Talk:Echinacea

I added a few things from a Univ of Maryland Medical Center site that appear to contradict some of what Robert added. I'll leave it to him to reconcile the two.  :-) Stephen Ewen 23:09, 3 February 2008 (CST)

Alright, I took a stab at reconciling the two. Just a stab. Stephen Ewen 03:36, 4 February 2008 (CST)

1. Surprisingly, there are a number of studies to show that publication bias is especially a problem in alternative medicine. Even harder to believe is that it seems especially problematic in publications from Germany (these analyses were done by German authors). I added this to this article and to the publication bias article.

2. Are you sure you want to cite the University of Maryland website? Problems are that this is a non-systematic summary of evidence (see Antman, JAMA 1992. "A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction". JAMA 268 (2): 240–8. http://pubmed.gov/1535110). In addition, this site has not undergone peer review, and does not link specific studies to specific claims. If you want to represent the pro-Echinacea camp, you should work with the meta-analysis I cited from Lancet Infectious Disease; I think its validity is much better than a the U of Maryland webpage. Maybe if you look closer at the meta-analysis you will see a better interpretation of it than the interpretation I offered. If you want to keep in the Maryland webpage, I think we need to note it is not systematic, does not link specific studies to specific claims, and has not been peer reviewed. This does not mean it is incorrect, but means it has a lesser chance of being correct and more of a chance of overstating effect size. - Robert Badgett 12:55, 6 February 2008 (CST)

What is Echinacea?

Is this like saying that "Bos taurus, also called the cow, is a type of cattle eaten as steak?":

"Echinacea, also called coneflower or rudbeckia purpurea, is a genus of nine perennial herbs used topically and internally."

Should the introduction be about the plant in a general sense before moving onto one specific use of the plant? Echinacea is a perennial herb that's a member of the Heliantheae, a familiar tribe of the Asteraceae that also includes the agricultural sunflower, Helianthus annuus. Its flowers are composite inflorescences made up of many individual small florets, etc., etc. I believe the genus is native to only North America. Only this information, the etymology of the scientific name, and the last general sentence about medicinal use belong in the introduction, unless this is a guide to its usage as "alternative medicine" as discussed above. I'm new to Citizendium and this may be an article specifically about herbal use of the plant? Should it then have a title indicating such? Wouldn't a general encyclopedia start with describing what Echinacea is before describing its specific uses in one limited area? It's also an important garden plant, and it's weedy in some areas, in addition to being used medicinally in Western culture and among Indians of the Great Plains. Have Indians stopped using Echinacea? The archaeological sentence is sketchy. Which 400 years did they use it for? When and why did they quit if they did?

Also, is "scale" correct? I couldn't find it in an on-line botanical dictionary used for describing the projectiles on Echinacea heads--are the pointy structures bracts subtending the disc florets? Are they called scales? Is there a source for this?

Is this a synthesis of the line on the University of Maryland's page or rather too close to the text there, if it is copyrighted?

"In Germany (where herbs are regulated by the government), the above-ground parts of Echinacea purpurea are approved to treat colds, upper respiratory tract infections, urinary tract infections, and slow-healing wounds. The root of the Echinacea pallida plant is also approved for the treatment of flu-like infections."

The Citizendium lines:

"The above-ground parts of Echinacea purpurea are approved by the German government to treat colds, upper respiratory tract infections, urinary tract infections, and slow-healing wounds, while Echinacea pallida root is approved to treat flu-like infections.[2]"

I think the list of approved treatments should be in quotation marks within the Citizendium article's sentences.

Parts of the shoots of Echinacea purpurea are approved by the German government for treatment of "colds, upper respiratory tract infections, urinary tract infections, and slow-healing wounds," while roots of E. pallida are "approved for the treatment of flu-like infections."

