Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 I recently became aware of some disturbing news first reported to me on NPR and then researched on the web. a controlled double blind study has shown St. John's Wort to be ineffective against depression. see this link for more: http://www.cspinet.org/nah/9_00/stjohnswort.html I bring this up because of the implications for TCM. About a dozen european studies contradict this American study. However the european studies were poorly controlled for assessment of depression. GP's who had no expertise in making the dx of depression or evaluating its remission were the major participants in Europe. the american study used a large dose of a standardized extract, so this was not a factor in the failure. The implications for TCM are that much of the Chinese research we may refer to is also likely of poor design. Dx may often be wrong in china, so rates of remission may be irrelevant. there may be outright fraud since there is no blind peer review. This puts us on shaky ground and exacerbates the need for controlled research in the US. Anyone who thinks that the US will ever accept historical anecdotes or chinese research as a basis for accepting TCM herbology is gravely mistaken. I believe the acceptance of TCM has already plateaued amongst the choir of open minded patients and the only thing that will extend the use of this medicine is research. It is thus very disturbing to me that most of the research I am aware of focuses on topics that are clearly designed to generate funding for institutions and individuals with little benefit for patients or practitioners. We have to settle the issues of herb potency and purity and correct ID plus interrater reliability before we can do anything else of any validity. Yet my attempt to get such studies started was summarily dismissed. Such studies run the risk of exposing schools and manufacturers as failing in their basic missions while still generating huge profits for the vested interests. If we cannot determine interrater reliability prior to doing TCM style studies, we will be forced to rely upon western dx as the basis for our studies. All the more reason to accelerate the process of adding objective laboratory parameters to TCM ASAP. But until that time, we are really left with disease oriented studies. I know the objection to this is that we may validate a disease oriented form of TCM and diminish our own professional worth. I think Benssousan's IBS research was well designed because it used dz dx and bian zheng to satisfy all parties. The fact is that disease oriented research will generate very good results, not as good as TCM style, but good enough to lead to mainstream credibility. this may lead to MD's prescribing herbs based upon disease dx only, as is done in Japan by about 50% of MD's who use kanpo. While this is also heresy to the fundamentalists out there, I ask whether it isn't still a step towards less iatrogenic healthcare? Since even disease oriented herbal tx causes far fewer side effects than allopathic drug therapy, isn't it our ethical responsibility to support such research even it does meet our standards of philosophical purity? Some say this is a shot in the foot. I say Benssousan's research is a foot in the door. Any MD who reads Benssousan may decide to prescribe the herbs allopathically, yet may also be intrigued by the better longterm success of TCM style. Yet the question will be immediately begged as to how valid the TCM dx were since interrater reliability has not been proved (BTW, for more on IR reliability, search the CHA archives; it has been discussed at great length in the past). I propose that between the 360 CHA members and nonmember colleagues we could generate huge amounts of data from our private practices. this would not be controlled double blind research, but we could set certain criteria that would be akin to phase one drug trials. 1. We could agree to study a disease that had been diagnosed according to modern western medicine and could be documented (example hepatitis C with liver enzymes and viral titers and PCR in certain ranges at outset) 2. We could further make TCM diagnosis based upon agreed parameters, not a free for all (example liver constraint with distension, moodiness, wiry pulse) 3. we could treat said disease using preparations from a single company. Following Benssousan, we could use a standard formula for one disease dx group and select several other formulas to use for another group which was dx by TCM. Example: we could give chai hu gui zhi tang plus dan shen and yin chen hao to all hep C patients and then do a differential group that would only receive CHGZT if it was liver depression heat, xue fu zhu yu tang for blood stasis, yin chen zhu fu tang for yang xu, dang gui liu huang tang for yin xu, bao he wan for food and phlegm accumulation We could collect regular lab tests every month for six months and collect the data in the CHA database and perhaps publish in print. question: are there 100 people out there with hep C patients? would you feel comfortable treating one group disease style? this would have to be done randomly, NOt after determining the patient met the TCM dx of liver constraint. If you had two qualified patients, you could toss a coin. We could probably get free herbs since the manufacturer would benefit from