An Herbal Cure for Peanut Allergy?

Peanut allergy is uncommon but devastating. Even a tiny trace of peanut can cause an anaphylactic reaction and death. That’s why labels specify “produced on shared equipment with nuts or peanuts” or “produced in a facility that also processes nuts.” There is no effective treatment: patients have to rely on avoiding peanuts and carrying emergency epinephrine injectors. Parents of peanut-allergic children live in fear that their child will be inadvertently exposed at school or at a friend’s house. Wouldn’t it be great if we could fix it so they could eat peanuts with impunity?

There is a ray of hope. Studies are underway on a Chinese herbal medicine (FAHF-2) that shows promise. I generally shy away from Chinese herbal remedies, because they are marketed without adequate testing and the products are not quality controlled. The typical course of events is (1) a preliminary study or a history of use in China, (2) marketing in the U.S. with overblown claims.

This is different.

FAHF-2 has been tested in a mouse model in well-designed studies at reputable U.S. institutions (Mount Sinai and Johns Hopkins). Research was funded by private foundations and government grants (not by manufacturers or business interests) and published in a reputable peer-reviewed journal, The Journal of Allergy and Clinical Immunology. As far as I can find, it’s not being marketed in the U.S. No claims are being made for it. It hasn’t been tested in humans. The NCCAM has funded the first clinical trial with an estimated completion date of December 2009.

The researchers had been studying a mouse model of allergic asthma and had had some success with another herbal formula. This prompted them to look into peanut allergy. Food allergy is not described in the traditional Chinese medicine (TCM) literature, but there was an herbal formula called Food Allergy Herbal Formula -1 (FAHF-1) that had been used in Asia for prevention of allergies and asthma. It contained ling zhi, an herb that had anti-inflammatory and anti-allergy properties, and wu mei wan, which had been used to treat gastrointestinal symptoms. It also contained 9 other herbs.

They tested FAHF-1 on a mouse model of peanut allergy. They found that it completely blocked the anaphylactic reaction when the allergic mice were challenged with peanuts. It not only blocked clinical symptoms, but it reduced mast cell degranulation, histamine release, peanut-specific serum IgE levels, and Th2 cytokine secretion. They checked the mice for possible toxic effects on liver and kidney and for possible immune suppression, and found no abnormalities.

Two of the ingredients were worrisome. Xi xin is wild ginger, which can contain aristolochic acid. Fu zi contains aconite. Both are toxic to humans. Aristolochic acid was implicated in an epidemic of kidney damage in Belgium from a contaminated herbal weight loss product. They simplified the mixture by removing these two ingredients, and called the new formula FAHF-2. They tested this new formula and found it worked just as well. The effects persisted for several weeks after treatment was discontinued.

They wondered if using just wu mei or ling zhi alone would work. In preliminary studies it appeared that neither was as effective as the whole formula. They postulated that some kind of synergism was at work. I wondered why they didn’t try eliminating herbs one by one, starting with the ones they thought were least likely to contribute. I find it difficult to imagine that all 9 herbs are necessary for the synergism, especially since they already removed 2 herbs without making any difference. It’s always possible that one herb might be acting antagonistically and that removing it might improve the effect.

Lo and behold, in 2008 they did almost what I thought they should. They tested individual components and found only partial activity in them. They concluded that the whole shebang was the best thing to use in continued testing.

The formula they are now working with contains:

• ling zhi (ganoderma lucidum), 28.17%
• wu mei (fructus pruni mume), 28.17%
• huang lian (rhizoma coptidis), 8.46%
• ren shen (radix ginseng), 8.45%
• huang bai (cortex phellodendri), 5.63%
• gan jiang (rhizoma zingiberis officinalis), 8.45%
• dang gui (radix angelicae sinensis), 8.45%
• gui zhi (ramulus cinnamomi cassiae), 2.81%
• chuan jiao (pericarpium zanthoxyli bungeanum), 1.41%

They have experimented with different extraction methods and have tried to minimize the bitter taste.

A clinical trial was approved by the NCCAM and is in progress. It is only a small preliminary study with 18 subjects. If this trial is successful, they will go on to larger trials.

Most drugs that enter initial clinical testing never make it to market. I don’t have high hopes for this one. It may not have the same effect in humans. It may turn out to have harmful side effects. The mouse model may be flawed. One or more ingredients may be superfluous.

There doesn’t seem to be any rhyme or reason to the particular combination of nine ingredients. That doesn’t mean it can’t work, but it makes me wonder. How many evidence-based remedies can you think of that contain multiple herbal ingredients? I can’t think of any offhand. They thought for a while that PC-SPES was one. It was a mixture of 8 herbs that appeared to slow the progression of prostate cancer, but it turned out to be a real fiasco. Double-blind testing showed it was significantly better than placebo – but only because the manufacturer had been spiking the mixture with 3 pharmaceutical drugs! Independent lab analysis of early batches showed significant amounts of diethylstilbestrol (DES), which is a synthetic estrogen, and indomethacin, a potent anti-inflammatory drug. Later batches showed that warfarin, a powerful anticoagulant (blood thinner), had been added to counteract the tendency of DES to cause blood clots. The researchers were sincere, but their suppliers were engaged in deliberate and dangerous hanky-panky.

Whether FAHF-2 pans out or not, I have to applaud the researchers. They didn’t patent it as a diet supplement and try to sell it to the public. They are doing good science. This is the way all herbal medicine claims should be handled, with stepwise investigation including attempts to isolate effective components.

If it does turn out to work, they’ll have to come up with a snappier name.

Posted in: Herbs & Supplements

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53 thoughts on “An Herbal Cure for Peanut Allergy?

  1. overshoot says:

    Whether FAHF-2 pans out or not, I have to applaud the researchers. They didn’t patent it as a diet supplement and try to sell it to the public. They are doing good science. This is the way all herbal medicine claims should be handled, with stepwise investigation including attempts to isolate effective components.

    If it does turn out to work, they’ll have to come up with a snappier name.

    More like a whole series. It does seem as though the pharmacologists are going to have a fun time trying to track down the active ingredients in this mess. Even animal models to narrow the scope are going to be hideously expensive, so finding a way to study the effects in vitro should be a high priority.

    Perhaps the best thing that could come of this would be an improved methodology for exploring large pharmacological spaces.

  2. qetzal says:

    Interesting post.

