Echinacea has really modest benefits (if any)

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    Dec 21, 2010 12:56 AM GMT
    http://www.annals.org/content/153/12/769.abstract?aimhpResults: Of the 719 patients enrolled, 713 completed the protocol. Mean age was 33.7 years, 64% were female, and 88% were white. Mean global severity was 236 and 258 for the blinded and unblinded echinacea groups, respectively; 264 for the blinded placebo group; and 286 for the no-pill group. A comparison of the 2 blinded groups showed a 28-point trend (95% CI, −69 to 13 points) toward benefit for echinacea (P = 0.089). Mean illness duration in the blinded and unblinded echinacea groups was 6.34 and 6.76 days, respectively, compared with 6.87 days in the blinded placebo group and 7.03 days in the no-pill group. A comparison of the blinded groups showed a nonsignificant 0.53-day (CI, −1.25 to 0.19 days) benefit (P = 0.075)...

    Conclusion: Illness duration and severity were not statistically significant with echinacea compared with placebo. These results do not support the ability of this dose of the echinacea formulation to substantively change the course of the common cold.


    So blinded echinacea works better than unblinded echinacea? Is it because the placebo effect is at work? icon_rolleyes.gif
    Not taking a pill seems to be the only group with no benefit.

    I.e. use your money to buy several cans of chicken soup instead, and take a pill but don't try to guess what the pill contains.icon_twisted.gif

    http://www.huffingtonpost.com/2010/12/20/got-a-cold-study-says-ech_n_799386.htmlIt was funded by the National Center of Complementary and Alternative Medicine, part of the National Institutes of Health. The center, set up to test herbs and other alternative health remedies, has spent $6.8 million testing echinacea since 2002.

    The center's director, Dr. Josephine Briggs, said there are no plans to support more human research on echinacea.

    "I think what we're seeing is pretty clear. If there's a benefit of echinacea, it's very modest, Briggs said.
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    Dec 21, 2010 2:11 AM GMT
    I have heard this before.. btw, what are the factors for an "illness duration" in the study, as far as both symptoms and signs were concerned? htat is both the objective tests and teh subjective level of well-being?
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    Dec 21, 2010 2:19 AM GMT
    free pdf of the studyIllness severity was assessed twice daily by using the
    Wisconsin Upper Respiratory Symptom Survey, short version
    (WURSS-21), a validated illness-specific quality-of life
    outcome instrument (60, 61)...
    Secondary outcomes included self-report on psychosocial
    questionnaires and biomarkers of immune response
    and inflammation. Self-report measures included general
    health-related quality of life, perceived stress, interpersonal
    support, optimism, and mood states. General health was
    assessed daily by using the Medical Outcomes Study Short
    Form-8 scale (62), a 24-hour recall version of the highly
    validated Medical Outcomes Study Short Form-36 scale.
    The Short Form-8 scale yields separate physical and mental
    health scores by using an item-weighted algorithm (62).
    General health was also assessed daily by using the Euro-
    Qol’s feeling thermometer (63). Perceived stress was assessed
    at baseline, day 3, and exit by using the 4-item
    Cohen Perceived Stress Scale (64–66) and daily by using a
    100-mm visual analogue scale developed for this study.
    Interpersonal support and optimism were measured at
    baseline, day 3, and exit by using the Ryff Personal Relationships
    scale (67) and the revised Life Orientation Test


    I dunno, filling out all these forms will probably make my cold better.icon_lol.gif

    There's been several trials that show similar findings (either negative or very small benefits), the most recent large one that I remember was the 2005 one in NEJM which was on experimentally-induced colds in 437 subjects (which was negative). This trial in Annals is useful because it's "real-world."
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    Dec 21, 2010 4:10 AM GMT
    Summary of PubMed data for human clinical trials of popular dietary supplements:

    http://www.informationisbeautiful.net/play/snake-oil-supplements/
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    Dec 21, 2010 5:04 AM GMT
    q1w2e3 saidConclusion: Illness duration and severity were not statistically significant with echinacea compared with placebo.


