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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Meri-Tuuli on October 3, 2006, at 9:53:11
http://news.bbc.co.uk/2/hi/uk_news/england/west_yorkshire/5402192.stm
Well, this style of journalistic writing really annoys me. And also the set up of the experiment.
Of course assitants in healthcare shops aren't going to know the ins and outs of herbal products. It would be like asking a shop assistant in a drug store which (conventional) anti-depressant drug they'd recommend. You go to a qualified herbalist etc etc. I suppose the arugment being is that you can buy herbs of the shelf, whereas conventional meds you can't. But still.
And secondly, I don't know why they seem to think that SJW is the only herbal supplement that is supposed to work. I suppose its the one that has significant research into it *just* for depression.
For example theres an article in Phytomedicine about Rhodiola rosea, and the authors say it helps brighten mood - but I guess the focus of that study isn't so much the depression improving effects, its more of a review of RR. Still, I hate the way the jouralists portray the imagine that SJW is the only worthwhile 'alternative' medicine.
Lastly, I dislike the way the jouralists seem to imply that its really danergous or something to take herbs:
"....'had no firm evidence base and had "potentially serious drug interactions" 'I mean, conventional drugs all have potentially serious interactions. I read a statistic somewhere that 10,000 people are admitted into hospital each year for drug interactions due to *doctors* errors and misjudgements.
I seriously seriously doubt that many people are admitted into hospital as a result of interactions between herbs.
And yes, there are side effects, but they are (usually) listed in the leaflet that comes with it!
Oh well. At least the authors are trying to build a bridge between 'alternative' and conventional medicine.
Sigh. Rant over.
Posted by Jlx on October 3, 2006, at 14:23:21
In reply to 'No science' behind health drugs, posted by Meri-Tuuli on October 3, 2006, at 9:53:11
I was really annoyed to read that report too.
First they expected these clerks to make a diagnosis of depression apparently -- how appropriate is that! Then they judged them for having failed and reported to the media that they didn't recommend products for *depression*. In a grand total of 10 shops too.
If psychiatrists are bothering to make this kind of effort to discredit alternatives perhaps they are feeling the heat of their own lack of ability to help people. Or maybe some financial pressure as folks reject their drug promoting services?
If I worked in a health store, I would be telling people that nothing helped me with my depression like magnesium. But I would not be promoting it as a cure for everyone.
It sounds to me like those clerks did a pretty fair job in recommending appropriate products based on the symptoms they were given. If they had called up and said, "Hey, what have you got for depression?" I would consider it more likely then that they might recommend SJW or fish oil.
This is junk journalism, imo.
JL
> http://news.bbc.co.uk/2/hi/uk_news/england/west_yorkshire/5402192.stm
>
> Well, this style of journalistic writing really annoys me. And also the set up of the experiment.
>
> Of course assitants in healthcare shops aren't going to know the ins and outs of herbal products. It would be like asking a shop assistant in a drug store which (conventional) anti-depressant drug they'd recommend. You go to a qualified herbalist etc etc. I suppose the arugment being is that you can buy herbs of the shelf, whereas conventional meds you can't. But still.
>
> And secondly, I don't know why they seem to think that SJW is the only herbal supplement that is supposed to work. I suppose its the one that has significant research into it *just* for depression.
>
> For example theres an article in Phytomedicine about Rhodiola rosea, and the authors say it helps brighten mood - but I guess the focus of that study isn't so much the depression improving effects, its more of a review of RR. Still, I hate the way the jouralists portray the imagine that SJW is the only worthwhile 'alternative' medicine.
>
> Lastly, I dislike the way the jouralists seem to imply that its really danergous or something to take herbs:
> "....'had no firm evidence base and had "potentially serious drug interactions" '
>
> I mean, conventional drugs all have potentially serious interactions. I read a statistic somewhere that 10,000 people are admitted into hospital each year for drug interactions due to *doctors* errors and misjudgements.
>
> I seriously seriously doubt that many people are admitted into hospital as a result of interactions between herbs.
>
> And yes, there are side effects, but they are (usually) listed in the leaflet that comes with it!
>
> Oh well. At least the authors are trying to build a bridge between 'alternative' and conventional medicine.
>
> Sigh. Rant over.
