The Amazing Meeting 2014

Like it? Share it!

Sign up for news and updates!

Enter word seen below
Visually impaired? Click here to have an audio challenge played.  You will then need to enter the code that is spelled out.
Change image

Please leave this field empty

Login Form

Another Herb Bites the Dust PDF Print E-mail
Written by Dr. Steven Novella   

A recent scientific study published in JAMA (Journal of the American Medical Association) looked at the drug silymarin for the treatment of liver disease due to chronic hepatitis C that has not responded to standard therapy with interferons. This would be just another obscure study except for the fact that silymarin is an extract of milk thistle, an herb commonly used to treat liver disease. Further, the study was funded in part by the NCCAM (National Center for Complementary and Alternative Medicine).

The study represents one more in a long line of studies of herbal remedies funded by the NCCAM - all negative. There have now been large, double-blind clinical trials of echinacea and cold symptoms, gingko biloba and memory loss or Alzheimer's disease, black cohosh and hot flashes, saw palmetto and benign prostatic hypertrophy, and others. Even St. John's Wort, which is supposed to be a big herbal remedy win, has been shown to have no effect on moderate or severe depression (although the jury is still out on minor depressive symptoms).

Despite this string of negative studies, the herbal remedy industry continues to rake in billions of dollars a year. Large, rigorous, and negative studies seem to have little impact on the sales of herbal products overall (although they may effect the relative popularity of specific herbs to some extent).

To make matters worse, in the US herbal drugs were essentially deregulated in 1994 by the Dietary Supplement Health and Education Act (DSHEA). Herbs are now regulated more like food rather than drugs. Further, a special category of health claims, so-called structure function claims, was carved out for supplements. Companies can market herbs without any prior approval from the FDA or need to provide evidence of safety or effectiveness. They can even claim that their product supports the structure or function of the body in some way, as long as they don't mention a specific disease by name. This amounts to a massive loop hole through which any savvy marketer can drive a truck.

The deal that DSHEA and NCCAM made with the public was this - let the supplement industry have free reign to market untested products with unsupported claims and then we'll fund reliable studies to arm the public with scientific information so they can make good decisions for themselves. This "experiment" (really just a gift to the supplement industry) has been a dismal failure.

The result has been an explosion of the supplement industry flooding the marketplace with useless products and false claims. The only result has been to part the American public from billions of health care dollars over the last couple of decades.

Part of the problem is that negative studies are too easy to dismiss. In every case the supplement industry found some reason to minimize the implications of the studies showing their products do not work, instead preferring to cherry pick small and unreliable studies with positive results. No study can possibly address every possible permutation of how an herb can be used.

For example, herbal apologists claim that the dose was not high enough, the wrong part of the plant was used, the preparation was not correct, or the treatment population was wrong in some way. For echinacea they claimed that the wrong cold viruses were used. There is always something they can point to. Of course, if it's so difficult to find the right preparation for the right condition, they how do they justify selling highly variable products to the general population with broad claims?

It should be up to the manufacturer and marketer of an herbal product to prove that their product is safe and effective for whatever it is they claim it treats. Not only is this not required under DSHEA, companies can continue to market their herbs with claims that have been contradicted by major scientific studies funded by taxpayer dollars.

We can now add milk thistle for liver disease to the list of failed herbal remedies. Of course, this study only involved hepatitis C. There are many other forms of liver disease, and until every single one is studies in a major clinical trial at sufficient doses and duration, sellers can continue to hold out the claim that milk thistle works for something. They have no burden of proof, so all they need is a little denial.



Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.

Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society and the host and producer of the popular weekly science show, The Skeptics’ Guide to the Universe. He also authors the NeuroLogica Blog.

Comments (7)Add Comment
Echinacea Cocktails
written by Sgith, July 21, 2012
Here's something else to think about. In 1994, I was in a job where getting sick was inconvenient. If I did get sick, that meant something very bad was in the air. Someone raved about echinacea to me and because I figured, at worst, it would be harmless, I went to the "health food" store and bought the small tincture bottle.
The instructions were to put "9-12 drops in a glass of orange juice" every few hours. I did what they said, but at some point, I ran out of orange juice. I thought that if I just measured out 12 drops by eyeballing the dropper, I could just give myself a "hit" and move on with my day.
I loved the taste. It was very familiar, yet looking at the bottle gave me no clue. There was a licorice taste to it and I really thought, "I'm looking forward to the next ...hit.". At some point, I was puzzled. In Canada, all contents must be labeled on the outside and this said nothing except "echinacea". The tasty little mystery was soon gone and with a curious excitement, I went back to get more. Here was something good for me and it tasted good as well.Who would have thought?
I soon found myself at the cash with my new bottle of heaven and I mentioned to the cashier how delicious it was. "You realize it's packed in Brandy?", he said. NO, I DIDN'T! By this point, I had been sober SIX years. Booze was not my friend. It seems I did my own double blind test with alcohol. I thought I tasted something but the label said nothing. Stupidly, I accepted that. These irresponsible snake oil sellers would sell alcohol to an alcoholic; for three dollars, they could happily ruin someone's life. Rather than have it ruin my life, I want people like you to go after them. Either they don't know or don't care; I don't know which is worse. Either one makes me hope this letter finds even one reader like myself.
report abuse
vote down
vote up
Votes: +6
..., Lowly rated comment [Show]
Dear Caller X
written by padego, July 22, 2012
Before spouting off and generally making an a** of yourself try doing a bit of homework. The preparation used by Sgith was a tincture in which alcohol (brandy, vodka etc.) is commonly used as a preservative, see here:

As he clearly states that there was no ingredient label, it could have been any type of alcohol with an anise base.

Your post only perpetuates the believe that the interwebs has a shortage of twits and needs to create more...
report abuse
vote down
vote up
Votes: +7
..., Lowly rated comment [Show]
written by C. P. Kirschner, July 22, 2012
Don't feed the troll.
report abuse
vote down
vote up
Votes: +8
written by Careyp74, July 23, 2012
Caller X, what is your deal with orange juice and alcohol? And who mentioned 12 step?

Anyways, here is an echinacea product listed as 25% alcohol.

As far as brandy tasting like licorice, perhaps that is the echinacea mixed with it. I am sure brandy doesn't taste like almonds either, but if you mix it with cyanide it might.
report abuse
vote down
vote up
Votes: +3
Methanol in orange juice
written by FledgelingSkeptic, July 23, 2012
Yes there is alcohol (specifically methanol) in orange juice. The amount is greatly reduced in pasteurized OJ, however, according to a bit of research I turned up here:

As for echinacea not being medicine, that's true. However, for the people who don't know any better, it could be considered by them as a medication.

I was an herbalist before I learned better. Tinctures are made in alcohol to "draw out the properties of the herb". Depending on what was in that "remedy" it could have tasted like anything. That's the hazard in buying unregulated herbal stuff. You just don't know what you're getting for sure.
report abuse
vote down
vote up
Votes: +2

Write comment
This content has been locked. You can no longer post any comment.
You must be logged in to post a comment. Please register if you do not have an account yet.