    I love you. Can I nominate you for president of the Remain Sane club here on RealJock?
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    Dec 21, 2010 5:28 AM GMT
    mickeytopogigio said
    q1w2e3 saidConclusion: Illness duration and severity were not statistically significant with echinacea compared with placebo.


    I love you. Can I nominate you for president of the Remain Sane club here on RealJock?


    Good luck with that...
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    Dec 21, 2010 5:31 AM GMT
    q1w2e3 said
    There's been several trials that show similar findings (either negative or very small benefits), the most recent large one that I remember was the 2005 one in NEJM which was on experimentally-induced colds in 437 subjects (which was negative). This trial in Annals is useful because it's "real-world."


    Yup I ve never heard of any positive test results for echinacea in colds... its pretty clear cut it does not work for colds... (I myself could not see how anyway, its not like theres anything in there to boost T-cell production or anything...

    But considering the fact it did not even statistically increase wellness (which is a subjective feeling) makes me wonder what use it has at all... at least if it boosted wellness means it did SOMETHING... and now it seems to have done absolutely nothing... surprising to say the least

    I must say I dont really think inducing colds in people is a good idea.. but thats personal
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    Dec 21, 2010 9:26 AM GMT
    I've been an herbalist for years and I agree it does not seem to have any effect on colds. However Mellissa does have a noticeable effective.
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    Dec 21, 2010 10:37 AM GMT
    echinacae's effect on the cold (or non-effect) to me is infact completely unsurprising, for the following reasons:

    1) Echinacea was used by Native Americans as a medicine before Europeans arrived here

    2) The common cold did not exist in the Americas before it was introduced here.. by the Europeans

    What we are seing in the use of Echinacea as a treatment for the common cold is thus obviously an erroneous applicaton of traditional medicine..

    Though wiki is not a reliable source, it does have the following to say about it:

    According to Wallace Sampson, MD, its modern day use as a treatment for the common cold began when a Swiss herbal supplement maker was "erroneously told" that echinacea was used for cold prevention by Native American tribes who lived in the area of South Dakota.[10] Although Native American tribes didn't use echinacea to prevent the common cold, some Plains tribes did use echinacea to treat some of the symptoms that could be caused by the common cold: The Kiowa used it for coughs and sore throats, the Cheyenne for sore throats, the Pawnee for headaches, and many tribes including the Lakotah used it as an analgesic.

    http://en.wikipedia.org/wiki/Echinacea

    It would be more interesting to me if a study were able to refute the actual proper uses that the traditional herbalists have ascribved to it...

    Clearly it's use as a common cold medicine or immunity booster is incorrect.
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    Dec 21, 2010 10:41 AM GMT
    I've been using echinacea capsules this winter for the first time and find if fantastic. I've a poor immune system but I've not as as much as a sniffle so far.
    Maybe just coincidence...
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    Dec 21, 2010 10:53 AM GMT
    mickeytopogigio said
    q1w2e3 saidConclusion: Illness duration and severity were not statistically significant with echinacea compared with placebo.


    I love you. Can I nominate you for president of the Remain Sane club here on RealJock?


    I thought it was the "Simply Sane" club. No evidence that we threatened to go insane any time soon.

    You can be president, I want to be the prime minister.icon_lol.gif
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    Dec 21, 2010 10:57 AM GMT
    other tradiional uses:

    The late great Dr Alfred Vogel wrote, "I watched the Indian women (in North Dakota) chew echinacea leaves and apply the pulp to wounds and injuries. It was even effective in combating the poison from venomous snakes and particularly in cases of high temperatures and badly healing skin eruptions."

    THE NATURE DOCTOR - 1952

    No colds hmmmm :-S
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    Dec 21, 2010 11:12 AM GMT
    thomeiza saidI've been using echinacea capsules this winter for the first time and find if fantastic. I've a poor immune system but I've not as as much as a sniffle so far.
    Maybe just coincidence...