    I’d often wondered if there was any evidence that such herbal preparations really benefited from having so many ingredients. This is the first apparently decent evidence of that that I’ve seen.

    I have to admit I’m still a bit dubious, though. How would ancient Chinese herbalists have determined that these 9 herbs (or 11, in the original formulation) in these proportions were optimal for treating allergies and asthma?

  3. Fifi says:

    qetzal – It seems clear that at least two of the ingredients weren’t necessary so the ancient herbalists didn’t create the optimal mix – it seems a bit more like an everything-and-the-kitchen-sink approach. You know, throw things at the wall and see what sticks – who knows how many unsuccessful formulations were used/tried before this mixture was hit upon. The history of medicine is full of happy accidents as well as things that get it sort of right but not completely :-)

    Another very obvious example of a synergistic herbal formula is ayahusca (used by South American shamans and Westerners who like to get high but want to frame it as a spiritual quest), it’s the combination of ingredients that make it psychoactive.

  4. Karl Withakay says:

    Interesting. Such a scientific approach from the NCCAM is surprising.

    I would hope that if the trial has positive results, that the next step would be to isolate the active compounds and test for ideal formulation. As long as it is an herbal cocktail, quality control probably leaves something to be desired in terms of being able to control levels of active ingredients in the formulation

    Of course if this pans out, it will be trumpeted by all the CAM supporters as proof that CAM works, whereas it would actually be proof that science based medicine works.

  5. Michelle B says:

    Excellent points regarding the solid and therefore admirable approach used by the researchers.

    Is this preparation just being tested for treating peanut allergy? And not allergies in general? And were the mice subjected to artificial selection in order to get a sample large enough that had peanut allergy? Mice being allergic to peanuts has never crossed my mind!

  6. RickK101 says:

    This is very near and dear to our family. Our daughter has tested as severely allergic to peanuts since suffering an anaphylactic reaction at age 3. In spite of our aggressive approach to avoiding exposure, her blood test still shows high sensitivity.

    Dr. Hugh Sampson is one of the leading reasearchers in food allergies, particularly PA. He is involved with the FAHF-2 studies as well. It will be interesting if an active molecule and a mechanism is idenfied in one of these herbs. It should come as no surprise – herbs are drugs too.

    There has also been some success with desensitization therapy, but it’s risky. It must be done in a hospital with emergency services if the child has a strong reaction.

    And there is at least one other drug in play for PA – Genetech’s Xolair – an asthma drug that has demonstrated the ability to dampen the IgE antibody response in an allergic reaction. But a key clinical trial was halted when two of the kids in the control group had severe reactions. There’s another compound.labelled TNX-901 which is reported to be more targeted to the specific peanut-sensitive antibodies. However, legal wrangling between pharmaceutical companies has held up progress on that treatment.

    FAHF-2 will face similar testing issues as it enters clinical trials. You can’t measure it’s effectiveness against a control group if it means putting the lives of the control group members at risk. So the trial will likely not involve a short-term test where participants are given peanuts and their reactions measured. Instead, it will likely require a longer study of a large population of peanut allergy sufferers.

  7. quackdoctor says:

    “I have to admit I’m still a bit dubious, though. How would ancient Chinese herbalists have determined that these 9 herbs (or 11, in the original formulation) in these proportions were optimal for treating allergies and asthma?”

    Never discount the intelligence of primatives and shamans despite their lack of science. Over generations they can learn relationships. Like a form of evolution. And the knowledge gets passed down. A shaman in the rain forest for example can work with plants that vary from month to month in their potency and give a person doses that require a very specific dose or they will kill the person. But thy learn to do this.

  8. Jules says:

    @ qetzal: lots and lots of trial and error. In human patients, no less.

    PHY906 also looks promising as a “cure” for cancer–four herbs, used in conjunction with each other. Apparently, “real scientific interest” in this has only popped up in the past 2 years, but it’s been around since the ’80s.

    Here’s what I don’t get about TCM: these are formulations of herbs that have been around for thousands of years. The literature is also thousands of years old. These formulations about what to prescribe, when, and how much, how often, have been written up based on actual human trials–you can’t say these were ethical studies in any sense of the word–and yet Western scientists, because they don’t like the idea of chi, dismiss the field in its entirety, and say, “Here, take this pill! We’ve tested it for eight years! It’s safe!” (and here we insert the obligatory snickers at Vioxx and Advantia).

    I don’t mean to disregard the need for accurate, careful, and thorough scientific study of these compounds and formulations. It just amuses me to think that science is as prone to fads as Vogue. Because, what else would it be, if everybody and their grandmother refuses to seriously consider herbal medicines just because the belief system it was developed under happened to include the idea of chi? And now, you have pharmaceuticals doing high-throughput screening of these compounds, looking for the next big thing….

  9. Jules says:

    I should add that when I refer to “human trials” in the third paragraph, I mean, “Well, the patient isn’t dead yet” kind of trials, not the kinds of trials most of us think of today. But 5000 years ago, that was really all that mattered.

  10. qetzal says:


    I don’t disagree in principle. However, consider how much effort would be involved in scientifically testing all possible combinations of 9 ingredients. That’s 511 different combinations, without even considering variable levels of each ingredient. Consider how many groups of rats one would have to test, with how many rats per group, to identify the best combination!

    Even using modern factorial designs, it would take a major effort to design and execute the necessary studies, and to properly analyze the resulting data. Do you really think shamans could manage that by testing one or a few patients at a time, using natural preparations that may vary considerably from batch to batch, and handing down their observations over generations?

    Sorry, but that strains credulity.

    I’m not trying to discounting the intelligence of primitive people. On the contrary – they’d have to be vastly more intelligent than modern scientists!

  11. pmoran says:

    QUackdoctor> “Never discount the intelligence of primatives and shamans despite their lack of science. Over generations they can learn relationships. Like a form of evolution. And the knowledge gets passed down. A shaman in the rain forest for example can work with plants that vary from month to month in their potency and give a person doses that require a very specific dose or they will kill the person. But thy learn to do this.”

    The shaman may well learn how not to kill people with herbs. Death, along with its preceding morbidity, is a pretty obvious, worrying and objective outcome — not likely to be forgotten over the lifetime of the shaman, and the first thing passed on to his apprentices.

    It is far more difficult to reliably determine any beneficial medical effects of herbs, or any other kind of treatment. History shows that practitioners are extraordinarily prone to pronounce useless remedies effective.

