More evidence indicating efficacy of echinacea

[Eos of the Eons]

Thank you JJM, the use of the work "miracle" would never fit with a serious study either. The whole "study" was a joke to read.

I wish I had time to look up the 14 studies in the Lancet article, so I'll worship anyone who does find them.

The studies in the Lancet article use strange protocols:
http://awayfromthebench.blogspot.com/2007/06/in-from-cold.html

Working through the calculations, 751 participants received echinacea, of these 414 (55.12%) did not develop colds. 604 participants received a placebo, of which 210 (34.77%) did not develop colds.

There are no controls on whether or not people were exposed to colds, if they had the cold/s before and were no longer susceptible, etc. What the was the common cold bug during the eperiment? What was judged to be a cold if no bug was identified?

Bad experiments have no controls to weed out so many variables. Giving people some stuff to eat and not knowing all the variables is just plain useless.

The biggest variable of all, which I brought up in my first post in this thread is also ignored in the studies:

Being fancy an' all with numbers is all very well but ignores a vital question; what is the right dose? This is a question that is not given a great deal of attention by either study, the assessments have been made on an intervention vs no intervention basis. Would it be reasonable to expect a dose-response relationship in echinacea? Would the absence of such a relationship mean that the benefit observed here is invalidated? I think it is reasonable to expect a dose response. If a highly dilute concentration of echinacea were having a benefit, it would suggest that something screwy was going on.

If you don't know how much people are taking and when (not administered in a controlled setting), then how do you know if that worked or something else the people are doing (washing hands more since they are more aware that they should be avoiding getting sick)?

It will take good study designs and a standardized dose that is in a bottle of stuff that I know contains the right ingredients at the right recommendation of daily intake before I buy any old bottle of junk off the shelf. We know you can't know what you are even buying off the shelf right now.

 

[kellyb]

Here are the first six:

Reference number one:

http://content.nejm.org/cgi/content/abstract/353/4/341

Results There were no statistically significant effects of the three echinacea extracts on rates of infection or severity of symptoms. Similarly, there were no significant effects of treatment on the volume of nasal secretions, on polymorphonuclear leukocyte or interleukin-8 concentrations in nasal-lavage specimens, or on quantitative-virus titer.

Conclusions The results of this study indicate that extracts of E. angustifolia root, either alone or in combination, do not have clinically significant effects on infection with a rhinovirus or on the clinical illness that results from it.

Reference number 2:

http://archpedi.ama-assn.org/cgi/content/abstract/158/3/217

Design Randomized, double-blind, placebo-controlled study.

Subjects Four hundred thirty children, aged 1 to 5 years, were randomized to an herbal extract preparation (n = 215) or a placebo elixir (n = 215).

Intervention Administration of an herbal preparation (Chizukit) containing 50 mg/mL of echinacea, 50 mg/mL of propolis, and 10 mg/mL of vitamin C, or placebo (5.0 mL and 7.5 mL twice daily for ages 1 to 3 years and 4 to 5 years, respectively) for 12 weeks.

Results Significant mean ± SD reductions of illnesses were seen in the Chizukit group in the number of illness episodes, 138 vs 308 (55% reduction); number of episodes per child, 0.9 ± 1.1 vs 1.8 ± 1.3 (50% reduction, P<.001); and number of days with fever per child, 2.1 ± 2.9 vs 5.4 ± 4.4) (62% reduction, P<.001). The total number of illness days and duration of individual episodes were also significantly lower in the Chizukit group. Adverse drug reactions were rare, mild, and transient.

Conclusion A preventive effect of a product containing echinacea, propolis, and vitamin C on the incidence of respiratory tract infections was observed.

Number three:

http://www.journals.uchicago.edu/CID/journal/issues/v38n10/32569/32569.html

A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the ability of Echinacea purpurea to prevent infection with rhinovirus type 39 (RV-39). Forty-eight previously healthy adults received echinacea or placebo, 2.5 mL 3 times per day, for 7 days before and 7 days after intranasal inoculation with RV-39. Symptoms were assessed to evaluate clinical illness. Viral culture and serologic studies were performed to evaluate the presence of rhinovirus infection. A total of 92% of echinacea recipients and 95% of placebo recipients were infected. Colds developed in 58% of echinacea recipients and 82% of placebo recipients (P = .114, by Fisher's exact test). Administration of echinacea before and after exposure to rhinovirus did not decrease the rate of infection; however, because of the small sample size, statistical hypothesis testing had relatively poor power to detect statistically significant differences in the frequency and severity of illness.

Number four:

http://jama.highwire.org/cgi/content/abstract/290/21/2824

Results Data were analyzed on 707 URIs that occurred in 407 children, including 337 URIs treated with echinacea and 370 with placebo. There were 79 children who completed their study period without having a URI. The median duration of URIs was 9 days (95% confidence interval, 8-10 days); there was no difference in duration between URIs treated with echinacea or placebo (P = .89). There was also no difference in the overall estimate of severity of URI symptoms between the 2 treatment groups (median, 33 in both groups; P = .69). In addition, there were no statistically significant differences between the 2 groups for peak severity of symptoms (P = .68), number of days of peak symptoms (1.60 in the echinacea group and 1.64 in the placebo group; P = .97), number of days of fever (0.81 in the echinacea group vs 0.64 in the placebo group; P = .09), or parental global assessment of severity of the URI (P = .67). Overall, there was no difference in the rate of adverse events reported in the 2 treatment groups; however, rash occurred during 7.1% of the URIs treated with echinacea and 2.7% of those treated with placebo (P = .008).