May I make these changes in the article? --K. Leo Pullin 01:03, 7 February 2008 (CST)

The list of approved treatments is precisely the sort of things that do not need to be added into quotes. Who has copyright to such a list? No one, it's just basic facts. Same as with listing what, for example, Prednisone is approved to treat. Do feel free to improve the article! Stephen Ewen 01:08, 7 February 2008 (CST)

Have you seen this precise list of approved treatments in this order elsewhere, though? Or is this only the German government's list of approved treatments according to the University of Maryland website? If the latter, it should be in quotes to indicate precisely where it is taken from, if used in the same manner as the sentence here. This isn't to say the treatments are dubious or to comment editorially upon them, rather to show that the text is taken from another site. It's not an issue of the validity of the treatments, but the choice to use almost the precise wording of the University of Maryland's website. If these are the standard four treatments, listed in this order, then maybe using another source as the reference to indicate that would be useful. However, in alternative medicine literature I've seen the wording "areal parts" of the plant rather than "above-ground parts," and this might be the University of Maryland's translation of the German text. Again, in this case, it should be quoted, or rewritten in our own words, rather than in someone else's. Again, this is why I offered alternative text ("parts of the shoots") in addition to the quotes above, to deal with the entire issue of the copied text, not the validity of the treatments.

Try a google of the phrase "colds, upper respiratory tract infections, urinary tract infections, and slow-healing wounds" to see what you get. I think these have all been copied from the University of Maryland's website.

You are making a mountain out of a molehill. There is no originality to the order Colds, upper respiratory tract infections, urinary tract infections, and slow-healing wounds - it is the order of importance, and it is simply a standard way of saying it factually. Stephen Ewen 05:00, 8 February 2008 (CST)

Please, let's discuss the article, not what I'm making. If this is the order of importance and these are the four standard treatments, it should be easy to find and attach a second source that shows this. In fact, if it is this common and standard, a second and possibly better source than a website would enhance the credibility of the article. Thanks. --K. Leo Pullin 23:28, 8 February 2008 (CST)

Also, as I'm a general reader, not specifically knowledgeable about the herbal medicine, like other general readers, I won't know this is a standard order of importance, so maybe something discussing this information, order of importance and where it comes from would help. --K. Leo Pullin 23:29, 8 February 2008 (CST)

There are some Canadian studies in what appears to be peer-reviewed literature on Echinacea angustifolia that appear to be straight-forward:

Saunders, PR, F Smith, R Schusky. Echinacea purpurea L. in children: safety, tolerability, compliance, and clinical effectiveness in upper respiratory tract infections. Canadian Journal of Physiology and Pharmacology 85 (11), 1 November 2007, pp. 1195-1199.

Altamirano-Dimas, M, JB Hudson, D Cochrane, C Nelson, JT Arnason. Modulation of immune response gene expression by echinacea extracts: results of a gene array analysis. Canadian Journal of Physiology and Pharmacology, '85 (11), 1 November 2007, pp. 1091-1098. NRC Research Press

Also, it's an important component of tall grass prairies:

Piper, JK. Does the Number of Species in the Seed Mix Affect the Establishment of Four Tallgrass Prairie Species? A Seven-Year Study in Kansas. Ecological Restoration 25, June 2007, 118-122. University of Wisconsin Press.

I will try to look at the ecology article, something in my area, but post the Canadian journal articles for others more interested in those areas as possible useful sources. --K. Leo Pullin 01:37, 7 February 2008 (CST)

I started this article with a medical focus since that is my background. Feel free to give it a botany focus with a section on its role in Medicine

This U of Maryland document is very problematic. Does anyone know how to verify that the German government has approved Echinacea?

Can we remove "German scientists have conducted the majority of research on echinacea." The best studies and the two American ones that were reported in the NEJM and the Annals of Internal Medicine and the Canadian listed above.

Can we remove "Both German and U.S. studies have suggested echinacea may be efficacious in treating upper respiratory infections." This is a summary of the U of Maryland document, and their document is not well sourced and is the opinion of an anonymous author without peer review. If we really want this text to remain, it should start with "According to a web page of the University of Maryland Medical Center..."