publication. this would be the pt. perk. we may also want to offer our services for free once per month, no acupuncture, just herbal consult. Someone could also write a grant application to NIH. see http://nccam.nih.gov/nccam/ for details. Some people object to using alcohol extracts in hep patients, but new evidence suggests that alcohol in small amounts is not dangerous and actually facilitates the uptake of herbs by the liver itself. It functions as a channel guiding substance and bypasses the impaired digestion of hep pt. I am too busy personally to take on the bulk of the writing project for a grant or coordinating this, but if someone out there is game I could give them guidance. BTW, hep was an example. Other ideas are welcome. -- Chinese Herbal Medicine FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 St. John's Wort to be ineffective against depression >>>>>Thats severe depression. it is effective for mild to moderate. Alon - cha Saturday, April 21, 2001 1:24 PM disturbing news I recently became aware of some disturbing news first reported to me onNPR and then researched on the web. a controlled double blind study hasshown St. John's Wort to be ineffective against depression.see this link for more:http://www.cspinet.org/nah/9_00/stjohnswort.htmlI bring this up because of the implications for TCM. About a dozeneuropean studies contradict this American study. However the europeanstudies were poorly controlled for assessment of depression. GP's whohad no expertise in making the dx of depression or evaluating itsremission were the major participants in Europe. the american studyused a large dose of a standardized extract, so this was not a factor inthe failure. The implications for TCM are that much of the Chineseresearch we may refer to is also likely of poor design. Dx may often bewrong in china, so rates of remission may be irrelevant. there may beoutright fraud since there is no blind peer review. This puts us onshaky ground and exacerbates the need for controlled research in theUS. Anyone who thinks that the US will ever accept historical anecdotesor chinese research as a basis for accepting TCM herbology is gravelymistaken. I believe the acceptance of TCM has already plateaued amongstthe choir of open minded patients and the only thing that will extendthe use of this medicine is research. It is thus very disturbing to methat most of the research I am aware of focuses on topics that areclearly designed to generate funding for institutions and individualswith little benefit for patients or practitioners.We have to settle the issues of herb potency and purity and correct IDplus interrater reliability before we can do anything else of anyvalidity. Yet my attempt to get such studies started was summarilydismissed. Such studies run the risk of exposing schools andmanufacturers as failing in their basic missions while still generatinghuge profits for the vested interests.If we cannot determine interrater reliability prior to doing TCM stylestudies, we will be forced to rely upon western dx as the basis for ourstudies. All the more reason to accelerate the process of addingobjective laboratory parameters to TCM ASAP. But until that time, weare really left with disease oriented studies. I know the objection tothis is that we may validate a disease oriented form of TCM and diminishour own professional worth. I think Benssousan's IBS research was welldesigned because it used dz dx and bian zheng to satisfy all parties.The fact is that disease oriented research will generate very goodresults, not as good as TCM style, but good enough to lead to mainstreamcredibility. this may lead to MD's prescribing herbs based upon diseasedx only, as is done in Japan by about 50% of MD's who use kanpo. Whilethis is also heresy to the fundamentalists out there, I ask whether itisn't still a step towards less iatrogenic healthcare? Since evendisease oriented herbal tx causes far fewer side effects than allopathicdrug therapy, isn't it our ethical responsibility to support suchresearch even it does meet our standards of philosophical purity? Somesay this is a shot in the foot. I say Benssousan's research is a footin the door. Any MD who reads Benssousan may decide to prescribe theherbs allopathically, yet may also be intrigued by the better longtermsuccess of TCM style. Yet the question will be immediately begged as tohow valid the TCM dx were since interrater reliability has not beenproved (BTW, for more on IR reliability, search the CHA archives; ithas been discussed at great length in the past).I propose that between the 360 CHA members and nonmember colleagues wecould generate huge amounts of data from our private practices. thiswould not be controlled double blind research, but we could set certaincriteria that would be akin to phase one drug trials.1. We could agree to study a disease that had been diagnosed accordingto modern western medicine and could be documented (example hepatitis Cwith liver enzymes and viral titers and PCR in certain ranges at outset)2. We could further make TCM diagnosis based upon agreed parameters,not a free for all (example liver constraint with distension, moodiness,wiry pulse)3. we could treat said disease using preparations from a singlecompany. Following Benssousan, we could use a standard formula for onedisease dx group and select several other formulas to use