Cobroxin: Pain Reliever or Placebo?

Some of you may know that I like to trade stocks.  You may even follow my trading blog.

One strategy that I like to do is to short sketchy Over-The-Counter Bulletin Board (OTCBB) stocks and pump and dumps.  For example, I had a nice profit off of shorting the fraud GVBP and covering near 0 after the SEC stepped in and investigated them.

What's this got to do with this blog?

Well, there's this one particular sketchy company named Nutra Pharma Corp. (NPHC).  There's a lot of reasons why this company is shady.  Some of these reasons include a CEO with sketchy scientific credentials and who was caught plagiarizing from scientific research, and a former director with a past full of embezzlement charges and FTC false advertising.  However, this blog post isn't about the company NPHC...it's about the product they're pushing...Cobroxin.

Cobroxin is supposedly the "the first over-the-counter pain reliever clinically proven to treat various levels of chronic pain associated with lower back pain, shoulder pain, cramps, migraines, neuralgia and arthritis".

The first?  Hardly.  Plain ol' Tylenol has been shown in numerous studies to be effective in treating chronic pain.

Of course, that's not what's most B.S. about this product.  The product is made from cobra venom. 

That's right....this pain reliever is made from cobra venom. 

Now, the idea isn't totally absurd.  There is evidence that cobra venom has components that may have analgesic effects when injected.

However, the problem is with the Cobroxin product itself, and the complete lack of quality evidence to support its efficacy.

Cobroxin's manufacturer provides a list of studies that supposedly showed cobra venom or its components to have pain-relieving effects.  However, the majority of the studies they list involved injection of cobra venom or its components.  Only 7 out of the listed studies used oral delivery, and only 1 used topical delivery.  Of the 7 that used oral delivery, 6 of them did not report the dose used.  1 of them was only presented as an abstract at a conference and was never published in full form in a peer-reviewed journal.  There is no reference for another one (Xu et al, 2001).  2 more of them were presented in a Chinese journal (Journal of Snake), and there is no mention of placebo controls or blinding.  3 of these didn't even look at pain.

The fact is, the research presented that supposedly supports the use of Cobroxin is of extremely low quality (even the injection studies).  Many of the studies listed don't involve blinding, placebo controls, randomization, or any of the other things that are necessary for an adequate study.  Many of the studies presented are of so low quality, they would never be accepted in today's peer-reviewed journals (particularly in American or European journals, which are more stringent than Chinese journals).  Also, none of these studies involved Cobroxin itself; they are just studies on cobra venom and its components.

When it comes to pain relief, unblinded studies and studies that lack a placebo control are worthless.  It is well established that there is a significant placebo effect in analgesia studies.   Just the mere suggestion that a substance might relieve your pain will often actually reduce your pain, even if the substance has absolutely no biological effect.  There is evidence that the expectation of pain relief causes the release of dopamine and opioids, which, in turn, have an analgesic effect.

Another reason to be skeptical of Cobroxin is the long list of ailments that cobra venom or its components supposedly treat.  In this document, the manufacturer lists the treatment of everything from pain to diabetes to cancer to addiction.  Any time an ingredient is presented as a near "cure-all", it should be viewed with skepticism.

The fact is, there are no double-blind, placebo-controlled trials on Cobroxin published in peer-reviewed journals.  Extraordinary claims require extraordinary evidence.  The claims being made about this product are quite extraordinary....that it causes significant pain relief for moderate to severe chronic pain, across a wide variety of medical conditions.  And this is all without major side effects.  Such claims require much more evidence then the sketchy evidence that has been provided thus far.  However, given the shady history of Nutrapharma's executives, I doubt we'll ever see this level of evidence.

Disclosure:  I do NOT hold any position in NPHC, and never have.  I just find the claims being made about this product quite amusing, and deserving of a blog post.