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Forks in the road

It’s been decades since the onslaught of organized quackery began against science and reason. Although most physicians are still capable of reasoning, the percentage of medical graduates whose brains have been cleansed of that ability seems to have increased. Either the brains have been cleansed or they have learned to coexist with unreason and to use both functions simultaneously. The latter is quite an accomplishment and is a testament to the flexibility and fluidity of the human mind (shorthand for brain function.) Psychologists have names for that function such as compartmentalization, rationalization, denial, heuristic maintenance, and cognitive dissonance.

Physician advocates of quackery are particularly unsettling because they seem to be so rational at times and appear so to the press and the public. Even more unsettling to me are the medical school department heads and deans and others who loosen the restrictions on the irrational so that peaceful coexistence and polite tolerance seem to be the preferred mode of mental existence in faculties. The NCCAM’s example needs no introduction.

Thus the matter-of-fact tone in which was reported an article in this week’s JAMA. As reported in our local papers, the headlines read: “St. John’s Wort fails to help kids with ADHD [Attention Deficit-Hyperactivity Disorder] in study.” That stopped me for more than one reason. First, any headline about a sectarian or implausible claim is a stopper. But second, StJW for ADHD? I’d never seen the claim. But the article explained that the author felt such a trial was worth doing because someone else had found that StJW increased the level of nor-epinephrine-like compounds in rat brains, so that perhaps St JW would work instead of stimulants for hyperactivity.


Makes some sense, right? But it is in fact a long jump. A reason was given by an interviewed mother of a patient, claiming to fear pharmaceuticals so much, she denied them to her ADHD daughter. So the ostensible reason for studying StJW for ADHD was to find a substitute for a purified, regulated pharmaceutical – an unrefined, uncontrolled, unpredictable plant extract. Just what positive social or medical advance does one call that? Perhaps there is a purifed isolate one might obtain from StJW? StJW has been tested in a number of other conditions and situations and found inactive, but with dangerous drug interactions. What IRB had the nerve to approve such a trial? Apparently those questions need not be answered if the NCCAM gives its assent.

Second, there was a small but definite chance the study could have come out positive by chance, or more likely, because of unreported variations in execution. The consequence would have been a series of confirming or disconfirming RCTs that would take 5-10 years and millions of dollars to resolve in the minds of real clinicians, and moreover, if negative would not alter the practices of either the public or naturopaths.

A further reading showed that the first author, described as “of Bastyr University’s School of Naturopathic Medicine, working with colleagues from Harvard University and the University of Washington…“ brought up the previously noted cooperation of UW with its neighbor, Bastyr U. The cooperation has been going on for years, and has resulted in some realistic clinical trials, one of which was a negative trial on Echinacea for prevention of colds in children.

Naturopaths have been consultants for the UW bone marrow transplant and oncology units also for a decade or more. As one Bastyr N’path explained to me on a visit here, N’paths are experts in natural substances and can help MDs to retain confidence of patients who are exploring alternatives, and who interpret words like “it doesn’t work” as personal rejection. N’paths, he said, can also serve as credible authorities in warning patients away from dangerous substances. I wondered aloud if Npaths were capable of warning people about dangerous practices – such as going to naturopaths.

Back to the report, a medical school cooperating with a naturopathic school? Good? Bad? Productive? Suspicious? Are the questions relevant? In a way the cooperation is all of the above, but with differing weights attached to each adjective. One thing is obvious. There is more to be gained by Bastyr than by UW from an alliance. Bastyr naturopaths have not to my knowledge published anything of consequence on their own. The alliance confers respect, allowing N’paths to break into the medical journal system, to build bibliographies, to publish enough credible studies to enable future federal grants, and eventually to obtain hospital privileges and expanded scopes of practice. About that can there be any doubt?

In reality, N’paths hold no fund of knowledge not available to MDs and other medical practitioners. At the same time, N’paths warp that knowledge’s application to fit ideological frames containing life forces, anti-technology, anti-public health measures and irrational fears of progress. Worse, N’paths believe a mass of unproved and false information that they claim as their exclusive area of expertise and which they apply on the basis of hunches and feelings. A N’path supplies no additional positive substance to healing the sick or to the science of medicine. In this sense, UW is an enabler of quackery, even if the short run product for the university could be algebraically positive. The overriding social consequence of enabling quackery, which is taught to Npathy students, is to spread a system of pseudo- and anti-science throughout the society.

One must grant the UW some degree of understanding for taking on this alliance, out of ignorance, innocense, and misplaced beneficense, but the establishing of precedent is an act they will one day regret and will find progressively more difficult to reverse. Bastyr’s existence and UW’s acceptance materialized in a social environment lacking an overarching theory of scientific social beneficence and a sense that something is wrong with anti-science.

Teaching a scientific ethic and philosophy begins with education in our pre-college schools, and continues with magnified importance in universities, which unfortunately have been taken over by political ideologues who teach ethical relativism and who belittle rationality, realism, and science. Medical schools are in a time of crucial transition and choice; to track into the new science of cellular and molecular biology while holding to and teaching classical traditions of reasoning, or to take the baited hook of social determinism and relativism, to an uncertain fate – likely to be as just another dish on the table.

Posted in: Clinical Trials, Medical Academia, Pharmaceuticals, Science and Medicine, Science and the Media

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40 thoughts on “Forks in the road

  1. Michelle B says:

    Excellent post. It is essential to define the problem so it can be solved eventually.

    It is heart breaking to have limited funds first of all to conduct important medical research, and then even more so to have such limited funds partly directed to silly research.

    PZ Myers recent very moving post is right on target regarding this disheartening aspect at present in the US:

    He includes some stats showing how much success good (I refuse to get entangled in the contrived fallacious controversy of pitting mainstream medicine against so-called alternative, there is only good or bad medicine) medicine has achieved in lowering death rates for certain cancers that strike down children. He also emphasizes how important funding is.

    http://scienceblogs.com/pharyngula/2008/06/support_cancer_research_now.php

  2. Michelle B says:

    BTW, good medicine to me is evidence based medicine–even if we do not know why a procedure or treatment works, we do know that it is effective, and that it is not just wishful thinking or worse, outright fraud.

  3. daijiyobu says:

    Dr. Sampson wrote: “n’paths warp that knowledge’s application to fit ideological frames containing life forces, anti-technology, anti-public health measures and irrational fears of progress [...they] believe a mass of unproved and false information [...it] supplies no additional positive substance to healing the sick or to the science of medicine [...] the overriding social consequence of enabling [such] quackery [...] is to spread a system of pseudo- and anti-science throughout the society.”

    I totally agree.

  4. overshoot says:

    If all they wanted was an “all-natural” herbal alternative to the usual ADHD meds, they could have just tried ephedrine. Poor therapeutic index and too many side-effects, but at least the stuff is known to work.

