AIDS and lymphoma quackery

[Deetee]

I just came across this report about the death of one of South Africa's prominent AIDS cases - a girl who was seduced by the promises of a quack cure from vitamins and magic herbs. Of course, it all ended tragically, like these things always do. At least with HIV medication she would have stood a chance.

Also, reading Orac's blog, I see there are 2 young kids with Hodgkins lymphoma (cure rate >80% with conventional chemotherapy) whose families have rejected orthodox treatment and have opted for the snake oil. What is so sad is that even when these kids have died, their families will doubtless remain true to the delusion that they did the best they possibly could for their kids, and feel no blame or shame.

Can someone slip me some St John's Wort please, I really need some.

 

[Ian Osborne]

I agree with all of this, but I must question the St John's Wort joke at the end. Is it really useless snake oil? People who are on prescribed antidepressants such as Prozac are told not to use it as it interferes with the medication, so it definitely isn't neutral.

St John's Wort is often sold alongside quack cures, but not every herbal remedy is untested and valueless. Perhaps someone with medical knowledge could fill us in on this one?

 

[Blue Wode]

Here’s what David Colquhoun (Professor of Pharmacology, University College London) had to say about St. John’s Wort following the Herbalism episode of the BBC2 programme, ‘Alternative Medicine:The Evidence’ which was broadcast earlier this year:

St John's Wort (Hypericum) is an interesting case, because there is at least some evidence that it works, though certainly not enough for it to be described as a "superherb", as Sykes did. Of course depression (like knee surgery -above) makes a pretty good case for herbalists, because conventional antidepressents are so very unsatisfactory themselves. It doesn't take much to do better than Seroxat (Paxil, paroxetine). At 9.38 pm we get the first actual numbers. And very selective numbers they are too. The view presented in the programme was desperately over-optimistic about the wondrous effects of St John's wort. Consider the recent review by Linde et al. (2005 Brit J. Psychiatry, 186, 99-107) (read it yourself -download pdf file). The conclusion was as follows.

“Current evidence regarding Hypericum extracts inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that Hypericum has minimal beneficial effects while other trials suggest that Hypericum and standard antidepressants have similar beneficial effects. ”

And another trial, again not mentioned in the programme, was published in Journal of the American Medical Association, 2002, 287, 1807 – 1814) [download the pdf file]. This paper was interesting because it compared placebo, St John's Wort and sertraline (Zoloft, a drug of the same class as Seroxat). All three were indistinguishable (on the two primary outcome measures). So St John's Wort was as good as Zoloft, but only because Zoloft was no better than placebo either. The paper concluded thus.

“This study fails to support the efficacy the efficacy of H. perforatum [St John's Wort] in moderately severe major depression. The result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy for H. perforatum is noteworthy.”

http://www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#bbc23

 

[Deetee]

You realise I only want some for its placebo effect, I trust.

 

[luchog]

Here’s what David Colquhoun (Professor of Pharmacology, University College London) had to say about St. John’s Wort following the Herbalism episode of the BBC2 programme, ‘Alternative Medicine:The Evidence’ which was broadcast earlier this year:]

I've read up on a number of different studies on St. John's Wort; and from what I can tell, the general consensus is that it does have an SRI effect similar to prescription SSRI-type antidepressants; but that the herbal sources are far too inconsistent in quality to be theraputically useful.

 

[eri]

I seem to remember reading that St. John's Wort also interferred with AIDS medication, and there's a sign up at the clinic I go to saying it interferres with birth control as well.

But yes, as far as your original post goes, I've also been distrubed reading Orac's blog lately about these cases. I wonder where we draw the line between 'religious freedom' and 'child abuse'. I think some people (Christian Scientists, I'm looking at you) may be there already.

 

[Dogdoctor]

An interesting fact about St Johns Wort is that it is considered a toxic plant in veterinary medicine. It causes photosensitization (sunburn) if ingested in large enough quantities by cattle and sheep.

 

[Aardvark]

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12483450&dopt=Abstract

http://www.herbalists.on.ca/journal/hypericum.pdf

Be carefull when considering how drugs interact with one another. There are several models for this but the most common is the effect that drugs have on the liver enzyme systems which are responsible for either activating pro drugs or deactivating and metabolising drugs prior to excretion by urine or bile faeces routes.

As can be seen, Hypericum has an effect on cytochrome P450 3A which is the enzyme system used to metabolise a lot of common pharmaceuticals including the statins atorvastatin and simvastatin to name but two. This would lead to a deacrease in serum concentrations of active drug. It is interesting to note that even grapefriut juice has an impact on CP4503A4 and its consumption can lead to doubling of serum concentrations of some drugs such as simvastatin

 

[deadrose]

An interesting fact about St Johns Wort is that it is considered a toxic plant in veterinary medicine. It causes photosensitization (sunburn) if ingested in large enough quantities by cattle and sheep.

It causes photosensitization in humans as well, IIRC. As can the regular SSRIs, although it's not a common side effect.

Heidi

 

[Aardvark]

Getting back to topic, it is criminal to not utilise all the best evidence based medicine when treating Lymphoma including Hodgkins and NHL.

Interestingl I was at a lecture on CLL this week, Chronic Lymphocytic Leukaemia and as this is a disorder of the elderly with slow progression in a lot of cases, active treatment is not always started by the Consultant staright away, some prefering a wait and see approach to see if the condition becomes more acute.

Coversely I was a trialist who told me the case of an NHL patient who tried the quack approach over 6 months, where scans continued to show greater nodal enlargement and involvment and when she finally agreed to chemo intervention hshe admitted her mistake and recognised that she may have left active treatment too late. Whilst this is sad for an adult, It is criminal for an adult to impose this on a dependant or child

 

[Deetee]

In the US there is the charge of child endangerment which can be applied to parents who do not act in their child's best interests. I don't know why this has not been tried in these cases.