More evidence indicating efficacy of echinacea

[Eos of the Eons]

You are right, Eos, in calling for a study with known amounts of active ingredient. However, in the case of echinacea (and the vast majority of herbs), nobody knows what the active-ingredient (if any) is.

Pharmacognosists often assume a compound that is either unique to, or plentiful in, an herb is the "active ingredient." This is irrational. However, if they persist, the next step is clear- isolate that compound and test it.

It's not really irrational, since if there's a claimed effect there must be something causing the effect. So, the first step is to standardize the dose of what is having an effect.

It's merely difficult when there's no clear cut evidence of any effect. You're left playing around and guessing what in the plant may have any effect at all. It's not the chlorophyll, it's not just the regular plant cell walls or mitochondria, or whatever else every plant has. There must be something else, and that is what you have to get a hold of to make sure everyone is getting the same dose. That is why you need these controls, to make sure the study is trustworthy.

It's irrational not knowing what the active ingredient is, but not to guess at what it is to try to attempt studies. Therefore, it is irrational to suggest the plant has a unique property that can cure the common cold (or lessen it's duration) when there really isn't any unique property. Studying and isolating this unique ingredient/property that causes the effect is an attempt to rationalize the claim.

If there is no real active ingredient, and no reason to support the claims, then the supplement makers need to stop making the claims (but they won't since they can make the stuff cheaply, and sell the stuff as food/supplements because there is no real effect). If there is an active ingredient, and it does actually do something, then you have an actual drug on your hands.

Then it will need to be regulated as a drug to prevent misuse, overdoses, etc. So, the supplement makers will have to make sure the right dose in their bottles. That is far more expensive than stuffing any part of the plant in a capsule.

Guess what, the usual whining that big pharma stole their weed will entail. It's better for the supplement makers to keep making ambiguous claims without having to prove it. So biased studies by the makers will keep them saying there is an effect to their customers. Studies that say there is no effect (good studies) keep it from being a drug.

Basically, it's a dumb plant that can be sold as food since there really isn't an active ingredient. That is irrational, but reality.

 

[JJM]

I wrote

Pharmacognosists often assume a compound that is either unique to, or plentiful in, an herb is the "active ingredient." This is irrational. However, if they persist, the next step is clear- isolate that compound and test it.

It's not really irrational, since if there's a claimed effect there must be something causing the effect. So, the first step is to standardize the dose of what is having an effect.

{snip}

It really is irrational because it is arbitrary. The pharmacognosist's assume that some compound they have found must be the active ingredient; without any independent confirmation that it is, in fact, active.

Yes, if there is an effect, the herb must be standardized on the active ingredient; but that ingredient must be identified, not merely guessed at.

Another problem with using herbs (instead of isolated, active ingredients) is the fact that herbs can also bring along many other chemicals that are, at best, irrelevant; and at worst- harmful in their own right.

 

[Eos of the Eons]

I wrote

It really is irrational because it is arbitrary. The pharmacognosist's assume that some compound they have found must be the active ingredient; without any independent confirmation that it is, in fact, active.

Yes, if there is an effect, the herb must be standardized on the active ingredient; but that ingredient must be identified, not merely guessed at.

Another problem with using herbs (instead of isolated, active ingredients) is the fact that herbs can also bring along many other chemicals that are, at best, irrelevant; and at worst- harmful in their own right.

How do you know who is assuming what? How do you know they aren't or are guessing? I'm betting most of the chemicals are known to be benign, and any in echnicea have all been plotted out and are well known for their properties. So to find that one that might do something, it's quite easy to find something that isn't well known and try to figure out which compounds in combinations aren't well known. It's not like chemistry and chemicals are a new science, we know a whole lot about chemicals and compound and reactivity, etc. It's not a guessing game anymore. Just take a course in organic chemistry, for one semester, and then know that pharmacologists and others in that field go to school for 7+ years.

This comes to the actual point of my post.

If there is no real effect, no matter what the chemical, then it's irrational to even be doing the testing. But one bad study says there IS an effect, so it has to be proven what. So, you use good study protocols and come up empty handed every time since none of the ingredients involved actually does what is claimed.

So, every good study will be negative no matter what. But, the supplement sellers get to make the claims still, just not on the bottles (since that is actually illegal).

You can claim all you want to with bad studies to keep selling your product. Meanwhile, it also doesn't have to be labelled a drug, since there is no actual proven effect.

If an actual active ingredient is found, and it actually shows an effect, then it will have to be regulated as a drug.