  5. TsuDhoNimh says:

    SJW is a clinically tested anti-depressant for mild to moderate depression.

    http://bmj.bmjjournals.com/cgi/content/abstract/321/7260/536?ck=nck
    Randomised, multicentre, double blind, parallel group trial.

    Conclusions: This Hypericum perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better.

    Other studies:

    # Steger W. Depressive verstimmungen. Z Allgemeinmed 1985; 61: 914-918.
    # Werth W. Psychotonin M versus imipramin in der chirurgie. Der Kassenarzt 1989; 15: 64-68.
    # Vorbach EU, Hubner WD, Arnoldt KH. Effectiveness and tolerance of the hypericum extract L1 160 in comparison with imipramine: randomised double blind study with 135 outpatients. J Geriatr Psychiatry Neurol 1994; 7 Suppl 1: S19-S23.
    # Kniebel R, Burchard JM. Zur therapie depressive verstimmungen in der praxis. Z Allgemeinmed 1988; 64: 689-696.
    # Bergmann R, Nubner J, Demling J. Behandlungen leichter bis mittelschwerer depressionen. Therapiewoche Neurologie/Psychiatrie 1993; 7: 235-240.
    # Warnecke G. Beeinflussung klimakterischer depressionen. Z Allgemeinmed 1986; 62: 1111-1113.
    # Panijel J. Die behandlung mittelschwerer angstustande. Therapiewoche 1985; 41: 4659-4668.
    # Harrer G, Hubner WD, Podzuweit H. Effectiveness and tolerance of the hypericum extract L1 160 compared with maprotiline: a multi-centre double-blind study. J Geriatr Psychiatry Neurol 1994; 7 Suppl 1: S24-S28.
    # Ditzler K, Gessner B, Schatton WFH, Willems M. Clinical trial on Neuropas versus placebo in patients with mild to moderate depressive symptoms: a placebo- controlled, randomised double-blind study. Complement Ther Med 1994; 2: 5-13.

    ********
    Yes, it can cause photo-sensitivity. So does a laundry list of other drugs:
    http://dermnetnz.org/reactions/drug-photosensitivity.html

    It can alter the way other drugs act. Not shocking. Drug interactions are common.
    ********

    I’m not a “woo merchant”, but herbs can be very useful. If it weren’t for the aqueous extract of a tropical seed and the purified, crystallized juice of a tropical grass, no one would make it through medical school.

  6. mjranum says:

    I’m not a “woo merchant”, but herbs can be very useful. If it weren’t for the aqueous extract of a tropical seed and the purified, crystallized juice of a tropical grass, no one would make it through medical school.

    That’s a very good case in point. The active ingredient in coffee and (some) teas is, of course, caffeine.

    Originally, this was not known, but science was able to identify and isolate the active ingredient, to prove its activity beyond the shadow of a doubt – including determining what constitutes a dangerous dosage and its side effects. While we do not completely “understand” the brain, we know a heck of a lot about caffeine and things surrounding its use. Caffeine’s claimed and observed effects do not contradict any other theory or observation regarding brain function and neurochemistry.* Science works!!

    Compare that to some of the CAMs – what’s a lethal dose of accupuncture? Are there side effects? What’s the mechanism of operation and does it contradict other areas of science? Is there an actual “active ingredient” in accupuncture; a mechanism that can be isolated? blah, blah, blah — as part of learning virtually anything useful about a CAM you’d also learn other interesting stuff as well. Where is that information?

    mjr.
    —-
    (*What I know about neuroanatomy is dated back to the early 1980s so I am waffling a bit – I haven’t got a good idea how precisely we understand how caffeine works at this time)

  7. apteryx says:

    Modern, scientific research has shown that there are multiple active ingredients in St. John’s wort. Dr. Sampson claims that “StJW has been tested in a number of other conditions and situations and found inactive,” but in fact the vast majority of tests for treatment of depression have shown activity, as have animal studies. It has been compared head-to-head with both tricyclic antidepressants and at least two SSRIs and shown comparable activity. If we had no idea of how it worked, that would not negate the fact that it works. However, those who are researching the question are beginning to elucidate the multiple mechanisms involved. If Dr. Sampson is not familiar with their work, that’s his loss; the work exists.

    There is no traditional use of SJW for ADHD (which, of course, was not traditionally recognized as a disease) and without any human case reports, the rationale for this study seems to have been very weak indeed. For the herbal community, this represented a waste of research dollars that could have been used to test a more plausible hypothesis, and an opportunity for certain mainstream media outlets to go off on a general “herbs don’t work” propaganda binge. Why someone from Bastyr was involved, I can’t guess, unless maybe the Tarot cards told her SJW would be good for ADHD or something…

  8. Wallace Sampson says:

    The intent of the post was first, to propose that doing such clinical trials has little to no usefulness, and that the naturopaths have hidden agendas in organizing such studies. The agendas are economic, political, and ideological. They are not scientific or those involved would not be in a N’pathic school.
    Second, that this trial used a substance with mixed results clinically in a disorder that is difficult to define, has no objective criteria, and the existence of which is even challenged as is not recorded as a “condition” in other cultures such as Japan and some European countries. So, if an effect were found, any but a highly significant effect would be inconclusive or negative.
    The trial’s outcome was based on tenuous basic science – the finding that StJW increased norepinephrine in rat brains…come now. Only the NCCAM with its bias toward life forces and mysteries would fund such a study.
    As for my statement that StJW is not effective, I repeat and with emphasis. One can find positive studies for homeopathy, acupuncture (in poorly controlled trials) and if one wanted to, in studies of counting backward from 100 by 7s. The overall assessment of StJW is one of lack of efficacy. Here is the conclusion of the Cochrane review of StJW – and it takes a lot of negative material to cdme up with such a conclusion…

    A total of 37 trials, including 26 comparisons with placebo and 14 comparisons with synthetic standard antidepressants, met the inclusion criteria. Results of placebo-controlled trials showed marked heterogeneity. In trials restricted to patients with major depression, the combined response rate ratio (RR) for hypericum extracts compared with placebo from six larger trials was 1.15 (95% confidence interval (CI), 1.02-1.29) and from six smaller trials was 2.06 (95% CI, 1.65 to 2.59). In trials not restricted to patients with major depression, the RR from six larger trials was 1.71 (95% CI, 1.40-2.09) and from five smaller trials was 6.13 (95% CI, 3.63 to 10.38). Trials comparing hypericum extracts and standard antidepressants were statistically homogeneous. Compared with selective serotonin reuptake inhibitors (SSRIs) and tri- or tetracyclic antidepressants, respectively, RRs were 0.98 (95% CI, 0.85-1.12; six trials) and 1.03 (95% CI, 0.93-1.14; seven trials). Patients given hypericum extracts dropped out of trials due to adverse effects less frequently than those given older antidepressants (Odds ratio (OR) 0.25; 95% CI, 0.14-0.45); such comparisons were in the same direction, but not statistically significantly different, between hypericum extracts and SSRIs (OR 0.60, 95% CI, 0.31-1.15).