for anothergroup which was dx by TCM.Example: we could give chai hu gui zhi tang plus dan shen and yin chenhao to all hep C patientsand then do a differential group that would only receive CHGZT if it wasliver depression heat, xue fu zhu yu tang for blood stasis, yin chen zhufu tang for yang xu, dang gui liu huang tang for yin xu, bao he wan forfood and phlegm accumulationWe could collect regular lab tests every month for six months andcollect the data in the CHA database and perhaps publish in print.question: are there 100 people out there with hep C patients? would youfeel comfortable treating one group disease style? this would have tobe done randomly, NOt after determining the patient met the TCM dx ofliver constraint. If you had two qualified patients, you could toss acoin. We could probably get free herbs since the manufacturer wouldbenefit from publication. this would be the pt. perk. we may also wantto offer our services for free once per month, no acupuncture, justherbal consult. Someone could also write a grant application to NIH.see http://nccam.nih.gov/nccam/ for details.Some people object to using alcohol extracts in hep patients, but newevidence suggests that alcohol in small amounts is not dangerous andactually facilitates the uptake of herbs by the liver itself. Itfunctions as a channel guiding substance and bypasses the impaireddigestion of hep pt.I am too busy personally to take on the bulk of the writing project fora grant or coordinating this, but if someone out there is game I couldgive them guidance. BTW, hep was an example. Other ideas are welcome.--DirectorChinese Herbal Medicinehttp://www..orgFAX: Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 , <alonmarcus@w...> wrote: > St. John's Wort to be ineffective against depression > >>>>>Thats severe depression. it is effective for mild to moderate. > Alon Actually the report said it was ineffective for moderate to severe. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 The implications for TCM are that much of the Chineseresearch we may refer to is also likely of poor design. Dx may often bewrong in china, so rates of remission may be irrelevant. there may beoutright fraud since there is no blind peer review. >>>>>Well nice to see someone else bring this up, about time. I was just told that a scientific review of Chinese medical research wrote a scaring critic, basically saying that most of the research coming out of china is worthless (including western medicine research). I am going to try to get more details. Another very good study showed Gingko to be ineffective for memory in the elderly and Yet another iproflevone to not help osteoporosis Alon - cha Saturday, April 21, 2001 1:24 PM disturbing news I recently became aware of some disturbing news first reported to me onNPR and then researched on the web. a controlled double blind study hasshown St. John's Wort to be ineffective against depression.see this link for more:http://www.cspinet.org/nah/9_00/stjohnswort.htmlI bring this up because of the implications for TCM. About a dozeneuropean studies contradict this American study. However the europeanstudies were poorly controlled for assessment of depression. GP's whohad no expertise in making the dx of depression or evaluating itsremission were the major participants in Europe. the american studyused a large dose of a standardized extract, so this was not a factor inthe failure. The implications for TCM are that much of the Chineseresearch we may refer to is also likely of poor design. Dx may often bewrong in china, so rates of remission may be irrelevant. there may beoutright fraud since there is no blind peer review. This puts us onshaky ground and exacerbates the need for controlled research in theUS. Anyone who thinks that the US will ever accept historical anecdotesor chinese research as a basis for accepting TCM herbology is gravelymistaken. I believe the acceptance of TCM has already plateaued amongstthe choir of open minded patients and the only thing that will extendthe use of this medicine is research. It is thus very disturbing to methat most of the research I am aware of focuses on topics that areclearly designed to generate funding for institutions and individualswith little benefit for patients or practitioners.We have to settle the issues of herb potency and purity and correct IDplus interrater reliability before we can do anything else of anyvalidity. Yet my attempt to get such studies started was summarilydismissed. Such studies run the risk of exposing schools andmanufacturers as failing in their basic missions while still generatinghuge profits for the vested interests.If we cannot determine interrater reliability prior to doing TCM stylestudies, we will be forced to rely upon western dx as the basis for ourstudies. All the more reason to accelerate the process of addingobjective laboratory parameters to TCM ASAP. But until that time, weare really left with disease oriented studies. I know the objection tothis is that we may validate a disease oriented form of TCM and diminishour own professional worth. I think Benssousan's IBS research was welldesigned because it used dz dx and bian zheng to satisfy all parties.The fact is that disease oriented research will generate very goodresults, not as good as TCM style, but good enough to lead to mainstreamcredibility. this may lead to MD's