Posted by Meri-Tuuli on October 3, 2006, at 14:42:05
In reply to Re: 'No science' behind health drugs » Meri-Tuuli, posted by Jlx on October 3, 2006, at 14:23:21
Yeah exactly.
I mean, 'Many drugs recommended by health shops to tackle depression have no sound scientific backing,'
well thats a load of nonsense! I doubt your magnesium which helped you has any 'sound scientific backing' - but that doesn't mean its a) not safe and b) ineffective.Its absolutely ludricous to assume that just because an 'alternative' treatment doesn't have 'any sound scientific backing' doesn't work. The reason these alternatives don't have the science to back them up is that they're not profitable to Big Pharma because they're unpatentable, not because they don't work!!
Anyway there are loads of Postive Commission E monographs covering all kinds of herbs for depression and various ailments.
I think this study is completely ludicrious.
Posted by Declan on October 3, 2006, at 15:43:27
In reply to Re: 'No science' behind health drugs » Meri-Tuuli, posted by Jlx on October 3, 2006, at 14:23:21
If the work of psychiatrists was taken over for a bit by the checkout staff of health food shops, it would give psychiatrists an opportunity to improve their education by doing a few years of philosophy. Then they could talk about issues involving the mind/body split properly.
Posted by psychobot5000 on October 12, 2006, at 11:08:10
In reply to 'No science' behind health drugs, posted by Meri-Tuuli on October 3, 2006, at 9:53:11
I must disagree somewhat with many opinions stated.
It costs 300-500 million dollars to bring a drug to market in the US--this goes into research on what the active chemical is, extensive evidence of its efficacy and sefety.
It is certainly not a perfect system, but I disagree strongly that herbs are safe from interactions--the moreso because they are not studied enough. Lack of information is dangerous. Information about herbs concerning what the mechanism(s) of action are, what liver and kidney enzymes are effected, toxicity, even proof of efficacy and what the active chemicals are, are almost always severely lacking.
The whole system is broken, because, without patents, medical researchers have no financial assets available to do extensive research on herbs. But it does not change the fact lack of knowledge is dangerous. And indeed, even better-known remedies like hypericum certainly do not have enough evidence (in terms of study-size, results, double-blind quality, and research into toxicity at the very least) to compare with approved pharmaceutical remedies. As a drug, even hypericum would be kicked back for another 200 million dollars of research before it were approved. There is legitimacy to the point of view suggesting that many herbal uses are not supported, or not supported adequately, by science.
Herbalists are also rash and ill-informed. How can you be well-informed when the information is not known in the first place? I've many times been in alternative stores and heard employees acting as authorities on the subject rattling off extensive advice on remedies that I, with my very limited knowledge, knew were dangerous or unsupported--'Oh, well you're sick? Let's just pile the ephedra on top of the ginseng, green tea, natural MAO inhibitors, eleuthero, rhodiola rosea and ginkgo biloba...and probably best to double-up and add some guarana and kola just to keep you going while you're under the weather. Now let's ring you up and do come back and see us again.'
And don't forget that the alternative health industry is a business too--they rely on sales as much as anyone.
As for interactions between herbs, we forget that many herbs are flat-out poisonous, and that alternative remedies can be very dangerous when combined with drugs (i.e. SSRIs plus St John's or tryptophan).
As for interactions between herbs, well, we wouldn't know. Because it's not studied much.
Sigh...it's not an easy issue, I guess. I don't mean to offend, but I feel people exaggerate the benefits of herbs as much as those of drugs, disregard irresponsible practices by herbalists, and forget that alternative medicine is also an industry. A balanced view is necessary.
Still, I wouldn't want you taking away my herbs. :)
Posted by Meri-Tuuli on October 12, 2006, at 12:31:34
In reply to Lack of research behind herbs legitimate complaint, posted by psychobot5000 on October 12, 2006, at 11:08:10
I'm not saying that herbs are totally safe. I'm not saying they don't have any interactions. I'm not saying that people should ask the assitants in healthshops.
I am just annoyed that this sort of article isn't written more often about conventional medical drugs and that medical drugs you get from the doc are deemed to be more safe, more thoroughly researched etc. Just because some herbs have not had Big Pharma industry funded studies, does not mean that they're not effective, safe, free of interactions.