Trust me, no supplement sellers want to have to treat the product like a drug, it's far more expensive to have to follow those strict guidelines.

So, the real studies are quite useless, and the researchers will be chasing their tails forever. But, every so often we see these headlines like in the OP. No real proof, no actual ingredient, and just claims that something supposedly shows it works.

I'll believe it when I know which compound or ingredient in the plant is actually the real one, and in what dose it needs to be taken to have the claimed effect.

I'm trying to say the compound or ingredient just doesn't actually exist in echinacea, and that just bad studies are showing some kind of effect where there is none. I've never seen a good study (no matter if the whole plant is used or just some of the ingredients found in it) show any effect.

Are you thinking they might actually find something yet, after all these years? Do you feel the researchers just are fumbling around "guessing" and just not finding it yet? If so, then I guess I don't feel that is so. They really aren't that stupid IMO.

 

[Skeptic Ginger]

The Cohen study is not easily exploded at a glance, but six out of nine of the studies on whether Echinacea has an ability to prevent infection are negative (confidence intervals include OR 1.0) but they are weighted much lighter than the Cohen study with its 0.136 OR.

Could you post the titles or bibs of the studies they used?

I lost faith in meta-analyses when the last one on the effectiveness of prayers came out. I looked at every single study in the analysis and not a single one was a valid study.

But, not only that, when you are evaluating effect, no effect, it only takes one study to get a positive result. And why these are considered valid is beyond me.

For example say you look at 10 studies, 9 negative one positive. Assign one point for the positive and zero for the negative. Do the math, what is the average? It's a positive number. Because -1 is not assigned to the outcomes where there was no result.

This analysis makes a bold statement of reduction of colds by >50%. That flies in the face of the research I have read. In addition, some of you reinforced that fact citing the research you have read. So this result seems rather odd considering all the research showing a lack of results, and little if any positive effects that those of us who read these studies have seen.

If you can list the studies they reviewed, Vitnir, we can track them down and take a closer look. And if we find the analysis to be poor, we can all write the Lancet and complain. Because if the analysis is poor, one stupid headline like this undoes all the efforts to educate people that we try to do.

Here's the abstract in Linda's link for those of you not registered at the Lancet website.

Lancet - free registration required

Summary

Echinacea is one of the most commonly used herbal products, but controversy exists about its benefit in the prevention and treatment of the common cold. Thus, we did a meta-analysis evaluating the effect of echinacea on the incidence and duration of the common cold. 14 unique studies were included in the meta-analysis. Incidence of the common cold was reported as an odds ratio (OR) with 95% CI, and duration of the common cold was reported as the weighted mean difference (WMD) with 95% CI. Weighted averages and mean differences were calculated by a random-effects model (DerSimonian-Laird methodology). Heterogeneity was assessed by the Q statistic and review of L'Abbé plots, and publication bias was assessed through the Egger weighted regression statistic and visual inspection of funnel plots. Echinacea decreased the odds of developing the common cold by 58% (OR 0·42; 95% CI 0·25–0·71; Q statistic p<0·001) and the duration of a cold by 1·4 days (WMD −1·44, −2·24 to −0·64; p=0·01). Similarly, significant reductions were maintained in subgroup analyses limited to Echinaguard/Echinacin use, concomitant supplement use, method of cold exposure, Jadad scores less than 3, or use of a fixed-effects model. Published evidence supports echinacea's benefit in decreasing the incidence and duration of the common cold.

 

[Skeptic Ginger]

I wrote

It really is irrational because it is arbitrary. The pharmacognosist's assume that some compound they have found must be the active ingredient; without any independent confirmation that it is, in fact, active.

Yes, if there is an effect, the herb must be standardized on the active ingredient; but that ingredient must be identified, not merely guessed at.

Another problem with using herbs (instead of isolated, active ingredients) is the fact that herbs can also bring along many other chemicals that are, at best, irrelevant; and at worst- harmful in their own right.

On the one hand you say here "arbitrarily assumed" and OTOH you say, "that ingredient must be identified, not merely guessed at". The latter statement implies you recognize an active ingredient can be identified, so why would you then assume it wasn't?

Here are a couple sources that put together reveal the problems with the commercial products. And I'm willing to consider that all the studies which failed to show results were indeed not even testing the same things, let alone an adequate dose.

Echinacea products unlikely to work

An analysis of popular echinacea herbal remedies in the latest issue of CHOICE magazine shows most don’t contain enough of some of the active ingredients to be likely to work....Scientists have identified the two compounds – cichoric acid and alkylamides – as active ingredients in echinacea, a herb belonging to the daisy family. The analysis found low levels of alkylamides in all samples. Cichoric acid levels were higher in some products but low in others. One contained no detectable cichoric acid.