    There are so many misleading influences in medical practice — spontaneous recoveries, placebo influences, reporting biases. The primitive practitioner also had to keep all the results of every trial of every agent in his mind over long periods of time, often without the wherewithall to keep written records or to perform any mathemantical analyses of results, and at the same time while trying not falling prey to confirmation. “last patient” and other biases.

    It is thus somewhat amazing that so many biologically and medically active herbs have been passed down to us from traditional herbal practice, although I note they are mostly ones with obvious and immediate pharmacological effects.

  12. qetzal says:


    I don’t dismiss herbal remedies simply because they were developed under a belief system that includes chi. I fully acknowledge that at least some herbal remedies are pharmacologically active and beneficial for certain medical conditions. There is ample evidence of this (willow bark & aspirin, yew bark & taxol, etc.).

    OTOH, there is also ample evidence that some herbal remedies do NOT work for their intended conditions. Some are actively harmful. There is also ample evidence that humans are highly prone to confirmation bias, recall bias, selection bias, and many other biases that can lead us to erroneous beliefs.

    As a result, my attitude toward herbal remedies is basically the same as my attitude toward drugs: some are no doubt useful, but proper testing is required to determine which ones those are.

  13. Fifi says:

    Why would anyone in their right mind think that all cultures that use herbal medicines believe in chi?!? Chi is a concept that’s associated with a specific culture not a pancultural belief. There’s a very wide variety of indigenous and ancient cultures with very different philosophies and concepts – much as people into new age stuff like to pretend they’re all the same since it serves their purposes (not the purposes of the people who’s culture is being appropriated and marketed). These types of cultural appropriations are usually for the benefit and financial gain of some white Western dude who grew up in the suburbs!

  14. quackdoctor says:

    Well you would be suprised what these shamans in the rainforest know. And what man learned without science. And I do not mean to discredit science. Let me put it this way. If I was sick I would rather be at the best medical center possible. But if I was sick and stuck in the rainforest and I had the choice between and MD with no medication and a shaman healer. I would opt for the shaman.

    If I was stuck in the rainforest with Andrew Weil and an experienced shaman I would pick the shaman. And if the year was 1900 and I had the choice between the MD and the shaman I would oick the shaman. And by the way. If I was diagnosed as being terminal and thinking about gambling on alt med to help me I would pick the shaman over modern alt med.

    With trial and error people tend to figure things out and adapt to their resources. And mind you many modern medications have come from the trials and errors of primative people in the rainforest. The thing is that the rainforest shaman is in a reality situation of needing to know what works. The alt med people are in a luxury situation. With financial interests and medical back up.

    For example in the rainforest the shaman uses certain roots and barks for visionary experiences. But for exaple some will not work without an MAO inhibitor. So they have figured out another plane too take at the same time that is an MAO inhibitor. Now that is a very superficial example. But the same goes for other plants they use.

    And actually sometimes in our culture things are initially derived by accident. A blood pressure medication if used and then we fine out it grows hair. So it evolves into a hair growth medication. A medication is used for allergy but we find it makes people tired so we market it as a sleep aid.

    So things are found without science and taken to a more advanced level than may think. many times good science serves to polish them up and make them safer. But what sparks the science is someone with no scientific education but common sense. When the human brain evolved from primitive molecules over billions of years nature did not know what science was. but look what was produced. So I mean no disrespect to science but one must give credit where credit is due.

  15. qetzal says:


    Again, I’m not disputing that shamans have real knowledge. I’m disputing that shamans could accurately ID an optimal formulation that required every one of 9 different complex ingredients mixed in a specific proportion.

  16. quackdoctor says:

    Oh well I find that kind of hard to believe as well.

  17. TsuDhoNimh says:

    Wow, what a witches brew to sort out. Some known anti-inflammatory action in the herbs.

    • ling zhi (ganoderma lucidum), 28.17% mushroom Ganoderma lucidum, and its close relative Ganoderma tsugae, which grows in the northern Eastern Hemlock forests. The only known source of a group of triterpenes, known as ganoderic acids, which have a molecular structure similar to steroid hormones.

    • wu mei (fructus pruni mume), 28.17% Fruit of Prunus mume, commonly known as Japanese apricot, or Black Plum. Smoked for use in medicine. (adding more complexity)

    • huang lian (rhizoma coptidis), 8.46% Root of Threeleaf Goldthread (Coptis trifolia) … well-known anti-inflammatory herb from American Colonial days.

    • ren shen (radix ginseng), 8.45% Ginseng Root

    • huang bai (cortex phellodendri), 5.63% Bark of the Amur cork tree, Phellodendro amurense

    • gan jiang (rhizoma zingiberis officinalis), 8.45% Ginger root

    • dang gui (radix angelicae sinensis), 8.45% Root of Angelica sinensis … analgesic activity and anti-inflammatory

    • gui zhi (ramulus cinnamomi cassiae), 2.81% Cinnamon twigs (not bark) normally steamed, then stir fried before use.

    • chuan jiao (pericarpium zanthoxyli bungeanum), 1.41% Shichuan pepper. Moderately effective anti-tapeworm herb, although not as good as pumpkinseed


  18. Is there a historian in the house? A botanist? A medical historian? A textile engineer? Someone who specializes in the history of science or technology? The topics touched on are vast. I am not an expert. Far, far from it, and I don’t have references in my head and even if I did, neither I nor a historian who specialized in any of the relevant fields could cover the topics in a post. All I can do is gloss over the the subjects pointing out some of the factual fallacies.

    Regarding the great knowledge of all of our primative ancestors, do you know how long it took civilization to develop machines to spin fiber into yarn? Anyone interested look up “drop spindle”, “spinning wheel – walking, woolen, treadle”. The first is a stick with a weight on one end. It is still used by what someone above referred to as “primatives”. (As a fiber artist, I find the term offensive.) Heavily used walking wheels are still easily found on the Vermont/Quebec border. I know people who remember their grandmothers using them and not as a hobby but to make wool yarn for blankets and clothes needed by the family for winter. While spinning wheels varied slightly from culture to culture, the basic mechanisms were the same. New improvements appeared around the same time all over the world and until the industrial revolution they were all, mechanically speaking, very primative.