And if a herb has even a slight chance of having serious adverse effects it gets dropped like a hot potato. For instance, kava kava is completely banned in the UK. But I'm sure there have been far more serious injury from say, MAOI interactions than from Kava kava.
I mean, lets compare SJW and prozac, two popular medications on the market for depression.
SJW is a traditional folk remedy, been around for well, literally thousands of years - little or no side effects in most people.... and pretty effective. But not so many studies...no BIg Pharma funding you see.
Prozac, developed late 80s.... massive amounts of funding, hmm, side effects, well lets see - how about the fact that it increases suicide in young people? Insomnia, nervousness, dry mouth, the list goes on and on.
I not saying conventional drugs don't have their place - they do.
This quote sums it up for me:
'Faith in the integrity of biological psychiatry would be greater if the single strongest predictive factor in the outcome of any published clinical trial wasn't the identity of the funding body.'
sigh.
Kind regards
Meri
Posted by Jlx on October 12, 2006, at 19:28:54
In reply to Lack of research behind herbs legitimate complaint, posted by psychobot5000 on October 12, 2006, at 11:08:10
>And indeed, even better-known remedies like hypericum certainly do not have enough evidence (in terms of study-size, results, double-blind quality, and research into toxicity at the very least) to compare with approved pharmaceutical remedies. As a drug, even hypericum would be kicked back for another 200 million dollars of research before it were approved. There is legitimacy to the point of view suggesting that many herbal uses are not supported, or not supported adequately, by science.
Are you sure?
"St. John's Wort Versus Placebo
Double-blind, placebo-controlled trials involving a total of more than fifteen hundred participants with major depression of mild to moderate severity have generally found that use of St. John's wort can significantly reduce HAM-D scores as compared to placebo.21–28,89,105,123
For example, in a 6-week trial, 375 individuals with average 17-item HAM-D scores of about 22 (indicating major depression of moderate severity) were given either St. John's wort or placebo.89 Individuals taking St. John's wort showed significantly greater improvement than those taking placebo. ...
St. John's Wort Versus Medications
At least eight double-blind trials enrolling a total of over twelve hundred people have compared St. John’s wort to fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil) or sertraline (Zoloft).3132,33,90,91,107,108, 117-118 In all of these studies, the herb proved as effective as the drug, and generally caused fewer side effects.
In the largest of these trials, a six week study of 388 people with major depression of mild-to-moderate severity, St. John's wort proved equally effective as the drug Celexa (citalopram) and more effective than placebo. 118Additionally, Celexa caused a significantly higher rate of side effects than St. John's wort. There were also significantly more side effects in the placebo group than in the St. John's wort group -- presumably because treatment of depression reduces physical symptoms of psychological origin.
St. John’s wort has also been compared to older antidepressants, with generally favorable results. 34 -38"
Refer to the link for the footnotes: http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=31050#ref21
Now to say that SJW is as effective as some ADs is saying what exactly?
2002: "Through a Freedom of Information Act request, two psychologists obtained 47 studies used by the FDA for approval of the six antidepressants prescribed most widely between 1987-99.
Overall, antidepressant pills worked 18% better than placebos, a statistically significant difference, "but not meaningful for people in clinical settings," says University of Connecticut psychologist Irving Kirsch. He and co-author Thomas Moore will release their findings July 15 in Prevention and Treatment, an e-journal of the American Psychological Association.
More than half of the 47 studies found that patients on antidepressants improved no more than those on placebos, Kirsch says." http://www.usatoday.com/news/health/drugs/2002-07-08-antidepressants.htm
And just who is in these clinical trials?
"Trials to determine the effectiveness of antidepressants have historically evaluated only a small subset of depressed individuals with a very specific clinical profile. People diagnosed with other psychiatric problems and people with mild depression are among those excluded, says the study, which appears in the March 2002 American Journal of Psychiatry.
“When you take any medicine you assume it’s been found to be effective for your condition,” said Mark Zimmerman, associate professor of psychiatry and human behavior, director of outpatient psychiatry at Rhode Island Hospital, and the study’s lead researcher. “No one knows for sure whether antidepressants are effective for most of the patients we treat.”...
To determine whether the clinic patients would qualify for the drug studies, the researchers reviewed inclusion and exclusion criteria used in 31 antidepressant trials published from 1994 to 1998 in five leading psychiatric journals. Many of the studies excluded patients who had psychotic features, a history of manic episodes, suicide risk, unstable medical illnesses, or a history of drug or alcohol abuse. Several also excluded subjects with eating disorders, obsessive-compulsive disorder or panic disorder.
