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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by mikes on April 18, 2001, at 15:13:24
http://www.msnbc.com/news/560669.asp
http://jama.ama-assn.org/issues/current/abs/joc02013.html
First of all, it was funded by Pfizer. That should immediately raise some red flags. Plus the article says Pfizer markets an extract of St. John's Wort. I find that hard to believe. In addition, a search for the term "wort" on the Pfizer website returned no results.
How could they say it shouldn't be recommended for mild depression when the study wasn't even done on mild depression? That's ridiculous. As quoted from JAMA, "The number reaching remission of illness was significantly higher with St John's wort than with placebo (P = .02), but the rates were very low in the full intention-to-treat analysis (14/98 [14.3%] vs 5/102 [4.9%], respectively)." So the remission of illness was much greater with SJW than placebo, for MAJOR depression, but they couldn't even say it might work for mild depression. They said it didn't work any better than placebo, actually.
The MSNBC article also says many St. John’s wort users do not seek medical advice and are unaware of many of the herb’s risks. Some studies have shown, for example, that St. John’s wort can interfere with drugs used to treat HIV-infection and heart transplant patients.No offense to those groups, but those don't really seem like risks for the vast majority of the population. Also, another quote from the study synopsis:
"St John's wort was safe and well tolerated. Headache was the only adverse event that occurred with greater frequency with St John's wort than placebo (39/95 [41%] vs 25/100 [25%], respectively)."I also know from personal experience that SJW works better than placebo. It was the first thing I tried for depression. I was not expecting it to do anything. But it made me feel better than I usually ever had in my life. And it worked quickly. For chronic depression, which I would consider to be at least moderate.
Posted by SalArmy4me on April 18, 2001, at 16:11:32
In reply to new study on st. john's wort, posted by mikes on April 18, 2001, at 15:13:24
What brand of St. John's Wort do you use?
Posted by vlvtelvis on April 18, 2001, at 20:40:06
In reply to new study on st. john's wort, posted by mikes on April 18, 2001, at 15:13:24
Not to rain on your parade, but that was probobly placebo effect. Everything I have read says that you have to take it several times a day for at least six weeks for it to do much. Too addled to look anything up right now. It may well have been a placebo effect that you experienced.
> I also know from personal experience that SJW works better than placebo. It was the first thing I tried for depression. I was not expecting it to do anything. But it made me feel better than I usually ever had in my life. And it worked quickly. For chronic depression, which I would consider to be at least moderate.
Posted by mikes on April 18, 2001, at 22:52:24
In reply to Re: new study on st. john's wort, posted by vlvtelvis on April 18, 2001, at 20:40:06
Fields of nature. Most brands worked well for me though. I have major doubts that it was a placebo effect. If it was, then screw pharmacological effects. I want the placebo effect. I remember that day fairly well (when it kicked in) and I felt so good I just started laughing, out of nowhere. I guess I was kind of high. It worked that way for about a week, then with lesser effects for a month.
> Not to rain on your parade, but that was probobly placebo effect. Everything I have read says that you have to take it several times a day for at least six weeks for it to do much. Too addled to look anything up right now. It may well have been a placebo effect that you experienced.
>
> > I also know from personal experience that SJW works better than placebo. It was the first thing I tried for depression. I was not expecting it to do anything. But it made me feel better than I usually ever had in my life. And it worked quickly. For chronic depression, which I would consider to be at least moderate.
Posted by Fred Potter on April 19, 2001, at 17:01:20
In reply to Re: new study on st. john's wort, posted by mikes on April 18, 2001, at 22:52:24
I think it should be made a rule that no patient who reports improvement should be told it's just a placebo effect.
Posted by mikes on April 19, 2001, at 18:45:58
In reply to Don't say it's just placebo, posted by Fred Potter on April 19, 2001, at 17:01:20
Well, maybe I agree with that somewhat, but I think "behind closed doors" the placebo effect should still be talked about.
Are there any studies of placebo effect for chronic depression?
> I think it should be made a rule that no patient who reports improvement should be told it's just a placebo effect.
Posted by Fred Potter on April 19, 2001, at 20:42:53
In reply to Re: Don't say it's just placebo, posted by mikes on April 19, 2001, at 18:45:58
You're exactly right. And from the patient's perspective, placebo effects usually fade. But to dash their hopes straightaway seems a bit cruel. I had it done to me recently, where I had a sustained response (Naltrexone + Prozac) just because the counsellor had never heard of it.
Posted by SLS on April 19, 2001, at 22:44:01
In reply to Re: Don't say it's just placebo, posted by mikes on April 19, 2001, at 18:45:58
> Well, maybe I agree with that somewhat, but I think "behind closed doors" the placebo effect should still be talked about.
>
> Are there any studies of placebo effect for chronic depression?