    All our ancestors, no matter what our ethnic backgrounds are, used what are now called medicinal herbs to treat disease. With very few exceptions, they didn’t work well. Scientists combed the jungles looking for effective botanicals long before the term “dietary supplement” was ever coined. But there are very serious problems with botanicals that contain active ingredients. Mother Nature doesn’t standardize plants and unless you have ways to analyze them, you can’t tell that by looking at them what they contain or how much.

    The pharmaceutical industry grew out of the dye industry. If you study natural dyes, it gives you an idea of the problems inherent in trying to use them as dyes or drugs. I have written and posted articles trying to explain this to the general public. You will find them here under “botanical drugs”. They contain references.

    Quackdoctor said, “A shaman in the rain forest for example can work with plants that vary from month to month in their potency and give a person doses that require a very specific dose or they will kill the person.” How do you know this? I’ve never heard it and I’ve read a bit about explorers in the S. Am. jungles going back to the time when the Spanish first arrived. The most recent book I read about living primatively in the jungle was “Secuestrada” (Kidnapped) by Leszli Kálli. It is the story of a young Colombian girl held hostage in the jungle for something like a year. I vaguely remember that one of her captors was a nurse who would periodically bring drugs to the camp to treat the prisoners with. I think if they had mentioned native remedies I would have remembered.

  19. Regarding the great knowledge all of our primative ancestors had, some examples you don’t have to look up.

    For how long did people use footpower, horses and wagons for transportation? How long did it take them to develop the knowledge base required to build trains, cars, planes? Trains were introduced in my great grandfather’s day. Cars in my grandfather’s and planes in my father’s.

    If you think about it, you will come up with many more examples that we all really know about but never think of on a conscious level simply because we are so used to them.

    Now think how much simpler mechanical things are than things like plants and drugs.

  20. RickK101 says:

    Vast time periods and long experience don’t trump modern scientific research combined with modern communication.

    When a new idea (say a new herbal treatment) was introduced in ancient China or by a village shaman, how many other herbal experts reviewed, commented on and refined that treatment? Compare that to the number of people who review and filter such ideas today. And only recently have we learned enough to understand biological mechanisms. This allows research to focus much more quickly on the actual source of the benefit.

    Also, in Quackdoctor’s example, we have to first filter out the effect of superior knowledge of the local (often extreme) environment. Once you do that, the advantage of shaman over science vanishes quickly.

    As for the subject of this blog, I would never consider exposing my child to some 9-herb concoction without a scientific basis for each of the ingredients. If there is real efficacy here, then science will pinpoint the specific molecule or molecules and their mechanism, and the result will be safer and better understood than the current herbal mix. The fact that 2 of the original 11 herbs were removed from the mix with no change in efficacy just reinforces this point.

    I too am pleased to see the NCCAM undertaking real science for this. It just goes to show you – science is a process, not a group or a belief. When done right, it works, regardless of who is doing it.

  21. DBonez says:

    I loved my Cultural Anthropology classes in college. They were a fascinating introspective into human beliefs, practices, rituals, and lives. We covered the full spectrum of humans from ancient civilizations and extremely isolated tribes still living today to modern, industrialized nations.

    I am simply shocked every time I see people claiming the brilliance and wisdom of the shaman and tribal medicine men and the romanticizing of their practices. From the documentaries we watched and from first-hand accounts from our teacher (who was very liberal, loved ancient tribes, and distrusted “advanced” societies, mind you), shaman are butchers and horribly corrupt people who are far better at practicing burial rituals than treating people with even simple ailments. They are barely able to keep people alive, have no clue about even washing their hands, let alone treating illnesses. In my estimation, for every one true* “cure” they posses, they have a thousand that are deadly, useless, hallucinogenic, purely ritualistic, or just cosmetic. Even today, many shaman and medicine men with “knowledge and brilliance acquired through the ages” can’t even cope with parasites, setting broken bones, rashes, iodine and vitamin deficiencies, dehydration, and other simple ailments that still plague their tribe’s existence.

    *True = scientifically plausible, works on a regular basis, has an effect grounded in reality, etc.

  22. Fifi says:

    DBonez – Personally I view the romanticization of indigenous and foreign cultures to be inherently racist and an odd sort of colonization and distortion of culture that is essentially exploitative and ignores the contemporary reality of many indigenous peoples. This new age take on indigenous cultures tends to totally ignore the struggles that native peoples face in favor of an updated version of “the noble savage” that kind of blends all cultures into one new age concept that denies indigenous peoples true identities and histories in favor of a Disneyfied version for the use of Westerners (as seen in the idea that “chi” is a pancultural concept).

  23. Jules says:

    I was using chi and TCM as a rhetorical device. I know herbal medicine in general isn’t limited to TCM.

    But RickK101: why isn’t a legacy of human experimentation enough to confirm that such-and-such a formulation of herbs work, while an 8-year clinical trial is fine? When Vioxx came out, it was wonderful because it worked according to our theories of how it should work, but it still didn’t prevent people from foreseeing the dangers from taking it. You mean to say that, if your child came down with the sniffles, you wouldn’t be tempted at all to give him a zinc/vitamin C combination? If you couldn’t sleep, you would head straight for the short-term benzos rather than make a cup of chamomile tea?

    I’m not trying to be accusatory (sorry if it sounds that way). And I do know why mechanisms of action are important to understand. But the body is enormously complex–you simply can’t dissect one pathological mechanism, target it, and expect nothing else to change. Heh–if you look at the downstream signaling pathways by which GPCRs work, it’s a wonder that anything happens at all. It just boggles me that you have as much faith in the scientific process as you do. I don’t have that much faith in science, and I’m a scientist (BS in biology/biochemistry, 4 years in MD/PhD before I went nuts, working as a lab tech).

  24. Fifi says:

    Jules – “But the body is enormously complex–you simply can’t dissect one pathological mechanism, target it, and expect nothing else to change.”

    Of course, that’s why medications have side effects and it’s expected that they will. It’s also why the idea that drugs have no side effects if they’re in a less refined from is just plain silly.

    That’s why relaxation therapy and learning proper sleep hygiene are better choices for dealing with insomnia. It’s why preventing colds by staying healthy is a better solution than giving a child a pill (even a vitamin) when the evidence suggests that vitamin C doesn’t do anything to improve colds. You’re only teaching your child to medicate something that goes away naturally with time – that all illness requires a pill (even a useless one) rather than letting it run its course.