Once those two sentences are out, then the entire pargraph "Of note, in the field of complementary..." can be removed as it is not needed as long as the link to publication bias is present. - Robert Badgett 15:27, 7 February 2008 (CST)

Thanks, I'll rearrange the article as I find the time. The University of Maryland site has reviewers listed, their (the reviewers') credentials could be easily verified. I've seen medical websites elsewhere, through large medical centers or schools of medicine, with information about various topics, and reviewers listed in a similar manner. This puts it one step above an anonymous reviewer, a big step. And, it's not just any website, it's from the University of Maryland Medical Center, Center for Integrative Medicine, at the medical school there. Again, this makes it less problematic, it seems? I don't disagree, though, with directly referencing the source in the article as you suggest above ("According to a web page ...."). I'm just pointing out that the source does not seem to be "very problematic" because of the bona fides I list. I agree the "Of note, in the field...." paragraph can be removed, it does not appear to be well tied directly to the article. I have no issues, though, with any of your suggestions on the medical aspects. These are merely my comments about the issues you raise. --K. Leo Pullin 00:30, 8 February 2008 (CST)

I missed the paragraph at the end of the Maryland site that list fairly extensive reviews. So my remaining problem is that it is a narrative review without clear citations, but your right, my calling it 'very problematic' seems excessive. I googled for a while to try to verify the fact that this drug is approved in Germany. No luck, but yet seems hard to believe Maryland would make this statement whimsically. - Robert Badgett 00:40, 8 February 2008 (CST)

Have you tried just herbal medicine in Germany, in addition to looking for Echinacea specifically? I've tried various searches with no luck, either, but haven't tried a general search of this order, yet. --K. Leo Pullin 23:28, 8 February 2008 (CST)

It may be that searching must be done in German. If it comes to that, I know a very helpful CZ user here fluent in German, User:Arne Eickenberg, who may be willing to help. Stephen Ewen 01:58, 9 February 2008 (CST)

Jan 2008 studies

Apparently some of the latest:

• Sharma, M et al. Echinacea Extracts Contain Significant and Selective Activities Against Human Pathogenic Bacteria, Pharmaceutical Biology; Jan 2008, Vol. 46 Issue 1/2, p111-116, 6p.

"...certain preparations of Echinacea, especially ethanol formulations, could provide useful protection or symptom alleviation in cases of various upper and lower respiratory infections, such as sinusitis, bronchitis, pharyngitis, tonsillitis, and pneumonia, as well as cutaneous infections, by means of their selective bactericidal activities, although we do not know which components of the extracts are responsible for these activities."

• Matthias, Anita, et al. Echinacea alkylamides modulate induced immune responses in T-cells, Fitoterapia; Jan2008, Vol. 79 Issue 1, p53-58, 6p.

"The effects of Echinacea and several of its phytochemical components on NFκB expression by Jurkat cells (a human T-cell line) were investigated in vitro.... opposing effects demonstrate the importance of a knowledge, not only of the phytochemical make-up of a herbal preparation, but also of the actions of each component and the consequences of differing relative amounts in the preparation being investigated."

Found them through EBSCO.

Also:

"...published in The Lancet Infectious Diseases, lead author Graig Goleman, PharmD, and colleagues at Hartford Hospital and the University of Gonnecticut looked at 14 randomized controlled trials total- ing 1,630 participants. The researchers concluded that echi- nacea reduced the average duration of colds by 1.4 days. Among 1,356 participants tested for echinacea's effectiveness in preventing colds in the first place, the herbal treatment reduced the chances of catching a cold by 58%. Although in line with a meta-analysis performed in 2000, the findings contradicted a large, highly publicized 2005 trial reported in the New England Journal of Medicine."

From: Reviewing the Evidence for Cold Fighters: Echinacea, Vitamin C & Zinc. Tufts University Health & Nutrition Letter, Oct2007, Vol. 25 Issue 8, p6-6, 1p; (AN 27076730)

The study is not cited.

Stephen Ewen 03:04, 8 February 2008 (CST)

The Lancet Infection Disease meta-analysis is currently reference #14. Coleman is the senior author; not the lead author. This meta-analysis is complicated to interpret because it not only contradicts the NEJM experiment, but also the other very good RCT in the Annals of Int Medicine which was funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health. Note that the meta-analysis had funnel plot asymmetry which means it might be affected by publication bias. I think publication bias is a real threat to validity here. There are plenty of small, positive studies, but the two large, well-done studies are negative...- Robert Badgett 07:37, 9 February 2008 (CST)