Did any of Quitkin's stuff address that?
- Scott
Posted by SLS on April 19, 2001, at 23:03:27
In reply to Re: Don't say it's just placebo, posted by SLS on April 19, 2001, at 22:44:01
> > Well, maybe I agree with that somewhat, but I think "behind closed doors" the placebo effect should still be talked about.
> >
> > Are there any studies of placebo effect for chronic depression?
The following issue is devoted to the use of placebo and placebo effect in psychiatry. I haven't looked at it. Let me know what you think.Biological Psychiatry Vol. 47, Issue 8, April 15, 2000
- Scott
Posted by mikes on April 19, 2001, at 23:51:57
In reply to Re: Don't say it's just placebo, posted by SLS on April 19, 2001, at 22:44:01
Well, probably, but that wasn't a very well thought out comment about placebo...I was mainly posting about st. john's wort.
>
> Did any of Quitkin's stuff address that?
>
>
> - Scott
Posted by SLS on April 20, 2001, at 8:44:33
In reply to Re: Don't say it's just placebo, posted by mikes on April 19, 2001, at 23:51:57
> > Did any of Quitkin's stuff address that?
> Well, probably, but that wasn't a very well thought out comment about placebo...I was mainly posting about st. john's wort.
Hi Mike.I don't know if you were addressing me specifically with your above comment. I wouldn't think so. Someone asked whether or not studies have been conducted focusing on the place that placebo control has in human psychiatric studies and the phenomenology of a placebo effect in depression. I was simply offering sources of information to pursue an answer to that question.
I agree with you about the post you are referring to. For me, it wasn't so much the content of the post that I found disagreeable as it was the tone of certainty conveyed by the author and that it was perhaps misplaced.
I haven't read the study cited, although I am aware of its existence. I am also aware of other studies that concluded the contrary. I don't know. Plenty of people claim that it helps them, including my sister. She was mildly depressed or dysthymic at the time.
- Scott
Posted by Mr.Scott on April 20, 2001, at 11:23:00
In reply to new study on st. john's wort, posted by mikes on April 18, 2001, at 15:13:24
I would think Pfizer would have better ways to spend it's money, like perhaps reducing the cost of it's drugs instead of funding research aimed at detracting from one of it's non-prescription competitors.
Posted by mikes on April 20, 2001, at 21:10:14
In reply to Re: Don't say it's just placebo » mikes, posted by SLS on April 20, 2001, at 8:44:33
I was referring to my comment! sorry.
> > > Did any of Quitkin's stuff address that?
>
> > Well, probably, but that wasn't a very well thought out comment about placebo...I was mainly posting about st. john's wort.
>
>
> Hi Mike.
>
> I don't know if you were addressing me specifically with your above comment. I wouldn't think so. Someone asked whether or not studies have been conducted focusing on the place that placebo control has in human psychiatric studies and the phenomenology of a placebo effect in depression. I was simply offering sources of information to pursue an answer to that question.
>
> I agree with you about the post you are referring to. For me, it wasn't so much the content of the post that I found disagreeable as it was the tone of certainty conveyed by the author and that it was perhaps misplaced.
>
> I haven't read the study cited, although I am aware of its existence. I am also aware of other studies that concluded the contrary. I don't know. Plenty of people claim that it helps them, including my sister. She was mildly depressed or dysthymic at the time.
>
>
> - Scott
Posted by ShelliR on April 20, 2001, at 23:11:47
In reply to Re: Don't say it's just placebo, posted by mikes on April 20, 2001, at 21:10:14
> >Main Outcome Measures The primary outcome > measure was rate of change on the HAM-D over > the treatment period. Secondary measures > included > the Beck Depression Inventory (BDI), > Hamilton > Rating Scale for Anxiety (HAM-A), the > Global > Assessment of
> Function (GAF) scale, and the Clinical Global > Impression–Severity and –Improvement >
scales (CGI-S and CGI-I). >Results The random coefficient analyses for the > HAM-D, HAM-A, CGI-S, and CGI-I all
> showed significant effects for time but not for > treatment or time-by-treatment interaction
> (for HAM-D scores, P< .001, P = .16, and P = .58, > respectively). Analysis of covariance showed > nonsignificant effects for BDI and GAF scores. > The proportion of participants achieving an a > priori definition of response did not differ > between groups. The number reaching remission >of illness was significantly higher with St John's > wortthan with placebo (P = .02), but the rates > were very low in the full intention-to-treat > analysis (14/98 [14.3%] vs 5/102 [4.9%], respectively). < <
Okay, this is the part that confuses me. (It's been a long time since I've taken statistics and methodology). So maybe someone can explain this:The number reaching remission of illness was significantly higher with St John's wort than with placebo (P = .02). Is this coming out of the analysis of the HAM-D alone? But then correlating the HAM-D with each of the other tests showed no significant difference? This is what I am having trouble interpreting.