    It is just a coincidence.
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    Jan 14, 2011 2:21 AM GMT
    yeah old news, i personally like zinc works like a charm for me
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    Jan 14, 2011 2:42 AM GMT
    If it works for you, fine. As long as you don't overdose on it, that is, and don't use it intranasally.
    http://en.wikipedia.org/wiki/Alternative_treatments_used_for_the_common_cold#Zinc_preparationsA 1999 Cochrane review found the evidence of benefit from zinc in the common cold is inconclusive.[24] A 2003 review however concluded supported the value of zinc in reducing the duration and severity of symptoms of the common cold when administered within 24 hours of the onset of common cold symptoms.[25] Nasally applied zinc gels may lead to loss of smell. The FDA therefore discourages their use.[26]

    Zinc acetate and zinc gluconate have been tested as potential treatments for the common cold, in various dosage form including nasal sprays, nasal gels, and lozenges.[27][28] Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse.[29][30][31] About half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action.[32] The studies differ in the salt used, concentration of the salt, dosage form, and formulation, and some suffer from defects in design or methods. For example, there is evidence that the potential efficacy of zinc gluconate lozenges may be affected by other food acids (citric acid, ascorbic acid and glycine) present in the lozenge.[33] Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.[34][35]
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    Jan 17, 2011 4:53 AM GMT
    Oh damn, I'm going to have to retype this all over again. Stupid me for writing this in the browser. Forgive me for trimming this one down a bit.

    FIrst, I really like this study. You should really link to the full-text, though, because the abstract leaves a lot to be desired.

    http://www.annals.org/content/153/12/769.full.pdf+html

    There are some issues with the study that need to be mentioned.

    a) The authors chose to research only (a presumably ethanolic extract of) echinacea augustifolia and echinacea purpurea, not echinacea pallida. They also chose only to research the rootstock, and not the arial parts. Finally, they do not cite the source of their materials. These decisions have significant implications. The chemicals present in the aerial parts are dramatically different from those present in the rootstock, with reputedly different pharmacological activity (macrophage activation via long-chain polysaccharides versus lymphatic motility via isobutylamides.) Still, were I designing this study, I would probably make the same choices re: species and plant part selection, but the failure to list the source and identification of the material used is a serious flaw in the study design. After all, there are radical differences in quality between suppliers, and there's inarguably a lot of sawdust for sale as echinacea out there. It's inappropriate for researchers to take that on good faith.

    b) The 36 hour window for self-report of being symptomatic is really problematic. Even the most optimistic echinacea enthusiasts do not suggest that it is effective in shortening the duration of the common cold if taken more than 24 hours after becoming symptomatic. Most herbalists say 12 hours.

    c) The study cautions that, due to a higher than expected variability in disease duration, it is unlikely to be taken seriously. This seems less significant than the other issues.

    Many a practicing herbalist like myself do not care much for echinacea except in specialized cases. Like anybody else, we like evidence-based medicine, even if our evidence is often clinical and empirical. If this is an attempt to use echinacea to try and make a generalization on the efficacy of phytotherapy as a whole, might I point you in the direction of ulcers and cholesterol? It wasn't even a decade ago that Hongqu was seen as Chinese hocus pocus, or that the association of H. pylori with stomach ulcers was seen as quackery, both of which are now mainstream. You're welcome.
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    Jan 17, 2011 4:57 AM GMT
    Glad zinc works for you guys. I generally only recommend it in lozenge form when there's an acute throat infection.

    There's never a general remedy for anything, but I'm partial to fungal polysaccharides (shiitake, reishi, maitake, et al) for pure immunostimulative action.
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    Jan 17, 2011 5:03 AM GMT
    BoulderingBum saidGlad zinc works for you guys. I generally only recommend it in lozenge form when there's an acute throat infection.

    There's never a general remedy for anything, but I'm partial to fungal polysaccharides (shiitake, reishi, maitake, et al) for pure immunostimulative action.



