I have just read the article Becoming a Stakeholder: Herbal medicine, Vampires and the Research Process by Andrew Flower. It discusses the usefulness of RCT's and herbal medicine.
Flower's asks, "should we engage (as herbalists) in RCT's?" He says, absolutely as then we have a voice in the studies. This point is made clear by him citing the study where Saint John's Wort - Hypericum perforatum (SJW) was studied on children with ADHD to the eternal head shaking and muttering of herbalists saying 'but we don't use SJW for ADHD'! Occasionally though I do see a study where a herb is used unconventionally and I think it is worth the effort as the outcome is thought provoking and possibly treatment changing. Such as the study: Maitake mushroom (Grifola frondosa) extract induces ovulation in patients with polycystic ovary syndrome: a possible monotherapy and a combination therapy after failure with first-line clomiphene citrate. This was a new use to me, for maitake.
But at the mention of the SJW and ADHD study and how ludicrous it seemed I remember a study from 2003 entitled:
Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial.
I am not going into the use of echinacea and upper respiratory infections (URI) in this post. There is lots of good information out there on echinacea and colds and maybe in another post we we will look at that. Instead I am going to focus on the reported adverse reaction of skin rash.
The study basics:
- children were 2-11 years of age
- Dried pressed E purpurea juice of the above-ground herb harvested at flowering was used
- Children 2 to 5 years old received 7.5 mL/d (3.75 mL twice a day) during a URI, while those 6 to 11 years old took 10 mL/d (5 mL twice a day). These doses provided 50% of the manufacturer's recommended adult dose in the younger group and 67% of the adult dose in the older group.
- The study medication was begun at the start of the URI and continued until all symptoms had resolved, up to a maximum of 10 days.
- Parents were asked to call the study coordinator immediately when their child developed at least 2 symptoms of a URI, including sneezing, coughing, nasal congestion, runny nose, or temperature greater than 100.4° F (38.0° C)
Here is the part that I have always wondered about
- Rash was reported during 7.1% of URIs treated with echinacea and 2.7% of those treated with placebo
- Although we attempted to exclude children with known allergies to echinacea species or those with other atopic conditions from participation, it is possible that the increased rate of rash seen in children whose URIs were treated with echinacea was a manifestation of an allergic reaction. Severe allergic reactions to echinacea, including anaphylaxis, have been reported. It is possible that the 2 children in our study who developed croup symptoms shortly after taking a dose of echinacea may have been experiencing an allergic reaction.
- Given its lack of documented efficacy and an increased risk for the development of rash, our results do not support the use of echinacea for treatment of URIs in children 2 to 11 years old
Certainly an adverse reaction is undesirable and uncomfortable but there is also something referred to as a 'healing crisis' in herbal medicine. In
Principles and Practice of Phytotherapy: Modern Herbal Medicine Mills and Bone talk of this in the skin disease chapter. Skin diseases are particularly prone to exacerbation and herbal medicine has to be used gently to prevent this. Herbs that can cause these flare ups are called alteratives and guess what is categorized as a alterative by some herbalists? Echinacea. An alterative is indicated for skin diseases and thought of as a detoxifier. Bartram in Bartram's Encyclopedia of Herbal Medicine describes an alterative as "medicines that alter the process of nutrition, restoring in some unknown way the normal functions of an organ or a system" and Matthew Wood in The Book of Herbal Wisdom: Using Plants as Medicines describes alternatives as "blood cleaners", "and such remedies act on the lymphatics and the liver to remove metabolic waste products." So maybe these children were having a healing crisis. There is no mention if they had had rashes in the past or if children with rashes were atopic (although they tried to screen out atopic children). So, now we have study that found echinacea lacks effectiveness in URI's and has a documented increased risk of rash that is reported as an adverse reaction and not seen from a broader perspective. If the echinacea had been given by a herbalist and the parents had had access to a herbalist they may have understood better what was going on and I am pretty sure they would not have been offered echinacea to start with as it is just one herb in a whole arsenal of herbs that can be used for URI's.