    AUTHORS’ CONCLUSIONS: Current evidence regarding hypericum extracts is inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that the tested hypericum extracts have minimal beneficial effects while other trials suggest that hypericum and standard antidepressants have similar beneficial effects. As the preparations available on the market might vary considerably in their pharmaceutical quality, the results of this review apply only to the products tested in the included studies.

    Note: The smaller trials were more positive that larger ones as we pointed out previously. Studies on antidepressants in depression are themselves mixed, and the controversy still rages whether or not they are effective. If A=B and B=C, then A=C. It doesn’t take a differential equation.
    Then, as I have previously recorded in texts and elsewhere, there is little to no role for researching herbs in medicine except under conditions of search for new compound isolates to purify or possibly synthesize. NIH and NCI have had new plant compound searches for 4 decades at least. Pharmaceutical companies as well.

    Last, JAMA published the paper. Why? There had not been any rush to that use for StJW that I know of. What was the problem?

    WS

  9. wertys says:

    “StJW has been tested in a number of other conditions and situations and found inactive, but with dangerous drug interactions. What IRB had the nerve to approve such a trial? Apparently those questions need not be answered if the NCCAM gives its assent. ”

    I can identify woth this comment. I was trying to set up a clinical trial using intra-articular botulinum toxin (an all-natural product !) for chronic osteoarthritis pain. This has a plausible biological mechanism (reduced expression of TRPV1 receptors in the synovium), some basic science to back it up, and some preliminary case reports suggesting pilot RCTs should be done. In short, a plausible treatment worth investigating.

    But because it would be a Phase 2 trial (use of an established agent for a new indication entirely) I was told by our local Human Research Ethics Committee (HREC) that it would need full co-operation and insurance from the company which makes the product, plus extra pages of consent, plus an extra oversight committee compared to standard trials. Consequently the required logistics were way beyond our pathetic research budget and personnel. Perhaps we should have done a trial of reiki instead, and just avoided the fuss…

    or maybe got NCCAM to fund and approve it, as it seems they can try any old shit…

  10. apteryx says:

    “Last, JAMA published the paper. Why?”

    That one’s easy: Because the results were negative. Both JAMA and NEJM are well known for feeling that where CAM is concerned, negative trials and only negative trials meet their exacting standards.

    If SJW and antidepressants may be equally worthy or worthless, but SJW causes fewer side effects, does not leave a significant percentage of patients addicted (sorry, “physically dependent”!), and is cheaper and doesn’t require costly repeated visits to the MD for permission to buy, it sure seems rational to me to try SJW before antidepressants.

  11. Apteryx, “Both JAMA and NEJM are well known for feeling that where CAM is concerned, negative trials and only negative trials meet their exacting standards.”

    Could it possibly be that because of Apteryx’s love of botanticals, it has never occurred to him/her that it just may be possible that none of the CAM trials with positive results has ever met the high standards of those publications?

    I know very little about psychiatry and the drugs used to treat serious mental diseases. My impression, and that is all that it is, is that the treatment of mental illness is not yet a science. With perhaps a few exceptions, like many cases of bipolar disorder and schizophrenia, psychiatry is still mostly trial and error although with advances in the technology used to scan the brain this may change soon.

    Looking into my very reliable crystal ball I predict that when psychiatry can offer safe, effective evidence-based treatments to people suffering from serious mental diseases like depression that no one, or very few, will be trying unscientific remedies or remedies that aren’t backed by studies meeting the standards of journals like NEJM and JAMA. (Actually, off hand I’m not even sure that JAMA’s standards are as high as those of the NEJM.)

    And you didn’t know that I’m psychic! Well not really. I’ve actually seen how silver supplements were abandoned by people with AIDS as drugs were developed to treat the disease.

  12. Harriet Hall says:

    apteryx said “Both JAMA and NEJM are well known for feeling that where CAM is concerned, negative trials and only negative trials meet their exacting standards.”

    No, JAMA and NEJM are well known for publishing trials that have met exacting standards. Most trials that meet exacting standards have produced negative results for alternative treatments. That’s why they’re still “alternative.”

  13. Harriet Hall says:

    apteryx said, “If SJW and antidepressants may be equally worthy or worthless, but SJW causes fewer side effects, does not leave a significant percentage of patients addicted (sorry, “physically dependent”!), and is cheaper and doesn’t require costly repeated visits to the MD for permission to buy, it sure seems rational to me to try SJW before antidepressants.”

    Gee, that sounds good. But it doesn’t take everything into account. We don’t know that adequate doses of SJW really cause fewer side effects or require less careful tapering than any prescription antidepressants. We don’t have enough long-term studies on SJW to know as much about it as we know about prescription drugs. Sources of SJW are unreliable: the active ingredient deteriorates over time, and independent labs have found wildly varying amounts in the products. And we really don’t know what effects all the other ingredients have.

    As a general principle, especially for an illness that is potentially life-threatening, I would rather spend more money and take something that we have more experience with, that we can reliably obtain in a pure form at a controlled dosage, and that doesn’t contain a lot of “other stuff” that we know nothing about. I’ll take acetylsalicylic acid over willow bark any day!

  14. Calli Arcale says:

    Any day? What about after civilization collapses and all you can get at is willow bark? ;-) Just kidding.

    St John’s Wort is not adequately studied. It’s naive for folks to say that it has fewer side effects than, say, Prozac. All that we can say with confidence is that there are fewer *reported* side effects. But since it isn’t as well studied, there is a very obvious source of bias in those numbers — there will *always* be more side effects known for a drug which is better studied simply because we know more about it.

    And because it’s not sold as a drug, the sellers are under no obligation to let you know that if you’re taking birth control pills, antibiotics, or anti-rejection drugs, you could be in serious trouble if you also take St John’s Wort. That certainly helps its profitability, but I do not trust manufacturers that much. The only reason I can see to insist on a dichotomy between drugs and “herbs” is so that one can avoid all of that pesky regulation associated with drugs.

  15. apteryx says:

    Sorry, several of you simply are not familiar with the research on SJW. You are right that less money has been spent studying SJW than antidepressants – although much of the latter work, including most of the data on Prozac in healthy people, was buried because it did not make the antidepressants look good.