Conclusions Echinacea purpurea, as dosed in this study, was not effective in treating URI symptoms in patients 2 to 11 years old, and its use was associated with an increased risk of rash.

Number 5:

http://www.annals.org/cgi/content/abstract/137/12/939

Results: No statistically significant differences were detected between the echinacea and placebo groups for any of the measured outcomes. Trajectories of severity over time were nearly identical in the two groups. Mean cold duration was 6.01 days in both groups as a whole, 5.75 days in the placebo group, and 6.27 days in the echinacea group (between-group difference, –0.52 day [95% CI, –1.09 to 0.22 days]). After controlling for severity and duration of symptoms before study entry, sex, date of enrollment, and use of nonprotocol medications, researchers found no statistically significant treatment effect (adjusted hazard ratio, 1.24 [CI, 0.86 to 1.78]). Multivariable regression models assessing severity scores over time failed to detect statistically significant differences between the echinacea and placebo groups.

Conclusion: Compared with placebo, unrefined echinacea provided no detectable benefit or harm in these college students who had the common cold.

Number 6:

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11505787&dopt=Citation

Common colds are one of the most frequent acute illnesses with major economical impact. Echinaceae purpureae herba (Echinacin, EC31J0) has shown promising results in the relief of common cold symptoms and the time taken to improvement compared to placebo. This study was aimed to confirm these findings by performing a randomised, double-blind, placebo-controlled clinical trial. A total of 80 adult male or female patients with first signs of a cold were recruited. The number of days of illness with a complete picture of the common cold (defined by the modified Jackson score of at least 5 points and experience of rhinorrhea and/or a subjective sensation of having a cold) was the primary end-point. In the verum group the median time of illness was 6.0 days compared to 9.0 days in the placebo group, assigning zero time for patients without a complete picture (one-sided p = 0.0112). EC31J0 was well tolerated and clinically effective in alleviating symptoms more rapidly than placebo in patients with a common cold.

 

[JJM]

Here is an article about the futility of clinical studies of herbs since the "active ingredients" (if any) are, usually, unkown.

http://terrasig.blogspot.com/2006/02/another-botanical-clinical-trial.html

I have verified that the author is an academic pharmacologist. However, his institution requires him to be anonymous.

 

[robinson]

Here is an article about the futility of clinical studies of herbs since the "active ingredients" (if any) are, usually, unkown[sic].

Interesting. The "active ingredient" that cured scurvy was unknown for a very long time, as well as how it cured, but it didn't stop experimentation, and use of lemons to cure a disease. Theories about why lemons cured scurvy (most all of them wrong) came and went, but it had nothing to do with the facts of the matter. That lemons cured, and prevented, the condition known as scurvy.

Scurvy was a terrible disease, and it was suffered by certain populations, and lemons cured the disease. Telling somebody they couldn't do a study because they didn't know why lemons cured scurvy, would have been dumb. Of course we know now it is Vitamin C, but that wasn't discovered for hundreds of years after the fact.

Claiming you can't study a food or an herb without knowing the active ingredient, is dumb. Of course you can. It has been done for thousands of years.

I used the scurvy example because I hope you know about that. It isn't the only case. Obviously, discovering the ingredient, or ingredients, that work, is very helpful, (and profitiable), but not essential when it comes to study of plants and their effects on health.

 

[JJM]

Interesting. The "active ingredient" that cured scurvy was unknown for a very long time, as well as how it cured, but it didn't stop experimentation, and use of lemons to cure a disease. Theories about why lemons cured scurvy (most all of them wrong) came and went, but it had nothing to do with the facts of the matter. That lemons cured, and prevented, the condition known as scurvy.

{snip}

True, some historic observations have been useful; but we know how to make better observations (clinical studies) today. Keep in mind- those old observations also led to bleeding, leeches, purges, and poisoning with calomel and strychnine (to name a few).

In the case of Echinacea, nobody has reliably observed its effect on colds. The better the study design, the more it acts like a placebo. Moreover, treating colds was not a claim made by the ancients. Most of the clinical studies on Echinacea have been of inferior quality; but some claimed activity. So, what do you make of that- were the positive results due to poor study design, or did some preps have active Echinacea and others not? You cannot say without knowing the active component.

Claiming you can't study a food or an herb without knowing the active ingredient, is dumb. Of course you can. It has been done for thousands of years.

{snip}

True about the thousands of years; but, until the advent of scientific medicine (the last century, or so) it has mostly not been done well (bleeding, leeches etc.).

Herbs are failing high-quality studies all over the place. Nobody can say whether they fail because the preps are wrong, as opposed to a blanket statement that the “herb” is inactive. Read the article again, it not a difficult concept.