    As for using “chi” as a rhetorical device, it clearly wasn’t a very effective or accurate one since it reflected a common new age belief that all indigenous cultures share the same beliefs (not that TCM as promoted during the Maoist era is an indigenous culture, nor is it something that all Chinese believe in).

  25. Jules, are you really serious? You had all that education and never learned how unreliable subjective observations are?

    You said, “why isn’t a legacy of human experimentation enough to confirm that such-and-such a formulation of herbs work, while an 8-year clinical trial is fine?”

    Study the history of civilization and see where all those thousands of years of human experimentation got us and where the last hundred or so when medicine was approached as a science got us.

    History is full of examples of “remedies” and “therapies” people were certain worked but that were found to be absolutely useless or dangerous when they were investigated objectively. Airborne is a recent example that was well covered in the media. The company made millions selling what they advertised as a “cold remedy”. They reached an out of court settlement with prosecutors over their fraudulent advertising claims and dished out $23 million. Yet even after that the Internet was full of comments by people saying things like, “Airborne has worked for me and a lot of people I know. The times I have remembered to take it before flights, I have not gotten sick. I have also taken it when I feel a cold coming on and the cold never actually takes hold.” While the person may believe that Airborne is the reason that she didn’t develop a cold, she doesn’t even know if she was exposed to one on her flight or, if she was, whether or not she was already immuned to the particular pathogen. Neither does she know if the sensation she interpreted to mean a cold was coming, did in fact mean that. And we do not know whether or not she is a nervous Nelly who worked herself into a tizzy every time she had to fly or thought she was getting a cold and convinced herself that she had prevented that by taking the “remedy” the advertisers had convinced her would “work”.

    Regarding botanicals, as i’ve tried to explain in the link to my webpage given above, they aren’t standardized. You can’t tell by looking at or tasting an orange whether or not it contains vitamin C or, if it does, how much it contains. That might not be a problem with a food plant eaten for nutrition, but it is a huge problem for a plant that has active pharmacologal ingredients. That is because plants vary greatly even among the same species. (Read my article on dye plants.) They vary by growing conditions, the time they are picked and once picked by storage conditions.

    When natural dyes were all that was available, color was used as the control and even then and now (ask anyone who buys yarn) colors could never be reporduced exactly the same. Those variations may not be important for fabric, but they can be the difference between effective, useless and dangerous in a plant used as a drug. Our ancestors used bioassays to test crude drugs, but there was still a lot of hit and miss.

    Now if you combine the inability of humans to accurately determine cause and effect by subjective observations alone with the fact that when someone takes a botanical with pharmacological activity that has never been standardized for purity and potency to treat a disease, you start to see some of the very serious obstacles that make it impossible to draw accurate conclusions about the safety and efficacy of the botanical.

  26. RickK101 says:

    Jules: “You mean to say that, if your child came down with the sniffles, you wouldn’t be tempted at all to give him a zinc/vitamin C combination?”

    Absolutely not. Vitamin C for colds was a fad theory that is losing followers even among the credulous. The jury is still out on zinc, but the only reason I’d consider it (for myself perhaps, not for my kids) is because of scientific studies, not because of some mythical cultural wisdom.

    Jules, do you know what people did when under the care of shamans and ancient chinese doctors? They died younger.

    I’m sorry you don’t have faith in science, and that you feel science is a faith at all. I’m sorry that you raise examples of mistakes (Vioxx) to imply science doesn’t work. That’s like pointing to a collapsed building and saying architecture doesn’t work. Science is simply the best process derived so far for understanding the realities of our world and for improving the lives of people. It’s not perfect, but no other process or faith comes close in terms of delivering benefits.

    You’re reading this blog, you’re in some sort of effective shelter, you’re comfortably well fed, and depending on where you are at the moment, the average person around you will likely live past 70. This is all possible not because of the knowledge and wisdom of the ancients and the primatives, but because of the people who didn’t blindly accept that knowledge and wisdom and instead analyzed the world using a better process – science.

  27. Fifi says:

    rjstan – Thank you for that beautiful and eloquent explanation. You have a real gift for explaining things in an accessible and interesting way and a skill in bringing the science out of the lab and into the world.

  28. Jules says:

    @ Fifi, RickK101, and rjstan:

    The reason I don’t have much faith in science? Because people are the ones interpreting it. And people are idiots (I mean that generally, not any of you specifically).

    If you look at every single significant medical advancement in history, the proponents had to fight, tooth and claw, against established dogma saying something even more absurd (the one exception, as far as I can think this late at night, being antibiotics). Germ theory, even in the face of rather crystal clear evidence, was a long time in being accepted. The possibility that ALS is a viral disease isn’t even seriously considered. Ulcers were, for years, attributed to too much stress. Even Osler believed that malaria was caused by “bad air” (he at least had the good grace to know when he was wrong). And now we have morons who swear left and right that vaccines cause autism and will cite studies to “prove” their case. We still don’t know how acetominophen works (the jury’s still out on COX3), and yet people take that one in droves. Do you think overeating is a cause of obesity? Not the author of JunkFoodScience (I happen to disagree with a lot of how she interprets the results of the studies she cites).

    My point is not that science is faulty. Science itself is a beautifully systematic approach to the problems we encounter. But science is done by people, and people are also prone to fads and hype, and that tends to get in the way of appreciating other perspectives, and in doing so, becomes myopic in its view of the world. And it’s not just medicine that this happens in–physics, chemistry, and mathematics are just as prone to this.

    I guess what I’m trying to say is this: I am equally cynical about everything, even science. I’m (really!) not trying to say that TCM is any better than pills you can pop–I’m just, well, puzzled that people have that many doubts about the efficacy. Let me put it this way: if it didn’t work, you’d think that, after the 1970s, it’d have petered out by now.

  29. Jules referring to TCM, I think, “if it didn’t work, you’d think that, after the 1970s, it’d have petered out by now.”

    Perhaps you answered that when you said, “And people are idiots”

    Many of us aren’t very bright or well educated and we all, even the brightest, best educated among us, are human which means that we are subject to human foibles. We want the evidence to validate our beliefs and often cannot perceive that it doesn’t. Scientists recognized that and have developed a method which they continue to refine, the scientific method, to test their beliefs (hypothesis) objectively. Of course, they make mistakes, sometimes very stupid ones, but the scientific method is much better than what preceeded it. And that is very evident from the very recent scientific advances we all enjoy.