    We do know that SJW does not have, say, sexual side effects like those of SSRIs because of the many trials in which SJW was used, alone or versus an SSRI, and its side effects were tabulated. We did not learn about the likelihood of addiction to SSRIs from company-sponsored studies but from the experience of patients whose complaints were pooh-poohed for years, and we do not see similar complaints from users of SJW. The internet is an open forum and if many people are having that kind of problem, it’s hard to censor. Harriet says that “the active ingredient” deteriorates; we know that there are multiple active ingredients, and while product quality varies, we know that there are such things as good products. (It’s funny how often a single negative study using a product of unspecified quality is claimed to adequately refute the results of dozens of positive studies using better characterized material.)

    For these reasons, you may repeat all you like that SJW use is “unscientific,” but plenty of consumers and European physicians will still disagree. It’s not that they are stupid or quackish; it’s that they interpret the literature differently than you do, and are familiar with more of it than you are. The validity of their opinions would not evaporate even if Pfizer came up with a genuinely safe and effective antidepressant.

    Harriet, you can say that depression is “potentially life-threatening,” but you can say that about every other disease or symptom as well. If someone is mildly depressed (whether or not it is “major depression”), he does not need an MD trying to persuade them that even if he feels no desire to do himself in, he might find himself, like a puppet on strings, going home and eating a bullet one day whether he wants to or not. Talk about a nocebo effect! People who are severely depressed, or suffering severely from any other condition, ought to be under a doctor’s care, presuming they can get it. People who are suffering mildly from the ills to which flesh is heir should not be stampeded towards lifelong medication with dire warnings of the worst-case scenario for every conceivable condition.

  16. Stu says:

    apteryx: Dozens of studies? Wowie, zowie. Link, please?

  17. Harriet Hall says:

    apteryx,

    I don’t feel comfortable accepting the research to date as evidence that adequate doses of SJW would not have sexual or other side effects. The dose is variable, the studies supporting it are by advocates, there are many pitfalls in research, and side effects may be prefentially reported for pharmaceuticals in the community. There are a lot of people out there who hate Big Pharma and who are compiling testimonials from unhappy patients, but there is no equivalent group of haters of herbal meds.

    I don’t think antidepressants are addicting. I have explained before that they alter the body’s physiology, and that sometimes a tapered withdrawal is necessary to prevent symptoms while the physiology resumes its original state, but you can say the same of steroids, thyroid medication and many other drugs that are not considered addictive. Patients who no longer need
    antidepressants and have been tapered off them do not feel any cravings for the drug.

    “People who are suffering mildly from the ills to which flesh is heir should not be stampeded towards lifelong medication.” I wholeheartedly agree with that, and I think most clinicians do too. Most people with mild depression or simple unhappiness should not be put on any medication, herbal or pharmaceutical.

    Incidentally, the Natural Medicines Comprehensive Database has a long list of side effects for SJW, including reports of sexual side effects and serotonin-like syndrome. It also suggests that SJW can cause withdrawal effects similar to those of conventional antidepressants. It can induce psychosis in Alzheimer’s and other conditions. The NMCD has a two page list of its interactions with other drugs, foods, lab tests, and other diseases. It is NOT a benign drug, and patients should be made aware of all these side effects and concerns before they take it. That’s another problem I have with herbal medicines: they don’t give you all the information that you get from the package insert or accompanying information sheet with prescription drugs.

  18. apteryx says:

    Stu – Copying dozens of links is not an efficient use of either my time or this blog’s bandwidth. If you are genuinely interested, you can find many of these studies’ details and abstracts on the publicly accessible database PubMed. Looking up animal studies as well would be informative. Quite a few of the German trials will not be listed; you can find them summarized in authoritative reference works.

    Harriet rejects the studies in part because they are by “advocates” – well, plenty of them are by Germans, who are less biased against phytotherapy than Americans are. They tend to be done by people who think there is a reasonable possibility the product will work. If they did not think so, or were paid not to think so (as, perhaps, in the case of the Pfizer-run SJW study), it would be unethical to do the trial. We do not reject the positive studies of SSRIs because they are run by “advocates” and with plenty of personal income at stake to boot. Dosages, by the way, can also be varied for antidepressants, and there are people, much like those on this blog, who are dedicated to compiling anecdotes of harm from herbs.

    Some people have not been able to get off SSRIs despite years of trying. To the general public, this is called addiction. The fact that those who manage to make it off are grateful, rather than experiencing “cravings,” is a technical point that is used to conceal a serious side effect from the public.

    Harriet, you make a lot of assertions about the putative negative effects of SJW that have little if any support. You refuse to acknowledge positive effects that have been demonstrated in some dozens of human trials, yet you state as a fact that SJW “can induce psychosis” based, I suspect, on one or a few case reports in people who might have begun to act psychotically just because of their Alzheimer’s. Why is the standard of evidence so much lower there?

    And finally, regarding the “two page list of interactions with other drugs, foods, lab tests, and other diseases.” Some of that is true. SJW is, contrary to what you will hear in the media, the ONLY common botanical medicine that has been demonstrated to have a range of significant drug interactions comparable to, e.g., grapefruit juice. It should be avoided by people on many medications. Manufacturers generally warn about this, now that the FDA permits them to do so (there was formerly a danger that such a warning would be treated as an illegal drug claim). However, the food interactions do not exist. Back when SJW was briefly speculated to work as a monoamine oxidase inhibitor, because it had some MAOI activity in vitro, it was therefore also speculated that it could have the same food interactions as MAOI inhibitors. These are potentially very severe reactions to many common foods and beverages (e.g., sausage, cheeses, beer, wine). A depressed person on MAOI inhibitors must therefore forego many pleasures and must pause to nervously scrutinize each meal he’s served, constantly reminding himself of his “disease condition.” Not conducive to good mental health, one would think. Fortunately, SJW does not cause similar reactions. Again, it’s interesting how quickly anecdote and speculation become adequate evidence when negative allegations about herbs are the subject.

  19. Stu says:

    I ask for only one. Just one. ‘Cause I’ve been digging on PubMed, and am finding squadoosh.

    Well, I do find a lot of these, but I doubt these are what you were referring to:

    18544723
    18424529
    18537576

    Come on, just one. You can do it.

  20. Harriet Hall says:

    apteryx,

    Please read what I wrote more carefully. I do not “reject the studies” and I do not dispute the fact that SJW has been shown to be effective for mild to moderate depression. (But not for moderate to severe depression.)

    Some people have not been able to get off SSRIs because they need them to control their symptoms of depression. That is not addiction. We don’t say diabetics are addicted to insulin. Some patients just stop SSRIs and have no withdrawal symptoms at all. Some patients have had difficulty getting off the meds because they were not tapered slowly enough, but as you mention, they do eventually get off them. And certain SSRIs require more tapering than others. At any rate, we don’t know that SJW never causes similar difficulties when given in adequate therapeutic doses.

