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A GenePoool.com Essay
Echinacea:
A Skeptic's Journey
Sometimes it's not easy being a skeptic. Coming from a different perspective one might consider it a very simple task, following a fairly basic maxim, i.e., doubt everything. But that's not really skepticism; it's nihilism. For the nihilist, everything is worthy of questioning, and nothing, by extension, is real and provable. I'm not particularly fond of this particular brand of extremism. I happen to think there is a real, testable, objective reality out there.
Much of what I would call good science takes great pains, as much as it is possible, to eliminate subjectivity from the study of observable phenomena. In fact, the failure to deal properly with experimental bias is the biggest failing of a lot of the pseudoscience I have talked about in past columns and will undoubtedly be discussing in future ones as well. The necessary drawback is simply that there are some ideas which hold a great deal of appeal but which will never be any more than ideas simply because they cannot be tested for. The idea that our universe is nothing more than a mote in the eye of a much larger being in a much larger universe, while fascinating, is untestable. The notion that last Tuesday every single object in the universe instantly doubled in size at the exact same time is pretty cool but equally unverifiable, and therefore relegated to speculation.
My own personal brand of skepticism is far removed from the nihilist, and fairly close to the basis of the scientific method. If it's true, prove it. But this only goes so far. One cannot simply go about expecting double blind proofs of everything one encounters. The reason I named this column Occam's Razor is because this maxim, I think, better serves me on a day to day basis. I am skeptical of an extraordinary phenomenon when I can think of a simpler explanation that does not require acceptance of the extraordinary phenomenon.
But Occam's Razor cannot stand alone either. It's limited by my own knowledge and imagination. This can lead to a logical fallacy all its own.
Take spoon bending. I'll deal with this at length another time, but it serves as a decent example right now.
Say someone claims they can bend spoons with their mind. I say prove it. They show me a straight spoon, and then proceed to bend it without-- as far as I can observe-- physically touching it.
One requirement has been satisfied. They have proven it, so far as I can tell. I apply Occam's Razor to the situation and can come up with no simpler explanation. I declare that based on what I have seen, a spoon has indeed been bent before my eyes with only the power of the mind.
I'm committing a fallacy, of course. This is called an argument from ignorance. I am saying "if you didn't bend the spoon with your mind, how else could it have been done?" By concluding that there IS no other explanation than the one given, I'm allowing my own ignorance of basic sleight of hand to cloud my judgement. Any conjuror worth his salt could perform the same trick without invoking psychic powers, and I would be just as clueless as to their methods. Saying, in other words, "what else CAN it be?" does not prove that it cannot be anything else.
All of this brings me to my topic.
The first time I heard of Echinacea was nearly two years ago. It began with a conversation I had with a customer in my office who overheard me complaining about the advent of a head cold. She recommended Echinacea. Her exact words were "it's like a natural antibiotic."
Now, I'm not a doctor, but I do understand a few basic things about medicine, and so this statement immediately set off the skeptical alarm bells in my head. A cold is a virus. An antibiotic is useless against it, of course, because antibiotics only work against infections.
When I pointed this out to her she stood behind her recommendation nonetheless, even taking the time to write down the name for me. I did not elect to follow her advice.
A few weeks ago I came across Echinacea again when I overheard a co-worker recommending it. I bothered to ask more questions this time.
I was informed that Echinacea works as both an antibiotic and as an immune system boost. This would at least satisfy the effect it might have on a virus. The rest of what I heard made me even more skeptical.
Apparently, one is supposed to ingest Echinacea BEFORE one is actually ill.
That statement bears repeating. In order for Echinacea to work, it must be taken prior to the onset of a cold. I've had a lot of colds in my lifetime, and, like everyone else, I can generally recognize the early stages of one. A runny nose in the morning, for example. On a fair number of these occasions, I have been wrong; the early symptoms simply go away. If on one of those occasions, I had taken Echinacea, I might very well have attributed my speedy recovery to the herb. Better, there is a built-in safety net here, for if I DON'T get better, I obviously did not take the Echinacea in time. Either way, the herb wins.
Feeling by now extremely doubtful of the genuine efficacy of this remedy, I decided to take a trip to the drug store to examine a package for myself. There I discovered a truly remarkable case of clever marketing.
The front of the box touted, in large capital letters, that Echinacea would significantly reduce cold and flu symptoms. This claim was followed by an asterisk. Likewise, on the back, the same claims, along with a few more-- such as a reduction of arthritis pain-- were followed dutifully by an asterisk. The ingredients revealed that the pills contained approximately 55% Echinacea herb, 30% Vitamin C, and 15% Zinc. Both of the latter ingredients have also been shown to alleviate cold and flu symptoms, which begs the questions, how do they KNOW the Echinacea is doing it at all?
It took me a few minutes to locate the disclaimer the askerisk was hinting at. It was as follows:
"These statements have not been evaluated by the Food and Drug Administration. This produce is not intended to diagnose, treat, cure or prevent any disease."