Nearly all of the studies excluded patients who fell below a cutoff score on a measure of symptom severity, even though they were diagnosed with major depression. “We are not aware of any other medical condition in which individuals with the disorder are routinely excluded because they are not sick enough,” said Zimmerman.
“Drug companies are concerned that individuals with mild depression will respond just as well to a placebo as they will to antidepressant medication,” said Zimmerman. “However, this represents a sizable number of individuals who are prescribed these medicines, especially by primary care physicians.”...
“Drug companies have been correct in assuming that if they show their medicine works for a highly select group of depressed patients, physicians will use it for all patients,” said Zimmerman."
http://www.brown.edu/Administration/News_Bureau/2001-02/01-091.html
The National Institutes of Mental Health is funding a "real world" study that has been reported on throughout the year.
"First Antidepressant Fails 70% of Time" http://aolsvc.health.webmd.aol.com/content/Article/116/112381.htm?pagenumber=1
30% remission rate is the same as the expected placebo rate.
In the subsequent trials of further drugs for those for whom the first drug didn't work, the remission rates went down.
"Subsequent Treatment Strategies for Persistent Depression Yield Modest Results" http://www.nimh.nih.gov/press/stardphase3and4.cfm
>Herbalists are also rash and ill-informed.
Are they? How many people actually consult trained herbalists? Clerks in health stores are generally not trained herbalists.
>Sigh...it's not an easy issue, I guess. I don't mean to offend, but I feel people exaggerate the benefits of herbs as much as those of drugs, disregard irresponsible practices by herbalists, and forget that alternative medicine is also an industry. A balanced view is necessary.
I agree, it's not an easy issue. I think people have to be well informed, or find people who are about alternatives.
I also believe that the whole point of alernative therapies is to be holistic in using them.
Expecting to substitute "something" alternative for a drug "something" is not realistic, imo.I was suicidally depressed while on various meds, on disability for years, and now I'm working again and feel pretty good these days from being my own alternative practitioner. :)
JL
Posted by psychobot5000 on October 12, 2006, at 22:56:23
In reply to Re: Lack of research behind herbs legitimate complaint » psychobot5000, posted by Jlx on October 12, 2006, at 19:28:54
I am impressed with the number of studies showing efficacy for hypericum! I certainly admit that I was not aware there were such a high number, showing good efficacy. Perhaps this is part of the problem... But I was also referring to the other research that is behind legal drugs, showing toxicity, half-life, interactions,and etc, which I don't -believe- has been done systematically for hypericum. It would be very difficult to, since we don't know what exactly are the active chemicals or mechanisms...this makes me less comfortable with it.
'Just because some herbs have not had Big Pharma industry funded studies, does not mean that they're not effective, safe, free of interactions.'
That is an excellent quote! It definitely true that there seems to be this monopolistic Big pharma thing going on that dominates everything. ...I just get very frustrated with the alternative industry for what I see as misleading people about how much is -actually known- about their products. They knowingly (or in willing ignorance) encourage a false veneer of safety and expertise about a subject (human chemical psychology and its manipulations) that isn't well understood by anyone at all!
That said, I guess my strategy with herbs is the same as with medications: read up, cautiously experiment (within certain limitations), and try to find what works for me. I'm very glad that some herbs seem to help with that (theanine, skullcap, and maybe fish-oil for me. So far.).
Keep in mind, use of alternative remedies is very much on the rise!
Cheers everybody--good dialogue, I hope.
Psychbot
Posted by Meri-Tuuli on October 13, 2006, at 13:45:41
In reply to Lot of info about Saint John's!, posted by psychobot5000 on October 12, 2006, at 22:56:23
Hey!
Well I'm glad we can have this dialogue.... The thing is, 'drugs' like SJW don't have the corporate advertising, marketing stategies that Big Pharma sponsered drugs do. SJW can't be patented - there's no profit in it.
>But I was also referring to the other research that is behind legal drugs, showing toxicity, half-life, interactions,and etc, which I don't -believe- has been done systematically for hypericum. It would be very difficult to, since we don't know what exactly are the active chemicals or mechanisms...this makes me less comfortable with it.