Whatever, remember each study set up it's own hypothesis and choose its tests and cross analysis. So first of all, you have to consider that the criteria was set up by the testers, and then you have to consider whether the criteria really justified the results (no improvement for major depression). That's why I was trying to understand the parts of the analysis.
Next the part I am not confused about. As Mike said, St. John's Wort has only been recommended for mild to moderate depression. So even if the criteria is valid, nothing new has come out of this study. I believe it was well known in Europe and more recently in the U.S. that St. John's Wort was not recommended for treatment of major depression.
There is absolutely nothing in this study that would indicate that any positive results from St. John's wort could only be accounted for by placebo effect.
NIMH has sponsored a large study to analyze St. John's Wort against other medications. (going on now). Hopefully they will also measure it against placebo for less than major depression. And it's not being funded by a drug manufactorer, so that in itself is a plus.
Shelli
Posted by ShelliR on April 21, 2001, at 4:43:30
In reply to Re: Don't say it's just placebo-I'm a bit confused, posted by ShelliR on April 20, 2001, at 23:11:47
One thing I forgot. Suppose this study was totally legitimate and even concluded results had been the same for minor and moderate depression. That still wouldn't prove for any one individual, positive results were merely based on a placebo effect. These studies crunch numbers and come out with a significant difference. Of course that is useful for prediction of success. But after crunching numbers one could never claim that if one, or two, or x number of subjects actually had positive results, that is not legitimate for those individuals. Body chemistry differs, and the point of these studies is not to study each individual.
I'm not saying that placebo effect does not exist; of course it does. I'm just saying that the only way it could be proven for any individual is (1) what they claim they are experiencing is scientifically impossible, or (2) a blind study is given to that individual and the placebo works better or equal to the non-placebo.
Posted by SLS on April 21, 2001, at 11:23:10
In reply to Re: Don't say it's just placebo-I'm a bit confused, posted by ShelliR on April 20, 2001, at 23:11:47
Me too.
I wish I had gone far enough in school to be able to interpret the numbers for myself. Statistics are pretty much a mystery to me. It would be great if someone who is strong in statistics were to go back to the full article and obtain the raw numbers (if they are given) and "crunch" the results for himself.
Although it is no guarantee of validity, the list of researchers contributing to the study includes many well-respected personages who publish very frequently. I should think that they have secured a reliable stable of statisticians over the years. Hopefully, there will be some people who will scrutinize this study as well as the authors have scrutinized those of others. My guess is that the study was performed properly and the results documented and interpreted properly given the design of the investigation. The focus of the investigation helped to determine its design. They seemingly wanted to answer the question as to whether or not St. John's Wort was effective in treating moderate to severe major depression (HAM-D > 20). Of course, it is important that these results to be repeatable and corroborated by different study designs. We'll see. In the meantime, anecdotes can sometimes be very persuasive.
- Scott
Richard C. Shelton, MD
Martin B. Keller, MD
Alan Gelenberg, MD
David L. Dunner, MD
Robert Hirschfeld, MD
Michael E. Thase, MD
James Russell, MD
R. Bruce Lydiard, MD, PhD
Paul Crits-Cristoph, PhD
Robert Gallop, PhD
Linda Todd
David Hellerstein, MD
Paul Goodnick, MD
Gabor Keitner, MD
Stephen M. Stahl, MD
Uriel Halbreich, MD
Posted by Kathy99 on April 22, 2001, at 12:38:03
In reply to Re: Don't say it's just placebo-I'm a bit confused, posted by SLS on April 21, 2001, at 11:23:10
I tried SJW for MONTHS and it didn't do a thing for me...
Just read an article in Science News discussing how St. John's Wort induces enzymes that neutralize the effects of OTHER drugs a person may be taking... even contraceptives. It may be that users of the herb get pregnant due to this effect, or worse if they are on drugs for life-threatening diseases. Beware!
Posted by vlvtelvis on April 22, 2001, at 17:03:09
In reply to new study on st. john's wort, posted by mikes on April 18, 2001, at 15:13:24
I just stumbled across this.
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/04/18/MN183130.DTL
> http://www.msnbc.com/news/560669.asp
>
> http://jama.ama-assn.org/issues/current/abs/joc02013.html
>
> First of all, it was funded by Pfizer. That should immediately raise some red flags. Plus the article says Pfizer markets an extract of St. John's Wort. I find that hard to believe. In addition, a search for the term "wort" on the Pfizer website returned no results.