prescribing herbs based upon diseasedx only, as is done in Japan by about 50% of MD's who use kanpo. Whilethis is also heresy to the fundamentalists out there, I ask whether itisn't still a step towards less iatrogenic healthcare? Since evendisease oriented herbal tx causes far fewer side effects than allopathicdrug therapy, isn't it our ethical responsibility to support suchresearch even it does meet our standards of philosophical purity? Somesay this is a shot in the foot. I say Benssousan's research is a footin the door. Any MD who reads Benssousan may decide to prescribe theherbs allopathically, yet may also be intrigued by the better longtermsuccess of TCM style. Yet the question will be immediately begged as tohow valid the TCM dx were since interrater reliability has not beenproved (BTW, for more on IR reliability, search the CHA archives; ithas been discussed at great length in the past).I propose that between the 360 CHA members and nonmember colleagues wecould generate huge amounts of data from our private practices. thiswould not be controlled double blind research, but we could set certaincriteria that would be akin to phase one drug trials.1. We could agree to study a disease that had been diagnosed accordingto modern western medicine and could be documented (example hepatitis Cwith liver enzymes and viral titers and PCR in certain ranges at outset)2. We could further make TCM diagnosis based upon agreed parameters,not a free for all (example liver constraint with distension, moodiness,wiry pulse)3. we could treat said disease using preparations from a singlecompany. Following Benssousan, we could use a standard formula for onedisease dx group and select several other formulas to use for anothergroup which was dx by TCM.Example: we could give chai hu gui zhi tang plus dan shen and yin chenhao to all hep C patientsand then do a differential group that would only receive CHGZT if it wasliver depression heat, xue fu zhu yu tang for blood stasis, yin chen zhufu tang for yang xu, dang gui liu huang tang for yin xu, bao he wan forfood and phlegm accumulationWe could collect regular lab tests every month for six months andcollect the data in the CHA database and perhaps publish in print.question: are there 100 people out there with hep C patients? would youfeel comfortable treating one group disease style? this would have tobe done randomly, NOt after determining the patient met the TCM dx ofliver constraint. If you had two qualified patients, you could toss acoin. We could probably get free herbs since the manufacturer wouldbenefit from publication. this would be the pt. perk. we may also wantto offer our services for free once per month, no acupuncture, justherbal consult. Someone could also write a grant application to NIH.see http://nccam.nih.gov/nccam/ for details.Some people object to using alcohol extracts in hep patients, but newevidence suggests that alcohol in small amounts is not dangerous andactually facilitates the uptake of herbs by the liver itself. Itfunctions as a channel guiding substance and bypasses the impaireddigestion of hep pt.I am too busy personally to take on the bulk of the writing project fora grant or coordinating this, but if someone out there is game I couldgive them guidance. BTW, hep was an example. Other ideas are welcome.--DirectorChinese Herbal Medicinehttp://www..orgFAX: Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 Actually the report said it was ineffective for moderate to severe >>>Most European studies were on mild to moderate Alon - Saturday, April 21, 2001 1:42 PM Re: disturbing news , <alonmarcus@w...> wrote:> St. John's Wort to be ineffective against depression> >>>>>Thats severe depression. it is effective for mild to moderate. > AlonActually the report said it was ineffective for moderate to severe.ToddChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 Todd- I support your concerns about the quality of studies on TCM and suggestions for trials, but you should know that the US study which inspired your fears was poorly designed and suspect. St. John's wort is especially sensitive to herbal quality concerns as it is a formula unto itself, with various constituents (not merely the two standardized markers) affecting a balance of some 20 known physiological causes to depression. Standardized extracts frequently preform worse than non-standardized extracts made by small herbal companies which pick flowers only at the peak of ripeness instead of aerial parts harvested by machine at various stages. The study treated major depression which is not an indication appropriately treated with St. John's wort. Major depression etiology differs from that of mild to moderate depression, the focus of the European studies. And frankly I doubt that GPs are unable to diagnose depression. Further the study was only eight weeks in length, which is hardly enough for even the faster-onset pharmeceuticals to treat major depression. Needless to say there was no constitutional screening and the herb was used as a simple which is not how even a western herbalist would generally approach treatment. And the study has ethical problems since it lacked an active treatment group which is standard for conditions in which there is an effective treatment. Further it violates ethical studies to put patients at risk from major depression on a placebo for