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A decade and more ago we all had hopes. The wondrous herbal products our friends were taking and touting would be the secret to healthier and longer existences. The proponents of “Western” medicine were hopelessly outdated and narrow-minded. Echinacea would prevent colds and ginkgo biloba would protect our minds, without any side effects. Never mind the motivation of those selling unpurified, unstandardized, and unproven herbal products for lots of money. All would be well.

I was briefly a cheerleader for the herbal movement. I went to days of courses, bought reference books from Germany, and studied the tracts purporting to demonstrate that various herbal products actually did something. I was seriously concerned at the end of the past millenium that there was scant documentation behind any of the claims for most any herbal “medicine,” but I suspended disbelief, as it is said, while awaiting results of randomized controlled trials, or any coherent controlled trial, of these pharmaceuticals-in-waiting.

No There There in Ginkgo

Now we have solid results on the mother of all herbals (grace à the late, great Saddam Hussein) from the Journal of the American Medical Association (JAMA. 2009;302(24):2663-2670) that ginkgo biloba simply has no beneficial effect on memory. I am sad, since I was hopeful, though skeptical, but ginkgo is worthless. This NIH-sponsored study showed that ginkgo had no effect whatsoever to mitigate memory loss or other carefully measured signs of cognitive decline in a cohort group of over 3,000 grandparents followed for over 6 years in a multcenter randomized trial just published. It is hard to get clearer or more dispassionate results. There simply is no competing controlled data demonstrating any beneficial effect from ginkgo. A sad outcome. But real.

No There There in Echinacea Either

Remember, only several years ago (July 2005) we had a wonderful randomized, controlled trial of echinacea published in the New England Journal of Medicine that tested its ability to stave off the common cold virus by “stimulating the immune system.”  In “An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections,” the authors tested 399 subjects with a standardized rhinovirus #39 infectious model, with some subjects pretreated with echinacea and a comparable number left to the vicissitudes of their own immune systems. The results, again sadly, were clear. Echinacea had no beneficial effect. It did not reduce the onset, severity or duration of the cold symptoms induced by the model rhinovirus. Echinacea, a not-inexpensive herbal product, simply doesn’t work. People still buy it, and others promote it vigorously. But it doesn’t work.

The Import of This Study?The failure of ginkgo biloba, in some regards the matriarch of the entire lineage of herbal products that have been promoted to the public, to even move the dial in the critically important arena of preserving mental function in our grandparents,  should make us aware that there is almost no herbal medicine that has been studied carefully that has been demonstrated to work. Not by claims, attestations and exhortations, but by any substantive controlled trial that can hold up to more than brief scrutiny.

This failure leaves me sad, though not astonished. We badly need helpful medications, not to mention cures, for many illnesses and infirmities that may strike any of us in midlife or after. But we need remedies that work. We need science that discerns and disarticulates the amazingly complex workings of our bodies so that we can devise medications that intervene at the cellular level at the key points where we understand the detailed biochemical processes that are at work.

So far, the hype for “herbal treatments” is vastly overstated, judged simply on carefully measured tests of efficacy. More important, in almost no case have I encountered any biological explanation of the details of what exactly is the active ingredient in any herbal, what physiological process does it impact, and exactly where (which receptor, which enzyme and so forth) does it affect in order to achieve its beneficial impact? Such basic data, the central information for any normal pharmaceutical product, has been consistently lacking in the claims about herbal products. In this respect, I am hardly surprised that careful testing of ginkgo (and echinacea) showed no benefit.

How Do You Know That?

Finally, as a non-physician human, you can and should still think critically about what you hear. When a claim is made (“You’ll live longer.” “It stimulates your immune system.”) you should ask, “How do you know that?” just as you would  (I hope) ask “How do you know that?” if someone suggested that you could double your money in 3 months by investing with them. You’d be skeptical of the latter, I trust (think Bernie M.). The same critical attitude needs to be applied to any matter affecting your health. Why should I do that? How do you know that? Ask that of any product you read or hear about that is touted for your health.

And by all means, ask me and Dr. Isselbacher when we recommend a medication or course of action, “How do you know that.” The difference is that we will tell you, in as much detail as you are interested in, and will do our best to illustrate what we know securely, and what is likely but not proven, and what is conjecture, and why. You want your doctors to think clearly and carefully.

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