Loosely translated-- and maybe this is just me-- but I read this as:
"THIS PRODUCT WORKS!*"
"*this product doesn't work."
Every herbal remedy on the market carries this disclaimer. Why, you might ask, is it allowed to be sold without the FDA's imprimatur? Well, the answer is, herbs aren't regulated as drugs, but as supplements. And the onus of proof is on the FDA, not the manufacturer of the product. That is, the manufacturer does not have to prove the herbs do what they claim. Furthermore, the FDA must prove that the herb is harmful (again, there is no requirement to prove the claim) in order for the remedy to be pulled from the market.
I ate lunch that day with two friends who also happen to work Downtown. I've known them for quite some time, and overall I consider them to be sane, rational people. I recounted my dilemma regarding Echinacea, and especially my amusement with the FDA disclaimer, and was surprised when they defended the subject of my assault. After a few minutes of discussion went by, I was informed that both of them were ardent Echinacea users.
"I take it," said one of them, having heard my rants before, "that this is the subject of your next column."
Up until that question, I hadn't seriously considered it, for the simple reason that I had no hard data. What I had was a strong suspicion, but the declaration that something is snake oil without knowing for certain is also an argument from ignorance.
And the question "prove it" isn't sufficient either. I had declarations from three people whose opinions I trust that Echinacea works as advertised, but this is nothing more than anecdotal evidence. I could no less accept it on face value than I could accept a claim from a trusted source that they saw an alien space craft land in their back yard. The scientific method exists, in part, because anecdotal evidence is by its nature unreliable. I needed something more concrete.
Locating an authority was not going to be a simple matter. I began with a web search, and found-- not much to my surprise-- a wealth of pages devoted to providing information. And I couldn't rely on any of it.
Here's a sample:
"Echinacea has been reported as a virus fighter and immune system stimulator. In the past the root was used like an antibiotic. Echinacea contains a substance known as polysaccharide. In some studies, this has been known to destroy tumor cells. Research is currently being conducted on Echinacea to determine its use as an immune booster, antiviral, antibacterial, and antifungal agent. Echinacea seems to work well in conjunction with vitamin C to ward off colds."
This is, to say the very least, a marvel of obfuscation. There are only two definitive statements in the entire paragraph, i.e., that it contains polysaccharide and that research is being conducted. Everything else uses words like "reported as" and "seems to." There is also the "other people have used it so it must work" argument, which I find less than compelling. And at the bottom of the page where this passage was found were instructions on how to order some. Lesson one in basic research, don't go to the snake oil salesman to find out how effective the snake oil is.
I find that line about polysaccharides particularly interesting. Note the careful distance placed between the statement that Echinacea contains polysaccharides and the statement that polysaccharides have been effective against tumor cells. It's really very clever. THEY are not saying that Echinacea can destroy tumor cells at all. They're letting THE READER make that connection.
Every site I went to was like this. I found out that in additon to the above claims, Echinacea was a potential anti-inflammatory, a blood thinner, a yeast infection treatment, a cancer inhibitor, and, again, an arthritis treatment. Perhaps I could walk on water if I took it often enough.
But these disparate claims are not really too surprising. A logic is being employed here similar to the logic in the line about polysaccharides. What is missing, but is undeniably relevant to the discussion, is the question of doses. What QUANTITY of polysaccharides were effective against tumor cells in the studies referred to? What QUALITY? Was the administration of, preparation of, dosage of, the polysaccharides in the studies similar in any way to how they are found, prepared, and administered in Echinacea?
I'm reminded of a Bill Cosby routine in which he's put in charge of making breakfast for his children. When his youngest asks him for chocolate cake, he gives it to her, because what does chocolate cake have? Eggs! Milk! Chocolate cake, coming up!
So it's very possible the sellers of Echinacea are claiming the properties of the active ingredients without any real justification for doing so. Another possibility is that, in their minds, dosage is simply a non-issue. They don't believe in it.
Let me explain.
Many of the herbal remedies I've encountered on this quest, including Echinacea, were prepared in homeopathic laboratories. Homeopathy was founded more than a 150 years ago by Christian Friedrich Samuel Hahnemann. There are two basic concepts to it, both fallacious, one remarkably so. The first tenet is, "like cures like." What this means is, if a substance causes the symptoms of a particular disease in a healthy person, then conversely, it will cure that disease in someone so afflicted. While this does echo the basis of vaccination procedures, keep in mind they're talking about ALL illness here. The second fallacy is far sillier. It is believed, quite sincerely, that ordinary water will adopt the curative power of a compound, even when the water is so diluted that not a single molecule of the original compound remains.
These two notions are very fortuitously linked. Say the "cure," based on the first tenet, is a deadly poison. By virtue of the second tenet, nobody is actually ingesting any of the poison.
Homeopathy is, of course, absolutely ridiculous. By their reasoning, I could drop two aspirin in Boston Harbor and eliminate a headache in England. But if herbalists are also homeopaths, it could explain how some of these miraculous cures can be attributed to Echinacea. Not because the herbs are literally considered homeopathic cures (i.e., the ingredients on the Echinacea packet do list actual quantities of Echinacea) but because for a homeopath, dosage is utterly irrelevant.