Herbal Lottery: Science News Online, June 7, 2003

Several years ago, however, Christine M. Gilroy of the University of Colorado Health Sciences Center in Denver was unsure whether to trust data from those experiments because few reports included biochemical proof of which species of purple coneflower had been used. That's important, she notes, because three species—Echinacea pallida, Echinacea purpurea, and Echinacea angustifolia—turn up in supplements "and only the first two have data indicating they might make colds better."

Curious about E. pallida's reputed power against colds, Gilroy designed a study and then ordered dried samples from three suppliers. She sent some of each delivery out for analysis of chemicals that were known to distinguish the species and that might even have therapeutic activity.

The data that came back put her study on hold. They showed no batch containing pure E. pallida. The one from a bulk wholesaler that supplies herbal-products companies contained almost no Echinacea from any species, and what little there was consisted solely of E. purpurea. The other batches, acquired directly from coneflower growers, did contain E. pallida—but also contaminating plants, including E. angustifolia. [This could be dangerous mislabeling for people with allergies.]

Gilroy then turned to 59 commercial echinacea products from local stores. Her team's analyses, reported in the March 24 Archives of Internal Medicine, show that none offered consumers what had been promised by its label. Six contained no evidence of any echinacea, and 28 failed to contain the specific species that was listed on the box. Some offered echinacea in quantities exceeding or, more often, falling below the quantity on the label—sometimes substantially.

These findings call into question the conclusions of the many earlier studies of echinacea's purported cure for the common cold, says Gilroy. At the least, they suggest that health effects seen with one sample of supplement might not hold for others.

And this is from a commercial site (so take it with a grain of salt) which claims different processing results in different levels of what they also refer to as the active ingredients.

Barton said that the following measurements were those at which the ingredients were at their optimum levels : 0.25mg/ml of alkamides, 2.5mg/ml of cichoric acid and 25mg/ml of polysaccharides.

The efficiacy of these levels have now, according to the company, been confirmed in two clinical trials. The first, which was published earlier this year in Clinical Pharmacy and Therapeutics, found that the cold symptoms were reduced by 23 percent and the illness shortened by 1.5 days.

The second study, which Barton noted had been submitted for publication in the next couple of months, showned that echinacea had a positive effect on hightening the levels of natural killer cells.

The main thrust of Barton's argument is the need for this rigorous approach to be taken up by all companies producing echinacea. He believes standardization and consistency of product would improve the results of the herbal in trials and thereby increase the credability of the product.

 

[kellyb]

The main thrust of Barton's argument is the need for this rigorous approach to be taken up by all companies producing echinacea.

Why would they do that when they can just scoop out some lawn clippings out of their lawnmowers and sell it as a supplement?

 

[Skeptic Ginger]

Why would they do that when they can just scoop out some lawn clippings out of their lawnmowers and sell it as a supplement?

Advertising gimmick, of course.

 

[JJM]

On the one hand you say here "arbitrarily assumed" and OTOH you say, "that ingredient must be identified, not merely guessed at". The latter statement implies you recognize an active ingredient can be identified, so why would you then assume it wasn't?

...

"Arbitrarily assumed" is the same as "guessed at" for all practical purposes. I am sorry I wasn't clear, pharmacognosists lag behind in proving active ingredients- they make assumptions.

Of course an active ingredient (if it exists) can be identified. However, it requires clinical research, not chemical analysis coupled with flights of fancy.

Suppose you serve some beef stew, and I credit the cow for the great taste. You ask what about all the spices you have added, and I point out that spices are only present in trace amounts- the flavor is obviously due to the meat. That is the standard in pharmacognosy, to credit the meat and disregard the spices (congeners) simply because the beef is the most abundant and/or identifiable component in the stew.

They do this for a practical reason- it is simpler (and less expensive) to assume some compound is active than to demonstrate (clinically) its activity.

Yes, an active ingredient (if it exists) can be identified; but that is not the standard practice in herbology. For the vast majority of herbs- no active ingredient has been identified. In addition, toxic congeners are unidentified.

 

[fls]

I lost faith in meta-analyses when the last one on the effectiveness of prayers came out. I looked at every single study in the analysis and not a single one was a valid study.

My favourite was the inclusion of a study that was written as a joke for the BMJ Christmas issue.