    Just gonna suggest maitake. I rarely get sick when i can afford to continually take it. never had too much luck with echinacea.
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    Jan 18, 2011 8:06 PM GMT
    The American Botanical Council has an excellent analysis of the results right here. It answers a lot of the questions that I posed earlier about the study, in particular those about the source and quality of the material used.

    It's well-balanced, and proposed a few questions of its own, such as the possible inefficacy of encapsulated/tabletized echinacea preparations due to the lack of contact with oropharangeal lymphatic tissue. There are also some clinical observations in support of the researchers' findings and a reference to another echinacea study currently in press.

    Still, it's great to see a well-designed phytomedical study for a change, not to mention an echinacea study that doesn't use Esberitox/Echinoforce. I'm looking forward to seeing a study designed similarly using a liquid extract in the treatment of URTIs.
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    Jan 18, 2011 8:29 PM GMT
    BoulderingBum saidThe American Botanical Council has an excellent analysis of the results right here. It answers a lot of the questions that I posed earlier about the study, in particular those about the source and quality of the material used.

    It's well-balanced, and proposed a few questions of its own, such as the possible inefficacy of encapsulated/tabletized echinacea preparations due to the lack of contact with oropharangeal lymphatic tissue. There are also some clinical observations in support of the researchers' findings and a reference to another echinacea study currently in press.

    Still, it's great to see a well-designed phytomedical study for a change, not to mention an echinacea study that doesn't use Esberitox/Echinoforce. I'm looking forward to seeing a study designed similarly using a liquid extract in the treatment of URTIs.


    Interesting, thanks for that one, R
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    Jan 21, 2011 5:40 PM GMT
    Studies show that paracetamol has no noticeable effect on cancer or dandruff!!!

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    Jan 21, 2011 9:56 PM GMT
    I'm of the belief that everything has a purpose (not necessarily for humans, mind you)...it's only our ignorance of them that makes things like echinacea useless. But until it's proven to be efficacious and with reasonable mechanisms, there's no rational and economic basis to use echinacea for colds. This study is one of the better ones that show that we're foolish to keep studying this herb for colds, and if it works, the mechanism is likely mainly placebo.

    If shit (literally feces) nowadays is given to patients with C. diff to reconstitute normal bowel flora, it's only because it works. Shit (figuratively and literally) does NOT work for colds. icon_razz.gif
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    Jan 21, 2011 10:09 PM GMT
    q1w2e3 saidI'm of the belief that everything has a purpose (not necessarily for humans, mind you)...it's only our ignorance of them that makes things like echinacea useless. But until it's proven to be efficacious and with reasonable mechanisms, there's no rational and economic basis to use echinacea for colds. This study is one of the better ones that show that we're foolish to keep studying this herb for colds, and if it works, the mechanism is likely mainly placebo.

    If shit (literally feces) nowadays is given to patients with C. diff to reconstitute normal bowel flora, it's only because it works. Shit (figuratively and literally) does NOT work for colds. icon_razz.gif


    hmmm the problem is that that is completely denying the modest benefits that HAVE been shown... you're basing the statement: "no benefits" mainly on the rules of statistical analysis... which are not really important to most people... if its shown to help a little, that may be good enough for someone who uses it
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    Jan 22, 2011 12:44 AM GMT
    That's fine, buy an expensive placebo. It's your money, give it to the nutraceutical companies.
    Just don't ask your insurance or the government to pay for it.
    Hey, for SOME people shit might actually work for colds. icon_lol.gif
    I quote the Aphorisms again:
    "In science you need to understand the world; in business you
    need others to misunderstand it."--Nassim Taleb.
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    Jan 22, 2011 12:46 AM GMT
    q1w2e3 saidThat's fine, buy an expensive placebo..


    ehm no you now make the false claim that its a placebo, which you have falsely decided upon by a statistical analysis... the fact that it has MODEST benefits proves its NOT a placebo, its just a matter of you taking a random number as a cut-off point, which most people dont need to... it has benefits = not placebo in normal people's logic