New Echinacea Study Not Relevant to Informed Practice

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Now for the hype to keep you from good natural health products -

A much publicized article recently featured in the New England Journal of Medicine claims to establish that Echinacea has no effect in the prevention and treatment of the common cold. In the study, the authors compared the effect of different preparations of Echinacea angustifolia root on rhinovirus infection. The infection was artificially induced using a strain of rhinovirus type 39 which is considered to be safe. The dose of Echinacea root used was 900 mg per day for 7 days before the virus challenge and then 5 days after. The study evaluated both preventative and treatment effects of the various Echinacea preparations on the rhinovirus infection and found no significant results for either. An important consideration was that the dose was not adjusted for the acute infection phase of the study. The Echinacea angustifolia root was extracted under different conditions in order to compare the effects of the different phytochemical profiles that are typically found in Echinacea products.

The study has been widely condemned, especially in terms of the low dose of Echinacea used. To put this in perspective, the daily amount of Echinacea used in the trial was the equivalent of around one half of a MediHerb Echinacea Premium tablet. (This assumes that the extract the authors made themselves was at least comparable to the patented product we produce under pharmaceutical GMP. Since we have tested products worldwide and found not one that even comes near the levels of alkylamides in Echinacea Premium, this assumption in the authors’ favor is unlikely to be the case, making the relative dose used in the trial even lower). In contrast, MediHerb recommends 2 tablets per day as a preventative dose for immune support and 3 to 4 times this amount (6 to 8 tablets) during acute infections. No wonder the study found no benefit from the low dose of Echinacea used. It is like taking one quarter of a headache tablet and wondering why your headache is still there.

In defense of the dose used, Dr. Ronald Turner has recently claimed that: “There is no evidence from prior studies that the dose of Echinacea would have changed the outcome…”. But, in fact, a study published as far back as 1992 suggests that this is not the case. In a randomized, double-blind, placebo-controlled trial, 180 patients with upper respiratory tract infections received the equivalent of 1800 mg per day or 900 mg per day of E. purpurea root as a tincture, or placebo. Patients receiving the high dose experienced significant relief of symptoms. However patients receiving the lower dose (900 mg) were not significantly different from the placebo control. Also the doses recommended in professional herb texts are clearly higher than 900 mg per day.

Even one of the article’s authors has acknowledged that the amount of Echinacea used in the study may have been insufficient. David Gangemi, PhD, of Clemson University responded to a question posed about this research at last month’s Medicines from the Earth Symposium in North Carolina by stating, “I think in retrospect if we go back and we look at some of the other products that are out there maybe we're only one tenth the level we should be.”

Another aspect of this study which limits the generalization of its results to all users of Echinacea was that an artificial infection was induced in young, healthy volunteers. This could be irrelevant to the real life situation where people with compromised immunity are exposed to a range of constantly evolving viruses and bacteria.

Unfortunately, this trial represents a waste of money and a missed opportunity to better understand the real clinical value of Echinacea.

If only someone had asked an herbalist!