The purple coneflower echinacea, indigenous to the fields of North America, is among the most famous of wildflowers because of its medicinal use. But its fortune if not its fame took a dive last week when a study in the New England Journal of Medicine found it neither prevented colds nor eased cold symptoms. Sadly, echinacea's wilting was seized on as an opportunity to not only bury the hardy little herb prematurely but also attack the National Institutes of Health's National Center for Complementary and Alternative Medicine.
Last week's findings are quite convincing that echinacea is of no benefit to college-age healthy volunteers inoculated with rhinovirus, the culprit behind 30 to 50 percent of common colds. And the herb did no better than a placebo in otherwise healthy children after they fell ill with upper respiratory infections, as reported in the Journal of the American Medical Association almost two years ago.
But these were the healthy young, not the over-50 crowd with weaker immune systems that just might have gotten a helpful boost. Furthermore, in the current study, only one cold virus was inoculated. Only one species of echinacea was tested. And the American Botanical Council claims the herb extracts used were given at too low a dose.
So let's not spade the little flower under just yet: The very same arguments would be raised if clinical research on mainstream therapies delivered such negative results. And in much of the world, herbs are mainstream.
The World Health Organization is bullish on echinacea. The optimism comes from many human studies that support its use for a wide range of colds and infections, plus the 350 experimental studies over the years that show echinacea boosts several components of the immune system and has anti-inflammatory powers. This, along with the large following of devotees who spend hundreds of millions of dollars on the herb each year in the United States--with almost no side effects except for an occasional rash--should prompt some serious follow-up to the current study.
Instead, the Journal offers an adjacent opinion piece on the echinacea report by a former Stanford physician, Wallace Sampson, who has in the past called for abolishing NCCAM (yes, an enterprise I created in 1992 as director of NIH with pressure from Congress). Sampson uses the negative findings on echinacea to blast the alternative medicine movement as an errant social-medical trend. He dismisses herbal and nontraditional medical remedies as categorically implausible and unworthy of serious scientific support. Though alternative medicine does have a way of inspiring hot views among some of medicine's finest, his commentary is less scientific analysis and more culture war. And it's a war that, if won, would create a Catch-22, dooming the world of remedies that lack Establishment credentials to eternal ignorance and therefore discredit.
Ignored. Sure, some alternative practices have a whiff of new-age gobbledygook, but just look at some of what is also being dissed. Typically relegated to the fringe as alternative or complementary are studies of nutrition and diet. Historical neglect of vegetarian, high-protein, high-carb, low-carb, and other you-name-it diets creates the fertile ground for food fads that go unchecked by facts. The academy has largely turned its back on studies of supplements like chondroitin sulfate, psyllium, melatonin, and most minerals and vitamins, not to speak of the other medicinal herbs like St.-John's-wort or green tea. Research using words like holistic or mind-body sets off new-age alarms--yet no doctor would ever say that patients are mere collections of organs or that their brains and bodies are disconnected.
A fair recounting of medical history should leave us a tad more humble and a lot more open. Lest we forget, it was the academic elite that let frontal lobotomy walk away with a Nobel Prize some decades back. In the 1970s, as a result of negative research findings, aspirin was discredited as a heart medicine, and coronary bypass surgery to prevent heart attacks almost bit the dust. And who would have thought that the infamous anti-nausea agent, thalidomide, buried because of harm to the fetus, would re-emerge almost 50 years later as a powerful anticancer drug?
The nature of medicine is seeking, finding, testing, retesting, debunking, and being utterly surprised at how often established dogma crumbles. Echinacea aficionados should take serious stock of the new study. But academics should not be too smug in dismissing the herb as the fallen icon of medicine on the fringe.
This story appears in the August 8, 2005 print edition of U.S. News & World Report.