Natural Medicine Trials

Well, as you know, we've had a constant discussion going here for the last couple of years on the relationship of research to the proof of success of natural medicines. And the literature review to date hasn't been all that positive. As you know, there have been many clinical trials that have been published, most of which are either ambiguous or showing no positive effect and in some cases even showing some suggested negative in certain cohorts. So were we totally surprised when we saw this recent paper that just appeared in the Archives of Internal Medicine that discusses the echinacea trial, the largest trial that's been done on the use of echinacea for cold and flu in which the results were again, not positive, they weren't necessarily negative, they were just kind of not statistically significant above placebo. So what does all this say? You know, again, I think this is a very, very interesting learning opportunity for all of us. And I don't want to be too esoteric here, so let me try to summarize in simple language what I think we're learning. We're learning that drugs which are specifically developed to be very high affinity bioactive molecules that have no ambiguity in how they work in human physiology, they basically are very, very active at very low concentrations in doing whatever they're supposed to do, like blocking an enzyme or antagonizing some metabolic step. That's why we have H2 blockers and HMG CoA reductase inhibitors. Those are called statins or SSRIs, selective or serotonin reuptake inhibitors, that's antidepressants. These all are blocking agents and they have a very high affinity to do what they're supposed to do. So they don't have much conversation with individual's physiology. They work across all people to do what they're supposed to do. In the case of natural products, however, they're much more mild nature developed by evolution, a much more sympathetic system of communication tools with our food. And, and it gives us a different kind of messaging system from the therapeutics that come from nature generally that are much more mild, much more low affinity, lower, what's called higher IC50, meaning higher doses are required to get physiological activity. Now what does that mean about these studies? What it means is that because there can be a variable response at a lower affinity agent, lower potency agent, that there may be some people that have a very significant response to that within a large cohort and they get a positive affirmation saying that really worked for me. Because their affinity, their need, their biological relationship to that substance, let's say echinacea in this case was just what they needed for another individual. However, because of the weak interaction, it didn't have the same effect as a drug. It was a more ambiguous response. And, and they don't get that same positive response. And so that would be a non positive response to the study. So what happens is we get these very ambiguous results. Does it mean that no one responded, that it had no effect beyond placebo in certain individuals? Of course it doesn't mean that. What it means is that I believe the lower activity substances, that is the safer substances, also have more discrimination in how they work on an individual. And that is then making this more difficult to prove efficacy in these randomized placebo controlled trials in which maybe only certain cohorts of individuals within the broad range of people respond to these lower activity materials. It doesn't mean they're inactive. It just means the selectivity, the sympathetic relationship of that therapeutic agent to the individual is a different orchestration than that of the large hammer hitting effects of a drug that's designed to block, antagonize or control a certain metabolic step. So that to me is how I look at this whole nature of the symphony, the orchestration, the dance of natural interventions versus that of pharmacology.