>
> How could they say it shouldn't be recommended for mild depression when the study wasn't even done on mild depression? That's ridiculous. As quoted from JAMA, "The number reaching remission of illness was significantly higher with St John's wort than with placebo (P = .02), but the rates were very low in the full intention-to-treat analysis (14/98 [14.3%] vs 5/102 [4.9%], respectively)." So the remission of illness was much greater with SJW than placebo, for MAJOR depression, but they couldn't even say it might work for mild depression. They said it didn't work any better than placebo, actually.
>
>
> The MSNBC article also says many St. John’s wort users do not seek medical advice and are unaware of many of the herb’s risks. Some studies have shown, for example, that St. John’s wort can interfere with drugs used to treat HIV-infection and heart transplant patients.
>
> No offense to those groups, but those don't really seem like risks for the vast majority of the population. Also, another quote from the study synopsis:
> "St John's wort was safe and well tolerated. Headache was the only adverse event that occurred with greater frequency with St John's wort than placebo (39/95 [41%] vs 25/100 [25%], respectively)."
>
> I also know from personal experience that SJW works better than placebo. It was the first thing I tried for depression. I was not expecting it to do anything. But it made me feel better than I usually ever had in my life. And it worked quickly. For chronic depression, which I would consider to be at least moderate.
Posted by mikes on April 22, 2001, at 19:22:37
In reply to Re: Don't say it's just placebo-I'm a bit confused, posted by Kathy99 on April 22, 2001, at 12:38:03
How many people have tried prescription antidepressants for MONTHS with no results? Quite a few.
> I tried SJW for MONTHS and it didn't do a thing for me...
>
> Just read an article in Science News discussing how St. John's Wort induces enzymes that neutralize the effects of OTHER drugs a person may be taking... even contraceptives. It may be that users of the herb get pregnant due to this effect, or worse if they are on drugs for life-threatening diseases. Beware!
Posted by stjames on April 22, 2001, at 22:05:27
In reply to Re: Don't say it's just placebo-I'm a bit confused, posted by mikes on April 22, 2001, at 19:22:37
One study is a drop in the bucket. Wait for them to reproduce the study and get the same results before you decide SJW does nothing. isolated studies are often contradictary.
OTOH, I would not be surprized if SJW does nothing; we just think it does because we were told so.
James
Posted by Daveman on April 23, 2001, at 2:24:49
In reply to Re: Don't say it's just placebo » mikes, posted by SLS on April 20, 2001, at 8:44:33
Well I for one am glad to see that there are scientific studies being conducted of these "natural" substances. A quick walk through my local pharmacy or "natural food" store shows these things being advertised in big letters as "cures" for every disease known to mankind- followed of course by a note in small print that these claims have not been validated by scientific research. What's more, they are sold at outrageously high prices, much more than generic medications and in some cases not much less than non-generics. Yes I see this SJW study was funded by Pfizer, but the scientific methodology seems sound. Carefully read, the study does not rule out SJW for mild depressions, just serious clinical depression.
I for one would like to see similar studies of the following:
-Do valerian root and/or melatonin really help with sleep problems?
-Do SAM-E and/or Kava really help with anxiety?
Not to mention ginko biloba for memory, ginsing for sex drive, etc. etc. etc.....
Dave
Posted by Kathy99 on April 23, 2001, at 12:39:14
In reply to Glad to see studies of natural meds, posted by Daveman on April 23, 2001, at 2:24:49
I'd try searching for abstracts on medline before assuming "they" haven't done the studies. Whenever I check, I'm always surprised to see that some work has already been done. Often the news reporters don't bother with the results of certain studies, and they themselves would not know unless they carefully read journals each month; there are many new findings, and on a regular basis! As a past researcher myself, I can attest to the fact that many of the nutrition studies done in my institution never made it into the press, but it was always interesting when one did. We in science don't do enough PR work.
Posted by stjames on April 23, 2001, at 14:04:29
In reply to Glad to see studies of natural meds, posted by Daveman on April 23, 2001, at 2:24:49
Not to mention ginko biloba for memory
James here.....
Ginko has been well studied and really works. The studies bear out it's claim.
James
Posted by Daveman on April 23, 2001, at 23:19:35
In reply to Re: Glad to see studies of natural meds, posted by stjames on April 23, 2001, at 14:04:29
> Not to mention ginko biloba for memory
>
> James here.....
>
> Ginko has been well studied and really works. The studies bear out it's claim.
>
> JamesThen why the disclaimer on the bottle, i.e., "These statements have not been evaluated by the Food and Drug Administration. This Product is not intended to diagnose, treat, cure or prevent any disease". Present on every one of these "natural" remedies.
Don't get me wrong, I've tried some of this stuff myself, but I just despise all of these claims for unproven products. Have you seen the price for SAM-E? Migod! I think it's only fair to ask for some proof (other than anectodal stories, which may be based on placebo effects) that the stuff actually does what it claims to do. It really makes me think of the old carnival barkers and "miracle" cures at times.
Dave
This is the end of the thread.
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