    I cited a reliable source (the NMCD) for the negative side effects of SJW. The specific references supporting that information are listed there.

    As you point out, there is only one concern regarding interaction with foods. The NMCD says that SJW has weak MAO inhibitory activity and that large amounts might theoretically interact with tyramine-containing foods to cause a hypertensive crisis, but that an actual interaction has not been described in the literature. That doesn’t necessarily mean a food interaction “does not exist” as you claim.

    Hypomania, rapid cycling, and relapse of psychosis have been documented with SJW in patients with bipolar disorder, major depression, and schizophrenia.

    The interactions with drugs have been extensively documented and some are quite significant – and I seriously doubt that the average patient taking SJW has been given that information.

    You have not commented on my objections that I would rather spend more money and take something that we have more experience with, that we can reliably obtain in a pure form at a controlled dosage, and that doesn’t contain a lot of “other stuff” that we know nothing about.

  21. daedalus2u says:

    apteryx, suicide is the 11th leading cause of death. ~35,000 people died from it in 2005. There is inadequate treatment of depression.

    I have been on an MAOI, and had to watch what I ate very carefully. I have been on an SSRI that gave sexual side effects. Being on the SSRI and having sexual side effects was a lot better than being depressed. I am on an SSRI now, and may never get off it. Trying to get off the SSRI is so far down the list of what is important to me to accomplish in my lifetime that it doesn’t register. Being on the SSRI lets me do things that are a lot more important, work, think, feel, love and have a life, even if that “life” is writing comments on blogs ;)

    I see no advantage to SJW, even if it had a chance of working. Psychoactive substances are psychoactive substances; whether they are natural, or synthetic. What I want is something that works reliably and consistently. The consistent part is extremely important to me. I am very sensitive to things. I can feel the difference in subtle changes in my diet. While on imipramine, drinking one beer would make me extremely tired 24 hours later but had no prompt effects. I presume the one beer changed the metabolite profile. Taking sertraline in two doses of 100 mg/day was very different (and good) than taking one dose of 200 mg/day (which was unacceptable). I don’t think I could tolerate something with as much variability as a natural product is going to have. The active compound(s) are unknown in SJW, so it can’t be standardized.

    I completely agree with Dr Hall, I would rather spend more for some thing that was consistent. Even if it didn’t work as well, I can tolerate some amount of reduced effectiveness much better than I can tolerate variability.

  22. Apteryx, since you are ignoring the Cochrane review mentioned by Dr. Sampson above, I will direct you to the NCCAM site:

    http://nccam.nih.gov/health/stjohnswort/sjwataglance.htm#science

    Where it states:
    QUOTE:
    What the Science Says About St. John’s Wort for Depression

    Scientific evidence regarding the effectiveness of St. John’s wort for depression is inconsistent. An analysis of the results of 37 clinical trials concluded that St. John’s wort may have only minimal beneficial effects on major depression. However, the analysis also found that St. John’s wort may benefit people with minor depression; these benefits may be similar to those from standard antidepressants. Overall, St. John’s wort appeared to produce fewer side effects than some standard antidepressants.

    One of the studies included in the analysis was cofunded by NCCAM and two other components of the National Institutes of Health (NIH)—the National Institute of Mental Health and the Office of Dietary Supplements. This study found that St. John’s wort was no more effective than placebo in treating major depression of moderate severity. However, the antidepressant sertraline, used in one arm of the study, also showed little difference from placebo.
    END QUOTE

    Are you going to tell us that Cochcrane and NCCAM “simply are not familiar with the research on SJW” like the people posting here?

    Apteryx also stated, “you may repeat all you like that SJW use is ‘unscientific,’ but plenty of consumers and European physicians will still disagree. It’s not that they are stupid or quackish; it’s that they interpret the literature differently than you do, and are familiar with more of it than you are.”

    In other words unanimous consumers and European physicians have interpreted the literature differently than Cochrane & NCCAM and that is because these unnamed people are familiar with more literature than Cochrane & NCCAM so they are right and the scientists in the Cochrane group and the people at NCCAM are wrong?

    IMO, the problem is that the standards of evidence required to convince proponents of scientific medicine of the safety and efficacy of a product are simply much higher than yours and the other advocates of unregulated dietary supplements. There are only two reasons I can think of why supplement advocates don’t simply admit that. One is because they are trying to convince others that they are correct so that they will buy and use supplements even when there isn’t sufficient evidence for scientists to conclude that they are worth trying or else the advocates are trying to convince themselves that there really are simple, pleasant solutions to all of life’s problems.

  23. apteryx says:

    Stu – I have made it clear elsewhere that I do not do unpaid work in response to rude demands from strangers; if you wish me to do your research for you in future, you will have to ask more politely. However, I suggest you go back to PubMed and try to look up:

    Gastpar et al. Efficacy and tolerability of hypericum extract STW3 in long-term treatment with a once-daily dosage in comparison with sertraline. Pharmacopsychiatry 2005;38:78-86. [Moderate depressive disorder.]

    Szegedi et al. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine.

    Anghelescu et al. Comparison of Hypericum extract WS 5570 and paroxetine in ongoing treatment after recovery from an episode of moderate to severe depression: results from a randomized multicenter study. Pharmacopsychiatry 2006;39:213-219.

    These are not the only studies with similar conclusions, incidentally.

    Harriet, you write: “You have not commented on my objections that I would rather spend more money and take something that we have more experience with, that we can reliably obtain in a pure form at a controlled dosage, and that doesn’t contain a lot of “other stuff” that we know nothing about.”

    Well, taking those in order:

    1. Not true. Hypericum has been used medicinally for millennia; SSRIs were invented within the last few decades. “Experience” is not limited to clinical trial data generated by large companies (or rather, to the minority of it that looks good enough to publish). I have a book that lists hundreds of poisonous plants; none of those were determined to be so by placebo-controlled trials, but by human experience and intelligent judgement.

    2. “Pure form,” meaning single isolated molecules, is not important to me. Research has shown that molecules in SJW interact synergistically. Because of the presence of flavonoids, the hypericin is more bioavailable and does more good: it is superior to isolated hypericin. That lack of purity therefore means that you can get by with smaller doses of the active molecules. If SJW works as well as SSRIs in head-to-head trials, your concern for “purity” is merely a philosophical preference.

