If you read the box you posted, it doesn't say anything about, nor make any claim of, shrinking hemorrhoids. It says "Effective Relief of Anal Itch", which is what Hydrocortisone does. Granted, some might pick it up thinking it is regular Preparation H, but that would be their fault for not reading the package. I also agree that there are many sources of 1% Hydrocortisone cream which are less expensive and I also avail myself of those less expensive brands. Basically, this is just a case of Caveat Emptor and nothing more.