Wednesday 12 August 2009

Trial and Error

I’ve noticed at the time of writing this that there seems to be a bit of buzz going round the internet concerning Chinese herbal medicine (CHM) for the treatment of endometriosis. In particular there are some less than credible sources suggesting that CHM is better than conventional medicine for treating endometriosis related symptoms. The report on the website is perhaps one of the worst offenders, starting as they do the title “Vitamins and Chinese Herbs Prove More Effective than Drugs for Endometriosis”. A bold statement I think you’ll agree, so you’d expect they have some serious evidence to back up their claim, well let’s see.

But before I go into the report, I’d like to take a bit of time to show you a few things from that same website. They have some cartoons on this website, fair enough I like cartoons I draw them myself, so let’s see what they’ve drawn. Well take a look at this one and this one if you would like to see the true face of this website. They compare the use of chemotherapy to the gassing of the Jews during the holocaust. I am literally stunned (Oh and they lazily recycled that one from this one about mental health medication). This is just so you know what sort of people we’re dealing with here, so let’s move onto their article on endometriosis before I rupture something.

The article starts off by reporting on a recent publication from the Cochrane Database of Systematic Reviews. The Cochrane group is a large group of people from a wide variety of backgrounds who take in large amounts of studies on a particular subject (including a large amount of studies on drug effectiveness) and thoroughly review the evidence for and against, in an unbiased and methodological manner. It is for this reason that a Cochrane review is thought by many, including myself, to be a definitive source of accurate information. In this instance the Cochrane group have reviewed the evidence for the use of CHM for the treatment of endometriosis, the abstract from which you can find here. reports that “Chinese herbs were found to relieve post-surgical symptoms more effectively than the conventional hormone-based drug therapies, with a nearly 96% success rate of complete symptom relief, as compared to only 10% with danazol. The herbs caused virtually no side effects, while a significant number taking hormone medication suffered increased period pain and irregular periods, acne, fatigue, weight gain and evidence of liver damage.” I’m not sure where they are getting those statistics, because there is nothing like that on the Cochrane review.

If you would like to hear what the review actually said, here it is. The review only focussed on two clinical trials of CHM for endometriosis treatment and even these had major flaws in them. For example, although the trials were randomised, neither of them was placebo controlled or double blind, which leaves huge gaps for errors to creep in. Just in case you aren’t familiar with clinical trials here is the criteria a clinical trial has to fulfil in order to be deemed accurate and unbiased.

Large sample size: This means that the more patients you enrol to test a new medicine the better, and more accurate your conclusions will be.

It has be placebo controlled: This means that the people trying the medicine are divided into two groups, one group gets the real medicine, the other group gets a dummy medicine (placebo). This is to make sure any effects people get from the medicine aren’t just random effects you could get from a placebo.

It has to be randomised: This means that patients are randomly assigned to the real medicine or placebo group. This is to stop doctors selecting the patients they think will respond best to the real medicine.

It has to be double blind: This means that neither the doctors nor the patients know whether they are getting the real medicine or the placebo.

These are not just arbitrary rules dreamed up one day by some guy in his garden shed either. These criteria are the result of hundreds of years of clinical trial and error and much personal suffering.

So let’s move on to what these CHM trials found, I’ll quote directly from the abstract so as not to put any personal spin on things “There was no evidence of a significant difference in rates of symptomatic relief between CHM and gestrinone administered subsequent to laparoscopic surgery”.

Ok so what about the effect on fertility, claimed “Women taking the Chinese herbal treatments were also 10% more likely to become pregnant following surgery than those taking prescription medication”.

This is what the Cochrane review actually said “There was no significant difference between the CHM and gestrinone groups with regard to the total pregnancy rate”.

And here is what the Cochrane review said about the effects of CHM compared to Danazol “Oral plus enema administration of CHM showed a greater reduction in average dysmenorrhoea pain scores than did danazol”. So there is some positive news about the effect of CHM, however we must remember that these trials were neither placebo controlled nor double blind, so can we really take them seriously? doesn’t stop at CHM either, so neither shall I. They go on to report on the use of Pycnogenol, an extract from the French maritime pine bark for the treatment of endometriosis. proudly states “Pcynogenol, was found to decrease symptoms of endometriosis by 33% when used for nearly a year after surgery. In the study, patients took 30 mg capsules of Pycnogel twice daily for 48 weeks immediately after morning and evening meals. The treatment was found to have reduced all symptoms from severe to moderate within four weeks”. That is a direct copy and paste from the website, by the way its spelt ‘Pycnogenol’.

Here is a link to the abstract from the paper they are referencing, which compared the use of Pycnogenol with a Gn-RHa (leuprorelin). There is no mention of Pycnogenol decreasing symptoms by 33% or being effective after 4 weeks. This is what the paper does say though “Treatment with Pycnogenol slowly but steadily reduced the symptom scores. Treatment with Gn-RHa reduced the scores more efficiently; however, 24 weeks after the end of treatment, the scores suggested a recurrence of signs”. Not a very convincing incitement to use Pycnogenol I think you’ll agree. goes on the talk about the use of vitamins for the treatment of endometriosis. They say “Vitamin combinations have also been shown to be an effective therapy for endometriosis. Also in 2007, Italian researchers enrolled 234 women to assess the effectiveness of nutrition versus drug treatment for six months after surgery.Both the nutritional treatment, which included vitamins (B6, A, C and E), minerals (calcium, magnesium, selenium, zinc and iron), omega-3 and omega-6 fatty acids, as well as probiotic bacteria preparations, and the drug treatment were found to be effective in reducing menstrual pain, pelvic pain and pain during sexual intercourse. However, only the drug treatment was found to increase the risk of bone thinning and menopausal symptoms.”

Again here is a link to the article they are referencing, which compared the use of hormone therapy, dietary therapy or placebo therapy for postoperative symptoms. This is what they found “Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups. Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain. Surgery plus placebo showed significative decrease in dyspareunia scores. Postoperative medical and dietary therapy allowed a better quality of life than placebo”. Look back at the quote from, especially the part where they mention dietary therapy and hormonal therapy were equally as good at reducing menstrual pain. Then re-read the second sentence from the quote directly above, notice anything innacurate? Also notice that in no instance was dietary therapy alone better than hormone therapy. Another very interesting point is the comparative cost of both hormonal and dietary therapy. Take into consideration that the hormone therapy is just one tablet a day, whereas dietary therapy consists of tablets and pills for vitamins, minerals, fish oils and pro-biotic bacteria. Guess which one costs you more. Oh and kindly provides you with links to its affiliates who sell books on vitamins and nutritional supplements for you to buy, how kind.

I should probably point out that I am in no way against the use of Chinese herbal medicine or other natural medicines, if you have tried it and it works for you, that’s fantastic. What I am against is people or organisations manipulating or fabricating information in order to garnish support for their own twisted propaganda or to increase their own profits. Something that conventional and alternative medicine is both guilty of. Because when ideological one-upmanship and profiteering takes precedent over patient wellbeing do you know who loses out? You, the sufferer, that’s who.

1 comment:

  1. Interesting and very thorough take on this. :) I have tried both hormonal and dietary therapy for the treatment of my endo and, while the hormonal worked, it had side effects (weight gain, etc) that I just wasn't willing to deal with.

    I'm in no way saying that others shouldn't try it and see what works for them! Every person reacts differently to different treatments, and while CHT is a treatment that has worked for me (and I can tell when I've missed a day or two of supplements), I don't like the claims that the web site makes, especially where it claims that the endometrial tissue shrank. How did they determine this? Did they do laparoscopy surgery on each of the women? I would find that hard to believe.


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