    3. “Controlled dosage” is, I think, the only legitimate objection you have; daedalus2u makes the same point. Indeed, plants and products made from them are variable. However, just as it is possible through careful blending to get tea bags or California table wines that taste the same, batch to batch and year to year, it is possible to produce extracts of medicinal botanicals that are highly reproducible. Contrarily, as we have seen from news over the past few years, the use of single-molecule drugs does not guarantee that each batch will be of identical quality. The Germans, who have very strict regulations in this regard, have very well-characterized commercial extracts of plants such as SJW, ginkgo, and hawthorn, all of which have been shown to be effective in multiple human trials. If I were dealing with a serious illness or one causing serious suffering, I would certainly do some research and spend extra to get a good standardized product (if I did not make my own). Some choose to pretend such products cannot exist; they do their cause a disservice, as informed consumers know better.

    4. “Other stuff we know nothing about.” Here, we return to the philosophical issue. You don’t want any of that “other stuff.” I do, because I suspect it may prove to be useful, as is the case for SJW, which has multiple active compounds. Plant foods and conventional beverages all contain numerous active compounds as well. It has been a nutritionist fantasy that we could reduce all of our diet to standardized pills: why eat tomatoes when you can just pop a vitamin pill, or maybe vitamins plus lycopene? Alas, it has been pretty clearly demonstrated that even though they are essential to life, isolated vitamins do not provide the protection against chronic disease that whole fruits and vegetables do. What is responsible then for that protection? It can only be the “other stuff.”

  24. Harriet Hall says:

    apteryx,

    1. Bloodletting was used for millennia. I don’t accept the experience or the “intelligent judgment” of all the bloodletters and their patients. They all believed it was safe and effective, but testing showed it to be neither. “Ancient wisdom” may be “ancient folly.”

    2. If there is a synergism between ingredients, I would rather have a medication containing only those synergistic ingredients rather than one containing other stuff. The argument about synergism in natural products is rarely supported by evidence; in most cases when the active ingredients are tested against the whole product, the effect is the same. You say you don’t care about purity: would you want to take a prescription medication that had other ingredients that had not been properly identified or tested?

    3. I don’t deny that it is possible to find a good standardized product. But how many of the consumers taking SJW are getting such a product, and how many of them even know that products vary? If you recommend SJW, aren’t you obligated to explain all this to consumers and guide them to a product you know to be reliable on the basis of repeated testing?

    4. Yes, this is a philosophical issue. Your position is based on belief and speculation. You don’t have any evidence that the “other stuff” has any real benefits, and you don’t have any evidence that it doesn’t do any harm. The analogy to food may be a false analogy.

    The studies showing no benefit from vitamins were studies on diet supplements taken in addition to a normal diet. That is not the same as saying vitamins have to be provided in the form of food. We do a pretty good job of keeping patients alive with parenteral nutrition when they can’t eat. We can’t yet pop pills instead of eating normally, and I wouldn’t want to give up the pleasures of food, but I see no reason to think we couldn’t eventually identify everything of value in food and eliminate the unnecessary, and I would speculate that it might be healthier than our current diet, because food contains natural pesticides and other things that don’t help us and may harm us. We might some day learn to take harmful ingredients out of our food, sort of like decaffeinating coffee.

    Your position seems to be “we can’t know.” Science is based on the premise that we can learn.

  25. Stu says:

    Decaffeinating coffee? Are you insane?!

  26. apteryx says:

    Harriet – We evolved as primates for many millions of years eating plants. My assumption is that we are pretty well adapted to it by now, presumably much better than we would be adapted to a synthetic diet imposed over a generation or two. You think those “natural pesticides…don’t help us and may harm us”? Maybe, but you have no evidence, and since people who eat plenty of plants suffer significantly less cancer, etc., it would be less unlikely to say that plant secondary metabolites “don’t harm us and may help us.”

    Would I want to take a prescription drug with unidentified, untested synthetic ingredients never before consumed by mammals? Certainly not. Would I want to consume fruits, vegetables, herbs, and spices whose unstudied components have been part of the human diet for millennia? Certainly. You imagine that someday we will have the nice “safe, standardized” tomato pill; in the meantime, wise people will keep on eating tomatoes. Likewise, you claim (wrongly) that bioactive plants can usually be boiled down to a single active ingredient with equal safety and efficacy; that will no doubt be true for some plants not already so treated, but so long as those pills don’t actually exist, informed consumers will use the plants.

    You ask me: “If you recommend SJW, aren’t you obligated to explain all this to consumers and guide them to a product you know to be reliable on the basis of repeated testing?” Depends upon who “you” is. It is no more my job to give a page of details, every time I mention an SJW study, than it would be daedalus2u’s job, when he mentions his experience with SSRIs, to give 1000 words of warnings about impotency and *ahem* dependency. I am not an herbalist and do not provide medical advice to strangers, but if I were, I would most certainly explain the difference between good and bad products, with emphasis on those that have proven useful in clinical trials.

  27. Harriet Hall says:

    No insult to caffeine intended. It’s my drug of choice. :-)

    I didn’t mean to imply that caffeine was harmful – I only used it as an illustration that processes exist for removing one component of an organic mixture.

  28. Harriet Hall says:

    apteryx,

    You are muddying the waters by comparing food to herbal medicines. They are not quite the same thing.

    “Likewise, you claim (wrongly) that bioactive plants can usually be boiled down to a single active ingredient with equal safety and efficacy.”

    Please read more carefully. I didn’t say anything about a “single” active ingredient. I recognize that some plants have more than one active ingredient. I said, “in most cases when the active ingredients are tested against the whole product, the effect is the same.” I think that is an accurate statement.

    In fact it is a truism, since ingredients that act synergistically are by definition active and other ingredients by definition are inactive. If the whole plant outperforms the extract, it only means we haven’t extracted all the important components.

    Based on everything I have read, I think that if you look at all the plant-derived medicines that have been adequately studied, it is far more common to find a single active ingredient than to find significant synergistic effects. If you have evidence to the contrary, please share it.

    Yes, if a purified product is not available, consumers will keep using the plants. And I explained my reservations about that option, especially when there is another option with more guarantees.

  29. apteryx says:

    Harriet – Just as it no doubt takes you hours to write one of your quite eloquent blog entries, it would take me many hours to come up with a fully referenced discourse on single vs. multiple active compounds in plants. I can say that the number of single-compound plant-derived drugs now on the market seems to me to be much smaller than the number of plants that have been shown to have, e.g., multiple antibacterial compounds, or multiple bioactive flavonoids. I can say that thousands of other plants, less well studied, have been found to have similar suites of compounds, that the plants must go to this much effort for a reason, and that there is good reason from evolutionary biology to expect redundancy in active compounds. And I can say that there is published research showing both pharmacological and pharmacokinetic synergy in a number of plants, as well as ongoing research on the subject. (Contrary to your implication above, there are more options than Single Active Ingredient or synergy; there is also simple additive effect of multiple independently active compounds.)