eight weeks and a herb which is not noted for its use in major depression. And of course we note that Pfizer funded the study which looked at a major competitor to their drug Zoloft. Observers have criticized JAMA for printing an incomplete financial disclosure statement for Pfizer Inc., since JAMA states that the company is a St. John's wort manufacturer, when in fact, Pfizer did not manufacture St. John's wort St. John's wort product line, but discontinued the line shortly after the acquisition was made. Karen Vaughan CreationsGarden *************************************** Email advice is not a substitute for medical treatment. ______________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 Wow! Pfizer bought out and discontinued a st. johnswort product line? And funded a study? Talk about conflict of interest! What is sad is that this was plastered all over the media. . . .I learned about it reading the morning NY Times and San Diego Tribune, prominantly featured. More of the bad press that seems to be designed to 'eliminate the competition'. On Saturday, April 21, 2001, at 09:47 PM, Karen S Vaughan wrote: - > > > And of course we note that Pfizer funded the study which looked at a > major competitor to their drug Zoloft. Observers have criticized JAMA > for > printing an incomplete financial disclosure statement for Pfizer Inc., > since JAMA states that the company is a St. John's wort manufacturer, > when in fact, Pfizer did not manufacture St. John's wort St. John's > wort > product line, but discontinued the line shortly after the acquisition > was > made. > > Karen Vaughan > CreationsGarden > *************************************** > Email advice is not a substitute for medical treatment. > > ______________ > GET INTERNET ACCESS FROM JUNO! > Juno offers FREE or PREMIUM Internet access for less! > Join Juno today! For your FREE software, visit: > http://dl.www.juno.com/get/tagj. > > > Chinese Herbal Medicine, a voluntary organization of licensed > healthcare practitioners, matriculated students and postgraduate > academics specializing in Chinese Herbal Medicine, provides a variety > of professional services, including board approved online continuing > education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 , Karen S Vaughan <creationsgarden@j...> wrote: Standardized extracts frequently preform worse than > non-standardized extracts made by small herbal companies Karen, You are not suggesting that standardized extracts only contain the constituents for which they are standardized, are you? It is my understanding that these are full spectrum extracts that are assessed for potency by measuring several marker constituents. If the markers are of a certain strength, then the rest of the constituents are proportional in the final product. It is not cost effective to spike products with constituents; I tink that is a specious accusation I have seen from some circles. I think the reason small company products often perform better is because many of these companies are very scrupulous and ethical while many companies making unregulated " standardized extracts " in the US are unscrupulous profiteeers. Have you ever used phytopharmica? I think their products are excellent. However, my favorite western herbal line is indeed the unstandardized freeze dried ones from Eclectic Institute and best tinctures used to be from wisewoman herbs. > > The study treated major depression which is not an indication > appropriately treated with St. John's wort. Major depression etiology > differs from that of mild to moderate depression, the focus of the > European studies. The study uses the term major depression, but also says some patients only had moderate depression. these descriptions are mutually exclusive according to DSM-IV. Since no full text is yet available, it is unclear to me what was treated in this study. Major depression always involves suicidal thoughts. And frankly I doubt that GPs are unable to diagnose > depression. they do not use analytical tools such as accepted questionnaires, but often rely on patient reports alone, which is suspect for a study. Further the study was only eight weeks in length, which is > hardly enough for even the faster-onset pharmeceuticals to treat major > depression. the european studies were 4-6 weeks in length. > And the study has ethical problems since it lacked an active treatment > group which is standard for conditions in which there is an effective > treatment. Further it violates ethical studies to put patients at risk > from major depression on a placebo for eight weeks and a herb which is > not noted for its use in major depression. this also calls into question the use of the term major depression. If this is correct,they would never have gotten approval from the human subjects review board. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 Todd wrote 3. we could treat said disease using preparations from a single company. Following Benssousan, we could use a standard formula for one disease dx group and select several other formulas to use for another group which was dx by TCM. I have much admiration for the work that Alan Bensoussan has done for the TCM profession but I feel it brings up some points that I wish to express. The research was really aimed at creating a credible reputation that TCM works in the eyes of a western medical research model. This he achieved. But I ask has it made any difference in doctors refferring their patients with IBS to TCM practitioners . Or doctors /drug companies wanting to research it further. When I was in Dunedin (South NZ) population 120 000, I wrote a series of letters to all the resident 150 doctors there , outlining the research and results Bensoussan did on IBS, with all the journal back up and references etc. Over a one year period they got 4 such letters . How many referrals do you think I got? Thats right ...........NONE. Ironically I did get one retired doctor who had IBS who was the father of another of my patients. I even rang up and had meetings with some of the doctors , ...........Their comments included things like " well , it still needs more research " " what about the dangers of mixing the herbs with other drugs " " there are new drugs now available for IBS " " I would be hesitant to refer something as serious as IBS to a herbalist " My conclusion is that regardles how effective and proven any alternative remedy may be ...................its not going to change the doctors. This is why I feel any TCM research should be geared towards improving the condition of the patient and not trying to prove that such and such a formula/ herb is better than a placebo to satisfy some researchers in white lab coats. Ultimately Bensoussans work on IBS could of shown a much higher improvement if the patients had actually taken raw boil up herbs or large doses of freeze dried herbs. He was restricted to putting the individual herb formula in capsules so that it couldn't be distinguished between a placebo.Imagine , Todd if you were able to give the patient the high doses that you normally like to prescribe. The research you suggest on Hep C would be so valuable ( especially concidering bio med has no effective treatment) . I 'd like to go one step further , eg see if bao he wan plus hong hua is more effective than bao he wan alone . Or a group of x number hep C patients after 6 months of individually presribed herbal treatment and see which ones are doing best, and make the formula or herbs available for analysis by CHA members. For me its not so important that blood tests MUST show some change. I have had enough patients with hep B and C whose blood tests are normal but they feel shocking, and after herb treatment feel much better and yet the blood tests have had no major change. Simple criteria like " My wife says that I don't shout at her anymore or I can get up in the morning now " is proof enough to the patient . A herb company in Australia at the moment is conducting research with hep C and doing the double blind thing to show ALT changes etc. The company only has one goal in mind. And that is getting doctors to presribe their herbal pills which will be totally overpriced . Enough raving. I will send another email tomorow , I have some stuff from Clavey on hep C. Heiko Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 St. John's wort isespecially sensitive to herbal quality concerns as it is a formula untoitself, with various constituents (not merely the two standardizedmarkers) affecting a balance of some 20 known physiological causes todepression. Standardized extracts frequently perform worse thannon-standardized extracts made by small herbal companies which pickflowers only at the peak of ripeness instead of aerial parts harvested bymachine at various stages. >>>>>It sounded like they used a well known extract. Also, you have to remember that all the European studies were done on standardized extracts. The study treated major depression which is not an indicationappropriately treated with St. John's wort. Major depression etiologydiffers from that of mild to moderate depression, the focus of theEuropean studies. >>>>Major depression is just severe depression and is part of what they were looking at. Further the study was only eight weeks in length, which ishardly enough for even the faster-onset pharmaceuticals to treat majordepression. >>>>That is standard length of time of studies on depression it lacked an active treatmentgroup which is standard for conditions in which there is an effectivetreatment. >>>>>I thought they used Zoloft Further it violates ethical studies to put patients at riskfrom major depression on a placebo for eight weeks and a herb which isnot noted for its use in major depression.>>>>>Again that is standard and needed Observers have criticized JAMA forprinting an incomplete financial disclosure statement for Pfizer Inc.,since JAMA states that the company is a St. John's wort manufacturer,when in fact, Pfizer did not manufacture St. John's wort St. John's wortproduct line, but discontinued the line shortly after the acquisition wasmade.>>>>>>>>>>I thought they were this advertising on TV Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 My conclusion is that regardless how effective and proven any alternative remedy may be ...................its not going to change the doctors.