once it appears your in the right track of taking care of yourself. Uricinex

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