Another one bites the dust

I was looking over the most recent issue of the New England Journal of Medicine, and what did I see? A study showing that Echinacea has no detectable effect above placebo when it comes to preventing or ameliorating the symptoms of colds. It's a nicely designed randomized blinded study that tested three different preparations of Echinacea and a placebo on healthy volunteers, who took the preparation and then were challenged with rhinovirus. There was no detectable difference between groups in the infection rate or measurements of cold duration and severity. None of the Echinacea groups were better than placebo.

Now that's the way you evaluate alternative remedies! For once, NCCAM has actually funded a study that, when added to earlier studies, pretty well puts the final nail in the coffin of this particular remedy. More interesting was an editorial by Dr. Wallace Sampson, who argues that, when it comes to alternative medicine, we should stick to putting resources into evaluating scientifically plausible remedies:

The inability of randomized clinical trials and systematic reviews to establish inefficacy in research into alternative treatments contributes to a recent loss of bearings. Researchers and advocates of alternative medicine present a mass of information with inadequate heuristics for making sense of it and insufficient standards for making use of it. Should there be studies of other echinacea species, of other parts of the plant, and of each extract of each part of each plant on each cold and each influenza virus? Should these studies be repeated in various combinations, with dose modifications? Why? The possible combinations increase geometrically. Since 1999, the NIH has spent almost $1.5 billion in grants for research into alternative methods. NCCAM has spent almost half that amount and has found no evidence of efficacy and little evidence of inefficacy. NCCAM has three more randomized clinical trials of echinacea that are currently active. As long as research sponsored by NCCAM and private foundations continues, advocates of alternative treatments can claim that a state of equipoise exists when, in fact, the issues should have been settled on the basis of previous knowledge.

It is time for reassessment. First, there is an answer to the question, "Why are we doing randomized clinical trials of folkway uses of herbs and sectarian remedies?" The answer is that proponents and evaluators have excluded plausibility from the equation. What is needed is knowledge-based medicine, with randomized clinical trials of treatments with histories that indicate some reasonable chance of efficacy. This approach mandates a medicine based on evidence that has passed through the sieve of plausibility and that is consistent with basic sciences, other applied sciences, and history — all molded by wisdom and common sense. NCCAM, if it is to justify its existence, must consider halting its search for active remedies through clinical trials of treatments of low plausibility.

Unfortunately, as I've learned dealing with alties, no matter how many negative studies showing no efficacy of their favored remedy over placebo are done, they always find a way to rationalize the failure of well-designed scientific studies. There has to come a point when we must conclude that the question has been pretty much answered and that we should put our resources into other areas of investigation that might yield more promising results.