>>>This is not true up here in north CA. I get many referrals from MD's all the time. Although things change very slowly in western medicine. Also, One study positive or negative especially when small like 200 patients does not have much weight. Heiko if you could show 20 studies you may get a different response Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 No most standardized extracts contain a full line of constituents available when the plant was processed, but are concentrated to the requirements of the markers. (There are some standardized extracts which may be boosted with easily obtained markers as well and do not contain the full spectrum, but these are not the majority.) But extracts made from machine-harvested aerial parts of St. John's wort contain a different balance of constituents than those made with ripe buds and flowers. St. John's wort is more sensitive to the balance of constituents than many other herbs are. St. Johnswort has 25 known active compounds providing a variety of actions. The known active constituents which are found in different proportions in different parts of the plants, including hypericin, pseudo hypericin, quercitin, isoquercitrin, rutin, hyperoside, campherol, luteolin, 13-118-biapigenin, 1,3,6,7-tetra-hydroxyanthone, various procyanidines and hyperforin. The most prevalent action is probably that of a selective serotonin reuptake inhibitor, although other individual components are mono-amino-oxidase inhibiting, norepinene reuptake inhibiting or cortisol secretion inhibiting. There may also be increases in melatonin, increases in neurotransmitter metabolites, inhibition of dopamine and prolactin, and facilitation of binding to benzodiazepine receptors. The balance of these actions is probably critical. To make the extract from lower grade herb is equivalent to changing the proportion of herbs in one of our formulas. The perforated leaves with their " tears " and the black red dots on the flowers are probably the most potent constituents, especially when taken from the top of the flowering plant and tinctured in the field. Dried flowers are probably not a reasonable way to get the maximum value from St. John's wort. Many of the constituents are volatile or chemically change during drying- and protohyericin and protopseudohypericin change when a tincture is exposed to light into hypericin and pseudohypericin (which darkens your tincture). Most herbalists prefer a fresh plant tincture of the flowering tops in a high alcohol concentration, exposed to sunlight for the first 24 hours. Industrial extractions made with other solvents will change the balance as well. Standardization alone simply does not tell us about the quality of the product, although the Pharmaprinting technology could potentially do so if the model is based upon herbs at the peak of ripeness and enough markers are identified. Karen Vaughan CreationsGarden *************************************** Email advice is not a substitute for medical treatment. An archeologist is the best husband a woman can have; the older she gets, the more interested he is in her- Agatha Christie ______________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 mono-amino-oxidase inhibiting >>>SJW is not MAOI in humans. In order to achieve MAOI the dose must be too large and that is why one can take it with other anti-depressants Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 Alon, It is true that in a well-balanced SJW extract the MAO-inhibiting action is negligible. However I have clinically seen this action manifested in headaches in reactions to cheese and other MAOI-sensitive foods when patients were on poor quality standardized extracts. When one switched to a quality SJW tincture the reaction went away. We re-challenged and had the same reaction and she switched to tincture for good. I suspect that this was not an alcohol extraction and hence included extracted constituents not normaly seen in alcohol extractions (or at least in very different proportions). However at the time I did not contact the manufacturer to verify this. I did pass the information including brands onto Paul Bergner who was collecting data on SJW adverse reactions, but no longer have it in my files. I think it possible that the other constituents in hypericum may buffer the apparently adverse MAOI/SSRI interactions whereas, with pharmaceuticals we get two intense dosages, without buffers or proper proportions. Karen Vaughan CreationsGarden *************************************** Email advice is not a substitute for medical treatment. An archeologist is the best husband a woman can have; the older she gets, the more interested he is in her- Agatha Christie ______________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2001 Report Share Posted April 23, 2001 , <alonmarcus@w...> wrote: > >>>>>>>>>>I thought they were this advertising on TV you watch TV? shocking. just kidding. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2001 Report Share Posted April 23, 2001 It is true that in a well-balanced SJW extract the MAO-inhibiting actionis negligible. However I have clinically seen this action manifested inheadaches in reactions to cheese and other MAOI-sensitive foods whenpatients were on poor quality standardized extracts. When one switchedto a quality SJW tincture the reaction went away. We re-challenged andhad the same reaction and she switched to tincture for good.>>>That is hard to believe. You need a very strong none reversible MAOI (and usually both A and B) to cause a cheese reaction. no human studies no MAO-inhibition has been noted Alon Quote Link to comment Share on other sites More sharing options...
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