    Approved drugs have been studied extensively. That doesn’t mean that those studies reveal everything about the drugs or that mistakes don’t get through, but the scientific studies that approved drugs have been subjected to are a world apart from the uncontrolled personal observations made by people who use and promote supplements, including botanicals.

  30. Fifi says:

    Jules – “if it didn’t work, you’d think that, after the 1970s, it’d have petered out by now.”

    Do you believe knocking on wood actually prevents bad things from happening? People subjectively believe all kinds of things “work” based on confirmation bias, lack of understanding of what’s actually going on, religious or spiritual faith, etc. That’s what faith is, believing in something even despite the evidence (or on no evidence). Why do you believe “idiot” people who believe in TCM?

    I certainly wouldn’t advise you to have faith in medicine, a healthy skepticism and realism regarding medicine (and most things in life) is a good thing. However you seem more cynical about medicine than skeptical (cynical as in prepared to believe the worst). You also seem more inclined to believe in TCM and magic on no evidence. You may want to check your personal bias, since being human you’re prone to idiocy too! ;-)

  31. Jules says:

    @ rjstan: yes, the scientific method works better than most. But science is still a very human endeavor, and more often than not we wrap the facts to fit the theory than the other way around.

    You also have to remember that a lot of approved drugs are only tested because there’s money to be made from patents. Seriously: try getting a drug company to put lavender oil through Stage III clinical trials and you’ll get laughed out, because there’s simply no money in it for them (lavender oil, in case you’re wondering, is effective against eczema).

    @ Fifi: a) I don’t believe everything about TCM. But I make it a point to try scientifically plausible things at least once before deciding whether or not it works–for me. If I seem more of a believer it’s because things like St. John’s Wort, lavender oil, ginger, and licorice are efficacious for me (being an Asian woman and therefore lacking a few liver enzymes probably contributes). I’ve tried a lot of homeopathic things–yoga, tai-chi, herbal remedies–mostly out of curiosity, and while I don’t buy “their” explanations as to why they work, I have to say that they are not entirely without merit.

    b) I also happen to think that, given the history of TCM, the extensive literature that exists on the herbs and how they are used, and the fact that in China, if your doctor promised a cure and didn’t deliver, he’d lose his head (at least, until relatively recently), that it’s more likely than not that it works. Do I believe in meridians, the flow of energy, and what-not? No. But I believe that, 5000 years ago, it was the best way to explain what happened in the human body in sickness and health, and that, given how long many of the treatments have survived, there must be some merit to some of it. Is this a scientific reason to believe that (some) TCM works? Not by a long shot. But it’s not an unreasonable one, and isn’t that what science is all about? The application of reason to life?

    c) A part of me also wants to snark caffeine, alcohol, aspartame, sucralose, nicotine patches, phthalate compounds, the Bush administration’s approach to mercury pollution and global warming (my take on it is not as left-wing as you might think; I’m planning a series in my blog for next week), aspirin, pseudoephedrine, and the pet food industry at this point. What, pray tell, do all of these different things have in common? Their continual usage in spite of safety concerns that have been raised. My point being that while concerns about the safety and efficacy about TCM are quite legitimate, we might also want to re-evaluate the other compounds in our lives while we’re at it.

  32. Fifi says:

    Jules – “more often than not we wrap the facts to fit the theory than the other way around.”

    How do you know this? Is this what you did as a scientist? Do you find you have a tendency to do this now? (It does seem possible since you base your “evidence” on using something once and reach a conclusion this way!)

    Drug companies aren’t the only ones who do clinical trials and there are actually all kinds of clinical trials done on lavender so your claims ring hollow or reveal that you don’t actually follow the science that’s being done around the subject (or how research works in general).

    Exactly how is St John’s Wort TCM? It’s a traditional Western herb not Traditional Chinese Medicine! Same for licorice! And how is yoga “homeopathic”? As someone who’s practiced yoga for over 10 years, I can tell you that saying yoga is “homeopathic” makes absolutely no sense. Yoga is great physical and mental exercise so it provides those benefits (particularly if done regularly, not just dabbled in). There are schools of yoga that are intensely mystical and explain everything in those terms – for some people it’s a religion and for others it’s not. It’s like meditation – you can either practice awareness meditation (to be more “awake” and aware) or trance meditations (which tend to be about escaping reality).

    You speak about TCM as this ancient art but, from what I’ve read and been told, TCM is actually the Maoist version that was used and promoted because there simply weren’t enough real doctors (not the “ancient art”). I’d advise doing a bit more research into the history of TCM and medicine in China – you seem to hold a very romantic notion about it.

    Science is a method used to study the world. You seem to want it to be something else to support your vague subjective feelings and sense that “there must be something there because it’s been around forever”. Do you also believe that knocking on wood must work for warding off bad luck?

    Your “wanting to snark” to advocate for TCM is the desire to erect a strawman (plus President Bush is hardly science’s fault – he’s with you on your desire to brush aside “reality based thinking”). Do you base your beliefs on research? There’s been a lot of research done on coffee and it isn’t the evil you believe (and can actually have protective qualities). You ARE aware that the hoopla in the pet food industry was because of tainted ingredients from China? (Intentionally tainted for profit actually.) You are aware that all kinds of herbal formulas, vitamins and supplements are actually made in China – often in factories with health and safety violations that would be entirely unacceptable in North America.

  33. Fifi says:

    Jules wrote – “And the fact that in China, if your doctor promised a cure and didn’t deliver, he’d lose his head (at least, until relatively recently)”

    This is pretty hyperbolic – what do you base this assertion on? Do you mean that if a court physician didn’t cure the emperor he was beheaded once upon a time? Or that medical doctors in China were routinely decapitated if they failed to “cure” ordinary citizens at some point over the past century?

    Perhaps you’re confusing this with the fact that “saving face” goes on around clinical trials in China for political and social reasons, which means that Chinese research can be of poor quality and unreliable.

  34. Fifi says:

    Just to correct myself, licorice is ALSO used traditionally in Western herbal medicine and not exclusively Chinese (TCM and homeopathy aren’t the same thing, nor do they have the same conceptual/theoretical base). My point was that once again mishmashing disparate cultures into one homogeneous box ignores the diversity of the various cultures in favor of creating a homogeneous “product” to market to people who have romantic notions about “exotic” or “ancient” cultures and fears about the present (superstitious fears often, so they require magical solutions).