    If your earlier statement can be interpreted to mean “If only we could extract, purify, and recombine all of the directly or indirectly active flavonoids and OPCs in hawthorn, whether there be 50 or 100 of them, the mixture would be just as safe and effective as a ‘crude’ extract,” then your statement is doubtless true but also meaningless, as nobody has come close to doing anything like that. As you acknowledge above (“far more common to find a single active ingredient”), it is almost always the case that when people choose to isolate putative Single Active Ingredients to test, they test only one at a time. And when these are tested against the whole extract at equivalent doses, they are quite often inferior.

    Sometimes, by the way, food and herbal medicines are literally the same thing. If you really do enjoy eating, the chances are you consume medicinal plants on a regular basis. (If not, you are probably British…)

  30. Harriet Hall says:

    There might be lots of active ingredients and yet a larger dose of a single ingredient might work better. If I remember correctly, digitalis leaf contained several active ingredients, maybe even synergistic ones, but a purified synthetic product with just one ingredient proved far superior.

    Perhaps you could just give us a couple of examples where the whole plant was shown clinically superior in controlled studies. Not just single reports, but studies where the results were robust and were replicated elsewhere.

  31. apteryx says:

    Well, there is St. John’s wort. I believe an Israeli group tried studying pure hypericin and found no value, so it was concluded that hypericin was not a/The active ingredient. (Turned out to be premature, as hypericin is active in combination with flavonoids.)

    Virtually all of the botanicals that have been subjected not just to “controlled [clinical] studies” but to “robust, replicated controlled [clinical] studies” obviously have more than one bioactive molecule. Otherwise, the lab and animal studies that are done on such well-studied plants would have identified that one molecule, and modern inclinations being what they are, that molecule would have become the sole focus of clinical study. If the demonstrated benefits of ginkgo or hawthorn could have been plausibly attributed to one molecule or group of interchangeable molecules, one of them would have been picked out for drug development, and the numerous studies we’ve seen on plant extracts would not have been done. Therefore, the expensive comparisons you want to see will not exist.

    It is true that super-duper-dosing of one of several active molecules may provide more potency than a crude extract can give. Sometimes that makes safety worse; other times, as in digitalis, it improves safety. Consider high-dose artemisinin derivatives, which are more likely to offer complete parasite clearance (not always a desirable goal, as it turns out!) than Artemisia annua teas. Result: in recent years there have been plenty of clinical trials on single molecules, and only a couple of small developing-country trials using the traditional tea. The suggestion that this could be done for every beneficial plant is completely lacking in support.

  32. Harriet Hall says:

    You said lots of herbal medicines have been shown superior to their active ingredients. And now SJW is the only example you can think of? An example where the plant was found superior to something they thought was the active ingredient but wasn’t really? You’ll have to do better than that! I found this on the Internet: “The naphthodianthrones hypericin and pseudohypericin along with the Phloroglucinol derivative hyperforin are thought to be the active components.” So the question is: has the combination hypericin/pseudohypericin/hyperforin been tested against the whole plant extract? I searched and couldn’t find any such trial. If these molecules are effective in combination, unless the whole SJW is found to be significantly more effective, I would think a company could make a lot of money marketing that combination in a purified form with a controlled dose, especially considering the statement on the ConsumerLab website that most of the SJW products they tested did not pass their tests.

    The idea that “If the demonstrated benefits of ginkgo or hawthorn could have been plausibly attributed to one molecule or group of interchangeable molecules, one of them would have been picked out for drug development” is mere speculation and is not convincing either. There are other reasons they might not have been selected for development, such as maybe the effect is too small and variable to make it look promising, especially compared to other available pharmaceuticals. Or maybe there are difficulties in isolating the active ingredient. The studies on Hoodia were stopped because they couldn’t figure out how to separate out a component that was hepatotoxic.

    Even if a mixture of ingredients is responsible for the therapeutic effect, the product could only be improved by removing inactive or possibly antagonistic ingredients. I’m not a chemist, but aren’t there various ways of fractionating these preparations? Why do herbalists insist on the whole plant extract instead of testing smaller fractions?

  33. daedalus2u says:

    apteryx, there are many compounds that have pharmacological activity in plants. Plants evolved pathways to produce those multiple compounds for their own physiology; to improve their own survival and reproductive fitness, not so they would have pharmacological activity when humans consume them as drugs or food. Many of the pharmacologically active compounds are pesticides and deter herbivores. That includes caffeine, nicotine, tannins, estrogen mimics, cocaine, and opium. It is very likely that essentially all of them are.

    That some compounds that some plants produce happen to have some therapeutic effects in some humans at some dosages is a coincidence. There is no a priori reason why any particular compound in any particular plant should have any particular therapeutic value. Similarly there is no a priori reason why any two or more compounds should work synergistically for any particular human. Pharmacological activity of natural compounds is an artifact of common descent and sufficient similarity in physiology between plant herbivores and humans that there are cross reactivity of herbivore deterrents.

    Different chemical compounds are likely to be metabolized by different chemical pathways, usually by different cytochrome P450 enzymes. There is some variability in activity of different cytochrome P450 enzymes. Different individuals have different responses to the same compound. The expectation is increased heterogeneity of response to mixtures.

    The analogy with taste-testers standardizing teas is not apt. All tea is being assayed for is its taste, using people skilled at taste testing. Taste is very prompt. While taste is subjective, what the testers are looking for is mixtures that taste the same as the standard. Even if people have subjectively different tasting sensations, they define those sensations to be “the same” when tasting the standard product.

    How are psychopharmacological properties assayed? Teams of depressed people take SJW and titrate its antidepressant properties? If it is difficult to even show that it works in a double blind study, how can the activity be assayed precisely enough to standardize it? It can’t be. The best that can be hoped for is that the SJW grown under the same conditions will have the same activity.

  34. Apteryx, “Stu – I have made it clear elsewhere that I do not do unpaid work in response to rude demands from strangers; if you wish me to do your research for you in future, you will have to ask more politely. However, I suggest you go back to PubMed and try to look up:”

    In law a person a is innocent till proven guilty. Defense lawyers argue their cases in an effort to convince juries that the evidence the prosecution presents doesn’t prove guilt.

    In science and even in general sales the person who makes the claims presents evidence to substantiate them. If he doesn’t have any yet wants to convince others of the value of the product he is promoting, he tries to argue to devert attention from the fact that he doesn’t have evidence to substantiate his claims. He tells people who ask for substantiation that they are rude. (Name calling.) He tells them that it is up to them to go find it themselves and if they can’t, it isn’t because it doesn’t exist but because the person doing the looking isn’t diligent enough or smart enough to find it or else because he is so prejudiced that he refuses to believe it even when it bites him on the nose.