Linda

 

[Skeptic Ginger]

I would be more sympathetic with your claim, JJM, if you had evidence that the way the active ingredients in echinacea were determined actually occurred the way you are assuming they were determined. From what I gathered looking for information via Google in just a few minutes was the two identified active chemicals in echinacea were not arbitrarily guessed at. Those chemicals actually had a mechanism of action in humans identified and they also happened to be 2 chemicals which were more unique to echinacea.

I don't see how you could know if something was arbitrarily guessed at without at least looking into how that something was determined.

 

[kellyb]

Advertising gimmick, of course.

But they can make the claim without it being true and nobody notices or cares.

 

[JJM]

I would be more sympathetic with your claim, JJM, if you had evidence that the way the active ingredients in echinacea were determined actually occurred the way you are assuming they were determined. From what I gathered looking for information via Google in just a few minutes was the two identified active chemicals in echinacea were not arbitrarily guessed at. Those chemicals actually had a mechanism of action in humans identified and they also happened to be 2 chemicals which were more unique to echinacea.

I don't see how you could know if something was arbitrarily guessed at without at least looking into how that something was determined.

Good point (but "googling" is not the way to learn facts).

Read: Tyler's Honest Herbal by the late Varro Tyler. He was the Lily Distinguished Professor of Pharmacognosy at Perdue University. For most shrubs, where he lists an active ingredient, he lists a compound he thinks is particularly abundant or seemingly unique to the herb. He died a few years ago; but that remains the state of the art in herbology.

Assuming you are correct, that two "active" chemicals have been found in echinacea, they have not been subjected to proper, clinical study.

 

[Skeptic Ginger]

Nonsense one cannot learn facts from Googling. I have gone to great lengths to perfect my media literacy skills. I spoke at TAM about a side topic of media literacy. If there is one thing I know well besides infectious diseases it's how to find valid sources of information on the Internet and how to detect poor sources.

What effort did you make to confirm your claim that a proper clinical study has not been done? Are you simply surmising by the state of the research on Echinacea? That wouldn't preclude research looking at the activity of the chemicals at the cellular level.


For example, I found this article that looked at the effects on mice. Echinacea: a Miracle Herb against Aging and Cancer? Evidence In vivo in Mice; Sandra C. Miller; Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada

 

[JJM]

Nonsense one cannot learn facts from Googling. I have gone to great lengths to perfect my media literacy skills. I spoke at TAM about a side topic of media literacy. If there is one thing I know well besides infectious diseases it's how to find valid sources of information on the Internet and how to detect poor sources.

You are right, I made an overbroad claim. I meant that one must go to the source and try to evaluate it. I apologize. However, you claimed to have two articles that dispute me, and you did not cite them.

What effort did you make to confirm your claim that a proper clinical study has not been done? Are you simply surmising by the state of the research on Echinacea? That wouldn't preclude research looking at the activity of the chemicals at the cellular level.{/quote]Since you havn't cited an article, I cannot be sure what you mean. However, I do know that positives on"screening" tests more often than not fail in more comprehensive analyses.

For example, I found this article that looked at the effects on mice. Echinacea: a Miracle Herb against Aging and Cancer? Evidence In vivo in Mice; Sandra C. Miller; Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada

I will look at this in the morning; but I note it does not relate to the "cold" (the subject here) nor to humans.

ETA- the link does not work for me. Can you provide another, or the citation? Thanks

 

[Vitnir]

Edit: I copied the refs from the pdf of the article and the formatting is all weird and when I try to correct it the changes aren't saved so it doesnt get any better sorry.

The included studies are these:​

Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An
evaluation of Echinacea angustifolia in experimental rhinovirus
infections. N Engl J Med 2005; 353: 341–48.​

Cohen HA, Varsano I, Kahan E, Sarrell EM, Uziel Y. Eff ectiveness
of an herbal preparation containing echinacea, propolis and
vitamin C in preventing respiratory tract infections in children: a
randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med 2004; 158: 217–21.​

Sperber SJ, Shah LP, Gilbert RD, Ritchey TW, Monto A. Echinacea purpurea for prevention of experimental rhinovirus colds. Clin Infect Dis 2004; 38: 1367–71.​

Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C. Effi cacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 2003; 290: 2824–30.​

Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D’Alessio D. Treatment of the common cold with unrefi ned echinacea. A randomized, double-blind, placebo controlled trial. Ann Intern Med 2002; 137: 939–46.