It quickly became apparent my web search was not going to yield anything worthy of my trust. I was forced to consider other options.
The first one I thought of was CSICOP. CSICOP (the Committee for the Scientific Investigation of Claims Of the Paranormal) is a media watchdog organization and the publisher of the bi-monthly magazine, Skeptical Inquirer. Based on their track record, they met all my qualifications as a trusted source.
A quick e-mail to them for advice (they maintain an AOL address) led me to a marvelous website run by Stephen Barrett, called Quackwatch. (www.quackwatch.com.)
But again I was disappointed by the web. A search of the quackwatch site gave me only two citations for Echinacea, and neither of them were informational reports. It began to look like I wasn't going to have an answer, or a column.
My last trick was to e-mail Stephen Barrett for his advice. He knew very little about Echinacea, but he provided me with the phone number of quackwatch's herbal consultant, John Beutler, PhD.
I was fairly secure with the chain of information I had followed. I had gone from one trusted source to a second, and then a third. I called John Beutler.
Dr. Beutler was extremely helpful. In regards to the direct question, does it work, his answer could best be described as a definite maybe.
"There does seem to be something to it," he said. "There HAVE been some clinical tests suggesting it is effective in modulating cold symptoms."
I was suddenly very glad I had bothered to go this far. But regarding herbal remedies in general, and Echinacea specifically, there's a lot more to the picture, beginning with points I had never considered asking, but Dr. Beutler was kind enough to provide nonetheless.
It's not a easy matter to determine authoritatively what the active ingredients are in Echinacea, for the simple reason that it's difficult to eliminate the possibilities. Consider the variables in a single clinical test.
First, which species of Echinacea are the tests conducted on? There are several species. One of the sites I visited described their pills as containing equal parts Echinacea augustifolia, pallida, and purpurea. It's possible all three work independently, but it's also possible only one of them does. There's no point in using this brand of pill as a sample for this reason. Some of the pills advertised did not identify species at all. Some were mixed with vitamin C or zinc or both. This might seem like a minor detail to you or me, but to a chemist, it's critical.
Second, there's the matter of preparation. Do the active ingredients have a shelf-life? Does freeze-drying eliminate or reduce the effectiveness of said ingredients? How about liquification? It's possible that the act of pulverizing the Echinacea root destroys its effectiveness even before it's put into a pill form. We just don't know. (By the way, Dr. Beutler did point out that it is the root, not the flower, that is used medicinally. Should anybody try to sell you an Echinacea flower to cure what ails you, don't even take your wallet out.)
Third, the question of dosage is still unanswered. The package provides a recommended dosage, of course, and warns not to take it constantly or even for long stretches of time, but the recommended minimum to provide the declared cure has just not been established in any concrete way.
Fourth, no matter how well Echinacea may work, there is still the matter of the method of its use. Dr. Beutler recounted the case of a chemical that was found to be extremely good at counteracting the effect of poisonous mushrooms. The only problem was, you had to take the chemical before ingesting the mushrooms. In certain cases of espionage ("sure I'll taste the soup first") this might be useful, but otherwise, it doesn't help.
Fifth, there are no studies testing to see if Echinacea is safe to take in conjunction with other drugs. It may be considered a supplement, but this does not mean it's harmless. With any herb there is a possibility that it will conflict with a drug that has taken simultaneously.
In summary, then, when you're taking Echinacea, you may rest assured that there really are some studies suggesting it's effective in modulating or significantly reducing the effects of a cold. But what you don't know is whether the species of Echinacea you're ingesting is an effective one, nor do you know if the preparation involved retained the active ingredients, if it's past its shelf-life and therefore ineffective, if the dosages you're self-administering are accurate, if you're endangering yourself by taking aspirin at the same time, or if you are actually coming down with a cold at all.
Of course, much of this is true for ALL untested herbal remedies. Echinacea at least has a few real tests suggesting its efficacy, which is more than can be said for a lot of what's out there. Anecodotal evidence is the norm, rather than the exception, and while this does not automatically invalidate any of the claims made, it also introduces the ever-present specter of the placebo effect.
But I'm not going to say Echinacea flat-out does not work, because as much as that would make a fine capstone to this skeptical journey I've taken, it would not be accurate. I'll let you decide for yourself if the positive outweighs the negatives.
Which brings up the question, was I right in even doubting Echinacea in the first place. I freely admit that after all the logical steps I had taken beforehand I was surprised to find that it was in any way effective. There's a lesson here. Sometimes, even for a skeptic-- and perhaps especially for a skeptic-- it's important to remember that what may seem counter-intuitive could still turn out to be true. But this is no reason to stop questioning, especially when the other option is blind acceptance.
And the real reward of asking the right questions
is getting the right answers. Even when the right answer is maybe.
© 2000, Gene Doucette
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