    You’re also barking up the wrong tree (speaking of aspirin) if you don’t believe that licorice and other traditional medicinal herbs haven’t undergone clinical trials. There’s a great deal of research that goes on into food and herbs – it’s odd that you seem so unaware of this yet say you’re a scientist and have an obviously interest in using and promoting TCM (or some group of disparate things you label “homoepathic”).

  35. Jules, “lavender oil, in case you’re wondering, is effective against eczema”

    Actually, what I’m wondering is how you know this.

  36. Harriet Hall says:

    Rjstan said,

    “Jules, “lavender oil, in case you’re wondering, is effective against eczema” Actually, what I’m wondering is how you know this.”

    I’m wondering too. There is nothing in PubMed. The Natural Medicines Comprehensive Database cites only one article supporting the use of lavender oil in combination with other essential oils to treat alopecia areata. It also says lavender oil can CAUSE dermatitis.

    According to “In one study of topical lavender, however, children with eczema who received massage with or without lavender oil applied to the skin both did well. In other words, the improvement in the rash was related to the massage – whether lavender oil was used or not seemed to make no difference.”

    According to Wikipedia, lavender oil is cytotoxic and photosensitizing and has been suspected of causing gynecomastia.

    And of course, Jules’ statement that she tries things to see if they work for her shows a lack of understanding of the scientific method and the post hoc ergo propter hoc fallacy.

    I wonder if she thinks that because astrology has been around a long time there must be some merit to it too.

  37. quackdoctor says:

    Geeeeze Harriet…

    People need something to believe in.

  38. Harriet Hall says:

    Quackdoctor said, “Geeeeze Harriet…People need something to believe in.”

    Not all of us. Scientists don’t need to “believe” in anything; they reach provisional conclusions based on the best available evidence.

  39. quackdoctor says:

    Well I did not say that you did. I said that people did. I mean a lot of the people that you are talking to. Different people may have brains that are designed differently. That resolve reality differently. There may be genes that predispose people to need to have beliefs. That believing completes the circut so to speak.

    So for example somebody dies and you feel sad. But you resolve reality by thinking to your self that they had a full and happy life. Or you say to yourself that you are glad they are no longer suffering. But another person resolves differently. They say to themselves “They are in heaven” or “It was the will of the lord”.

    And also Harriet I know there is a scared little girl deep inside you that knows she needs Jesus and believes. :)

  40. Harriet Hall says:


    Despite the smiley face, I find your comment extremely offensive.

  41. nwtk2007 says:

    Interesting. Why?

  42. quackdoctor says:

    Relax Harriet. I am going to burn in hell fire my self…So they say. In this universe there is nothing but cold harsh immutable unbending universal law. There are no miracles. There is no justice. No God that gives one damn about us. Just universal law.

  43. Harriet Hall says:


    If I have to spell it out: he professes to know something about me that he couldn’t possibly know, he calls me a little girl, he accuses me of being scared, he assumes I “need” Jesus when he has no way of knowing whether I might be Jewish, Muslim, Buddhist, Wiccan, Zoroastrian or atheist), and he accuses me of believing in something when I have tried to make it clear that my whole intellectual stance is based on not “believing” but on provisionally accepting conclusions based on evidence.

    It was a personal put-down and contributes nothing to the discussion.

    If it was intended as a joke, it was in poor taste.

  44. nwtk2007 says:

    Harriett – “he assumes I “need” Jesus when he has no way of knowing whether I might be Jewish, Muslim, Buddhist, Wiccan, Zoroastrian or atheist)”

    Why would anyone with these beliefs be “offended”.

    If you are not comfortable with who you are, then I can understand the “offense”. Insecurity, lack of understanding who you are would make a reaction such as yours understandable.

    I mean really, if I were Jewish, mature in it and comfortable with it, why would it offend me? I am, in fact, somewhere in there, in your list, very comfortable with who I am, knowing myself very well, and would not be offended in the least.

    The Biblical description of offense suggests that Quackdoctor caused you to sin because of your lack of maturity in your “faith” or “belief”.

    That might be how he actually sees you. I doooon’t knooooww?

  45. Harriet Hall says:

    I am not offended because of my beliefs. I tried to explain that I have no “beliefs,” just provisional conclusions based on evidence.

    I am offended that someone would assume I believe anything without evidence. I would be offended if someone accused me of believing in homeopathy or the Tooth Fairy, because that directly impugns my intelligence and reasoning abilities. I think it is also offensive to call someone a “scared little girl.” That kind of language has no place in a rational discussion of a scientific topic. I am offended when someone resorts to personal attacks instead of sticking to the issues.

    On second thought, considering the source and the quality of reasoning displayed, I suppose I should not be offended – I should just laugh.

    In fact, I did laugh when I read nwtk2007′s Biblical reference and the suggestion that I had sinned. That was pretty funny!!

  46. Jules says:

    @ Fifi

    1) I would thank you to avoid libel from now on. If this debate is to remain civilized I would highly recommend doing so.

    I do not wrap my facts to fit the theories. Most scientists don’t. The ones that I know personally certainly don’t. But there’s a lot of crap out there. To give you just one example: a while ago (5-10 years) it was postulated that GPCRs dimerize. “HOLY COW THIS IS BIG NEWS!” and everybody who was in a GPCR field (and there are a lot of us) published something showing some receptor dimerizing with another. We are not talking small papers in obscure journals, here: big names, big journals. Mechanisms were postulated, BRET and FRET were used–and then holes began showing up. To make a long story short, it is now believed that while some GPCRs may require dimerization to function, most GPCRs don’t dimerize, and if they do, it’s most likely incidental. The really intersting thing is this: the science was sound. The scientific method was applied with rigid exactitude by many of the authors who published dimerization papers.

    Clinical medicine studies are even worse.

    2) We’ll have to agree to disagree on our interpretations of ancient history. But speaking as someone who speaks 4 languages, there’s a lot that gets lost in translation, and if you have to translate from ancient Chinese to modern Chinese to English (hell, the latter is hard enough), well, it goes without saying that a lot of what’s put out on the Net about TCM is crap.

    3) Why not mishmash all herbals under one roof? That’s what CAM is, isn’t it? Aren’t we looking for universal statements of efficacy and truth?