Schulten B, Bulitta M, Brigitta B, Koster U, Schafer M. Effi cacy of Echinacea purpurea in patients with a common cold: a placebocontrolled, randomised, double-blind clinical trial. Arzneimittelforschung 2001; 51: 563–68.

Turner RB, Riker DK, Gangemi JD. Ineff ectiveness of echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother 2000; 44: 1708–09.​

Lindenmuth GF, Lindenmuth EB. The effi cacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and fl u symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med 2000; 6: 327–34.

Grimm W, Muller HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity​

of colds and respiratory infections. Am J Med 1999; 106: 138–43.

[FONT=ScalaLancetPro][COLOR=#231f20]Berg A, Northoff H, Konig D, et al. Infl uence of echinacin (EC31)​

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[COLOR=#231f20]treatment on the exercise-induced immune response in athletes.​

J Clin Res ​

1998; 1: 367–80.

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[FONT=ScalaLancetPro][COLOR=#231f20]Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. Echinacea​

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root extract for the prevention of upper respiratory tract infections: A double-blind, placebo-controlled randomized trial. Arch Fam Med 1998;



7: 541–45. ​

[FONT=ScalaLancetPro][COLOR=#231f20]Hoheisel O, Sandberg M, Bertram S, Bulitta M, Schafer M. Echinaguard treatment shortens the course of the common cold: a double-blind, placebo-controlled clinical trial. Eur J Clin Res 1997; 9: 261–69.​

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[FONT=ScalaLancetPro][COLOR=#231f20]Scaglione F, Lund B. Effi cacy in the treatment of the common cold of a preparation containing an echinacea extract. Int J Immunother 1995; ​

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11: 163–66.





[FONT=ScalaLancetPro][COLOR=#231f20]Braunig B, Knick E. Therapeutic experiences with Echinacea pallida in infl uenzal infections. Naturheilpraxis mit Naturmedizin 1993; 1: 72–75 (in German).​

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[JJM]

I found the article: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1193558 "Echinacea: a Miracle Herb against Aging and Cancer? Evidence In vivo in Mice"

 

[Skeptic Ginger]

Nonsense one cannot learn facts from Googling. I have gone to great lengths to perfect my media literacy skills. I spoke at TAM about a side topic of media literacy. If there is one thing I know well besides infectious diseases it's how to find valid sources of information on the Internet and how to detect poor sources.

What effort did you make to confirm your claim that a proper clinical study has not been done? Are you simply surmising by the state of the research on Echinacea? That wouldn't preclude research looking at the activity of the chemicals at the cellular level.


For example, I found this article that looked at the effects on mice. Echinacea: a Miracle Herb against Aging and Cancer? Evidence In vivo in Mice; Sandra C. Miller; Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada

I see the problem, I forgot to paste in the address. Sorry.

 

[Skeptic Ginger]

Thanks, Vitnir. I'll start looking for them later tonight.

 

[Blue Wode]

You can find an analysis of the whole Lancet article here:
http://awayfromthebench.blogspot.com/2007/06/in-from-cold.html

The emerging consensus seems to be that at the moment you’re better off toughing out a cold with plenty of fluids and OTC analgesics, but watch out for andrographis paniculta...

so far six out of six studies have found that it is effective in fighting off colds

http://www.dailymail.co.uk/pages/li...rticle_id=464456&in_page_id=1798&in_a_source=

 

[JJM]

The industry standard for analysis of Echinacea is arbitrarily based on phenolic content http://www.consumerlab.com/results/echinaceaside.asp#how

So, I looked at this review articleEchinacea: a Miracle Herb against Aging and Cancer? As the title suggests, this is a pseudoscientific magazine. If the magazine is truly refereed, that function is served by other, credulous quacks. (See: http://www.randi.org/jr/2007-06/062907.html#i3 ).

The author describes finding some immune-system activity (in vitro) in two fractions of Echinacea components (neither is phenolic). [Speculation about immune-system activation is a favorite claim for woo, the other big claim is anti-oxidant activity. Given a strong-enough oxidant, just about everything is an anti-oxidant.] Having identified these components as potentially active, what do you suppose comes next? Feeding whole Echinacea to mice!? Apparently, the author is unclear on the concept of natural product research and development. Why not feed the components she thinks are active?

Wait, the author did try injecting (not feeding) some of one component into mice, and saw no result. From this, she concludes the compounds must work together. [Or, maybe the other one is the only one that works, or maybe another, unsuspected compound is active, or …]

It is nice if the author is looking for active ingredients, it would be nicer if she knew how to go about it and did work acceptable to quality, scientific journals.