    Apteryx, is still throwing out citations and ignoring Cochrane and NCCAM. But of course s/he will tell me that if I accept them that I am not looking at the evidence just taking the word of “authorities”, the wrong authorities. S/he wants me to accept his/her authority, the authority of an anonimous person on the Internet. S/he is arguing to convince others that SJW is worth buying while not substantiating his/her claims about it. Why?

  35. apteryx says:

    Harriet wrote: “You said lots of herbal medicines have been shown superior to their active ingredients.”

    An herbal extract’s activity will be identical to the activity of its active ingredients – meaning all of them, whether directly or indirectly active, together. But it will very often be different than the activity of a single compound or group of compounds. I believe there are quite a few lab studies that demonstrate that fact. You asked not for bioassays but for multiple clinical trials, found “robust” by you (possibly an unmeetable standard), and done by different groups of researchers. That hasn’t been done and never will be, for reasons previously explained. You suggest testing three “active compounds” of SJW as a mixture, but the flavonoids also seem to be necessary to make hypericin bioavailable and increase its activity. The mixture you suggest would therefore not be as good as whole SJW. If you think each and every one of these botanicals whose value has already been well demonstrated in clinical trials could “only” be improved by tranforming them into Big Pharma products, why don’t you start a biotech company and make a fortune doing just that?

    daedalus2u- There are ways of standardizing botanicals. German products such as the ginkgo extract EGb 761 are highly controlled chemically. Perhaps that is why it has performed in dozens of clinical trials. For some plants, it is also possible to use bioassays – not in humans, but affordably in the lab – to quantitate a known bioactivity in an extract. Digitalis used to be standardized by poisoning pigeons; we have better approaches nowadays. A lot of antibotanical argument seems to boil down to “I don’t know how you would make reproducibly high-quality products, therefore it can’t be done.” But it is, on a regular basis.

    Rosemary – It’s noble of you to come rushing to Stu’s defense, but I suspect he can take care of himself. To point out that a rude message is rude is not “name calling.” You tend to accuse people of that incorrectly; a “name” is a noun applied to a person, not an adjective applied to one specific instance of behavior. Just FYI. Finally, as I have said before, I am anonymous [note spelling] and do NOT claim to be any sort of authority. What I hope is not that anyone will believe me just because I say so, but that they will go and look up the issues I mention and think for themselves, rather than letting you, me, our hosts, or anyone else do their thinking for them. Your repeated false accusations that I want people to “accept my authority” are heartwarming, because they imply that you view me as providing enough logical and factual support for my opinions that you are afraid people will take me for a real expert. That’s a compliment! Thanks!

  36. daedalus2u says:

    I would agree that some botanicals can be made with reproducible properties. But until a particular botanical is shown to be reliably grown, harvested, processed and manufactured into a therapeutic with reproducible and reliable properties it should not be marketed as a therapeutic. That is not the case for virtually all botanicals sold today. The only reliable and reproducible therapeutic property many of them have is likely mediated through the placebo effect.

    We have been talking a lot about SJW, is there any technique to standardize SJW and for what properties? If there is, is that technique being used? SJW is not produced with reproducible and reliable properties because there is no assay system to determine if it is reproducible and reliable for what indication.

    We know that individuals have individual, diverse and idiosyncratic reactions to products that are chemically pure and identical. We know those things interact with the normal constituents of a normal diet. When that human variability to pharmacologically active substances is added to the variability of products with unknown purity and unknown reproducibility, therapeutic effectiveness is much more difficult to determine.

    It seems to me that the burden of establishing reliability and reproducibility for a particular indication should be on those who are selling the botanical. So far the strategy seems to be caveat emptor.

  37. Apteryx said about me, “Your repeated false accusations that I want people to ‘accept my authority’ are heartwarming, because they imply that you view me as providing enough logical and factual support for my opinions that you are afraid people will take me for a real expert. That’s a compliment! Thanks!”

    You are welcome, Professor! And thank you so much for the English lessons – grammar, word definitions and spelling!

    I hate to burst your bubble, but I don’t think you are dangerous because of your great ability in logic or because you have factual knowledge. I think you are dangerous because you are so articulate, well educated and adept in things like English grammar, definitions and spelling and absolutely excellent at using all the tricks lawyers and marketing professionals use so successfully to confuse and confound people who don’t know a topic and don’t have the time to study it, lawyers and marketers who convince ignorant people that black is white and that there is solid evidence where none at all exists.

    In my uneducated opinion it is people with your talents who are responsible for the passage of DSHEA and with getting unscientific medicine into what used to be scientific institutions. Your talents, talents which you spend an awful lot of time using here, are the kind that wear down and intimidate many hard working professionals, scientists who are looking for the cure for cancer and don’t have time to debate about the how great TCHers were at determining cause and effect based on personal observations. People who express ideas like Pec draw attention to topics. People with your education and techniques are the ones that the mainstream public and media take seriously.

    You start with a premise, a faulty one no less. THs learned through personal observation what botanicals worked for what. Then you draw all kinds of conclusions from that and assert that they are true.
    That is exceedingly dangerous and just the opposite of what good medical scientists do. Good medical scientists form a hypothesis and test it objectively to see if it holds up.

  38. apteryx says:

    rjstan – Are you insinuating that I am a lawyer or a marketer? Now that’s name-calling! :-) I did not say a word about your grammar, which is generally fine, but if I were to say anything about your rhetorical style, it is that you might learn from some of the less-educated pro-CAM advocates that shrill personal attacks are not an appealing approach, unless your audience are talk-radio fans. When you keep things rational and impersonal, you are more convincing (as you seem to acknowledge when you complain that “people with my techniques” are taken seriously by the public and media).

    Whether humans are capable of learning from observation is, indeed, a question I regard as being settled in the affirmative. Humans discovered thousands of food plants by observation. Animals learn from observation – and use medicinal plants. If you refused to accept the evidence of that, you would say that animals had zero knowledge of plant medicines. Now, if you asserted that humans not both modern and Western have no genuine knowledge about plant medicines, but a whole bunch of false “knowledge” that they believe to be true, you would essentially be saying that they know less than zero, in short, that they are in a worse position than animals. I find that hypothesis unacceptable based on my own personal observations.

    I do NOT conclude from that premise that every traditional remedy is in fact efficacious. Many are not. Many are better than nothing, but not as good as Western medicines for the same purpose (although you must realize that Western medicine is not available to most of the world’s population). I do regard the traditional claims for these remedies as hypotheses, formulated legitimately through observation even though not by people with PhDs, which can be tested as resources permit. When animal and/or human studies find that a remedy has the effects claimed, that is evidence in support of the hypothesis. You, it seems, don’t want to hear about those studies or admit their results into evidence.

  39. Apteryx, your posts speak for themselves.

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