    Yoga is used as physical therapy, but also as an aid for pain relief. It was, admittedly, a bit of a stretch to throw it in there, but on the other hand it’s not entirely out of place.

    4) I’m not actually a proponent of TCM. I believe a lot of work is still needed to understand fully how it works, but I would never say to someone “Oh try XXXX for your YYYY”. But I do object to close-mindedness and narrow-minded views of the world, irrespective of how objective that point of view happens to be. I happen to enjoy arguing against belief, because I feel that if you can come up with good arguments against what you believe in, then you’ve got to start asking more questions.

    5) I’m aware that there’s a lot of research going on in herbs and food. I’m also aware that most of the research isn’t that great–different preparations, different standards, different methods, wrong conclusions, etc. And clinical trials are a bitch to design and analyze correctly, and that not every place has a full-time statistician on hand.

    6) You missed the point of my snarking the list of things that I put up: it’s not that I actually believe any of them are evil, but to question the safety of everything just because it comes from China (which is perfectly okay) seems a little hypocritical in light of the current lack of questions over the safety of those things that I’ve listed. And no, I don’t believe coffee is bad for you, either–but too much caffeine never did anybody any good.

  47. Fifi says:

    Jules – To pointing out the obvious, you were the one being snarky. You were also the one that concluded that trying something once and thinking you felt better was evidence that a herbal formula works – my point about scientific methodology and bias stands if you believe this constitutes any kind of credible evidence (particularly when you’re clearly cynical about science and revealing a confirmation bias towards a wide range of diverse and not connected new age things, which you all lump together as if they’re all the same).
    Sure there are some badly designed studies and particular scientists have their hobbyhorses (some of them that look more like broomsticks and magical unicorns even), that doesn’t mean that the whole of science and medicine should mount the unicorn and ride off into the rainbow throwing money and resources at fantasy based research instead of dealing with real world research and real disease and illness.

    2) You made a claim that physicians would be put to death if they didn’t “cure” someone in China. There’s nothing to agree or disagree upon here – it is/was either true or it isn’t. Please just answer the question about when and where this happened and back up your claim somehow. Or, if you’re making it up for dramatic effect (like you did with your rhetorical use of “chi”) then just be honest about it rather than making things up. Sure things can get lost in translation but TCM was absorbed and reconfigured by the Maoist Chinese government so the “translation” doesn’t just involved Chinese to English. It IS definitely more romantic and exotic to think of it as pure ancient Chinese art and definitely more marketable.

    3) Science is looking for the facts (The TruthTM is really about religion) and to discern if and how something works. CAM isn’t evidence based anything (if it works it’s medicine not an alternative), it’s a hodge-podge of differing concepts that have been appropriated from different cultures and thrown together under on banner. You seem confused about what CAM is and what the various modalities are (and the concepts they’re based upon). Herbalism and homeopathy aren’t the same thing (in fact, their conceptual foundation is contradictory). Plants are plants, they don’t “belong” to CAM and it’s not CAM to to study them using the scientific method – it’s science.

    CAM IS a mishmash of various religious beliefs, disparate healing modalities that sometimes contradict each other and have different conceptual foundations – so if you perceive it as being a coherent system I’d suggest you spend some more time studying the various modalities that fall under the auspices of CAM. My perspective on CAM comes from knowing many people involved in it (as healers and patients, all well meaning people except for one or two) and taking the time to get to understand the concepts and try things out so I understand what they are on practical terms. Do you meditate or practice yoga? You’ve already said you use some forms of CAM (which ones?) to treat yourself and you believe they work based upon your subjective experience – this doesn’t seem particularly open minded to me, it seems more like a confirmation bias in action.

    Clearly we have different perspective on what is and isn’t close minded. To me you seem closed to the idea that many, most or some of CAM may indeed be worthless. To me it seems ignorant (and close minded) to not be aware that herbalism and homeopathy aren’t the same thing (and have contradictory conceptual bases). It also seems culturally ignorant to assume that the many cultures CAM steals/appropriates from are all the same and fall under TCM.

    5) Yes, the problems regarding the poor standards of CAM trials (and various other clinical trials by drug companies or research center that are shoddy) have been discussed in these blogs and Harriet is quite openly giving this well designed study the respect it deserves. That’s because this blog is about science-based medicine. I’m not sure why you’re making excuses for shoddy trials by anyone, particularly ones that waste taxpayer money.

    6) The reason to question products that come from China is because industry is poorly regulated in China and this means that things containing poisons get exported (Americans do this too when they can get away with it, like in the fringes of CAM and new age healing modalities since regulation of supplements and vitamins is lax). This doesn’t mean conditions are like this in all Chinese factories, nor is it about individual Chinese people, it’s about how the Chinese government monitors and regulates their industry and a social context that means sometimes inspectors and city officials are financially invested in the local businesses and factories so there’s a conflict of interest. It seems a little hypocritical to me that you’re dismissing a public health issue simply because it has to do with China and TCM, particularly when you’re bringing up things that have been studied and aren’t even health issues (such as coffee).

  48. Fifi says:

    Btw, a very common CAM treatment is coffee enemas and I’d agree that too much coffee up the bum is probably not good for one. Too much of anything isn’t good for anyone (that’s why it’s “too much”!).

  49. Fifi says:

    Jules – a bit more info for you on some of the issues around manufacturing practices and herbal remedies in China.

  50. superdave says:

    Jules said she (he?) would prefer a shaman to a doctor in several situations. I for one would prefer a doctor to a shaman, for well just about anything. an in possible scenario I could imagine related to medicine and probably very many scenarios not related to medicine.

  51. Fifi linked to Dr. Novella’s blog
    in which he states, “But another dirty little secret of the supplement industry is the occasional use of actual known drugs in supplement preparations to give it a real and quantifiable effect.”

    Chinese botanicals are not “occasionally” spiked with heavy duty pharmaceuticals. They are frequently spiked with them.

    People in publich health have known and been very concerned about this for years. The general public is just hearing of the problem, and not just with regards to drugs or supplements. Most first learned of the problem with Chinese products when news of the pet food and toy recalls were reported and if I remember correctly heparin rather recently.

  52. DLC says:

    Late to the party as usual — and if this combination of substances eventually proves to be effective, and some pharma co picks it up and produces it, will the CAM-Fans then point at it as how “big pharma” is conspiring to . . . make people well ?

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