There are studies out there on SJW, Jlx highlighted some of these - there are ones with the side effects/interactions too. I'm too lazy to find them out! But simply there aren't that many because SJW doesn't have that many interactions/side effects to begin with. The Extended Commission E monographs systematically reviews all the literature on an available herb and gives it a thorough review. Which is fantastic, because you have a one-stop reference source....I don't know if the same exists with conventional drugs. Also, the vast majority of herbs side effects/interactions pale in comparison to conventional drugs. Plus theres all that Big Pharma industry sponsered research...
> That is an excellent quote! It definitely true that there seems to be this monopolistic Big pharma thing going on that dominates everything. ...I just get very frustrated with the alternative industry for what I see as misleading people about how much is -actually known- about their products.
Thanks!
But herbs have histories of *centuries* of use - they have been popular folk remedies before even the advent of modern pyschiatry! Tea and coffee are 'herbs' that we use everyday without thinking about it.Of course you should be senisble and exercise caution and things and read up about the herbs.
But, in comparison to conventional drugs, I do believe that they are the more benign. I read an article which said that 10,000 people in the UK are put into hospital due to adverse reactions to medications that their doctors had prescribed them. I honestly honestly doubt that *that* many have been put into hospital due to herbs.
And if its any help, they are completely totally paranoid about herb safely - kava kava being one example. In the herb industry, they completely lean toward the ultra-safe side of things. I really doubt the same could be said of the conventional drug industry. I mean, if prozac, now its proven to cause suidcial tendancies in young people, were a herb, it would be completely abolished! There would be an outcry! But no, prozac is still being prescribed, albeit with cautions. Herbs don't have PR people......
But anyway....
Let the dialogue continue!
Kind regards
Meri
Posted by Meri-Tuuli on October 13, 2006, at 14:47:47
In reply to Re: Lack of research behind herbs legitimate complaint » psychobot5000, posted by Jlx on October 12, 2006, at 19:28:54
Hey Jlx,
> I also believe that the whole point of alernative therapies is to be holistic in using them.
This is so incrediably true IMHO. For instance, I've been seeing a herbalist and a pdoc. The herbalist has the holistic blurb in her leaflet, and I pretty much ignored it, expecting her to have to cater for the 'alternative' types...as much as I prefer alternatives, its only because of cold facts (although I suppose I am more alterative than the average person) - ie they have less side effects etc etc rather than being a particulary 'alternative' type person, I mean I believe in science, I mean, I'm not into 'new age healing' and things, and definately not things like crystal therapy - I'm a geologist for heavens sake! Quartz is the most natually occuring mineral on the planet....anyway I'm losing the plot...but yeah.....
So I was saying, yeah after my appointments with my herbalist, I feel engergized, I feel abit better, I...I don't know, it just generally feels good. After seeing my pdoc, I usually burst into tears.....pdocs, for instance seem to only ask questions like, 'how is the medication working' or things like that. Well I don't know, I can't explain it, then I realised the whole holistic thing..... and they way they treat a patient is sort of, complete opposite! A pdoc treats you like a problem that needs to be fixed, whereas the herbalist, I don't know what she does, but its good....she sort of, well Idon't know, the only thing I can say is its the 'holistic' thing going on.
Well, I'm going on now..... !
Kind regards
Meri
PS thanks for finding those studies on SJW.... I don't have the energy to write long informative posts like that!
Yeah i've done myself far far more good than anyone in the healthcare industry has. It makes me mad even to this day - I was sleeping like 12+ hours a day on celexa, and I said to my doctor 'I'm sleeping 12+ hours a day - its not normal' but did he connect it to the only thing I was taking at the time, the celexa??? No, he didn't. I found out myself that celexa can cause tiredness, apathy etc.....man. So then I weaned myself of it, blah blah. This place (babble) has been the best doc i've ever seen.....
Posted by psychobot5000 on October 13, 2006, at 22:37:10
In reply to Re: Lack of research behind herbs legitimate complaint » psychobot5000, posted by Jlx on October 12, 2006, at 19:28:54
It's very good of you to put that informative post, with all those study texts and links up here. I'm sure someone wondiring about SJW will be glad to find it in the Bob archives at some point!
-Pbot
This is the end of the thread.
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