Two heads that are no better than one

St. John’s wort, the popular herbal supplement used for more than 2,000 years to take the edge off mild depression, got kicked around in the press last week. And it wasn’t pretty.

The headlines went from bad to worse:

“Study Questions St. John’s Wort’s Effectiveness.”
“St. John’s Wort Ineffective for Common Form of Depression.”
“Herb Found Ineffective for Moderate Depression.”

It was enough to make anyone feel moderately depressed. In effect, the headlines were saying, “Don’t waste your money on St. John’s wort.” Until a lone voice, a press release from the American Herbal Products Association, spoke up with this headline: “New St. John’s Wort Study Misleads Public.”

That’s a refreshing headline, but in my mind, still misses the point. Here’s the more accurate headline (excuse the mouthful): “St. John’s Wort Isn’t Recommended to be Taken for Major Depression, but We Tested it Against Major Depression Anyway.”

While you’re at it, why not test to see if it’s an effective fertilizer, dessert topping or car wax? Obviously that would be pointless. Almost as pointless as testing it against major depression.
Missing the mark

We’ve been studying the benefits of St. John’s wort for several years, and we’ve never come across any claim that it is an effective treatment for major depression. St. John’s wort is generally regarded as a useful treatment for mild depression. Nevertheless, 340 adults with major depression participated in this study from Duke University. The conclusion: “This study fails to support the efficacy of H perforatum (St. John’s wort) in moderately severe major depression.”

A foregone conclusion if I ever heard one.

I would stop to ponder the “moderately severe” oxymoron, but I have a bigger fish to fry: namely, Zoloft. The Duke researchers broke their subjects up into three groups to receive St. John’s wort, placebo, and sertraline (as an active comparator) for eight weeks. Sertraline, is better known by the trade name Zoloft, the very popular drug widely prescribed to treat major depression. And how did the mighty Zoloft fare against the modest St. John’s wort? The study concluded that neither St. John’s wort nor Zoloft are more effective overall than the placebo in treating severe forms of depression.

Now there’s a headline!

Let’s recap the conclusion: St. John’s wort (not meant to treat major depression) is ineffective against major depression. But what about Zoloft, which is specifically designed, manufactured and promoted to treat major depression?

Steven Dentali, vice president of scientific and technical affairs for AHPA, summed it up perfectly, saying, “If this study is believable it showed that a blockbuster drug, with sales of over $2 billion and prescribed to millions of Americans for severe forms of depression, may be no more effective than a placebo.”
Extra! Extra! Read what we want to tell you

It’s pretty obvious that with a $2 billion pharmaceutical product – and all the advertising that goes with it – at stake, the mainstream media was reluctant to lead off their reports with banner headlines stating that this popular drug performs at the same level as a sugar pill.

I’m harping on the headlines for good reason. In this age of scrolling information and sound bites, headlines deliver the news. So while Reuters, for instance, actually did a pretty balanced job of reporting the story, their headline, shouting that St. John’s wort is “ineffective for moderate depression,” is simply negative and inaccurate. This sort of irresponsible headline does no favors for their readers, only for their advertisers.

The debate about the effectiveness of St. John’s wort is certain to continue, and it should. I would challenge Duke University to conduct a follow-up study to research the effects of St. John’s wort on mild to moderate depression. That’s a study that would be welcomed, and useful as well. But please don’t continue to waste valuable money and research efforts to study the effects of natural supplements on health problems they were never meant to address in the first place.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:
JAMA 2002;287:1807-1814, 1853-1854
American Herbal Products Association (www.ahpa.org)

Copyright 1997-2002 by Institute of Health Sciences, L.L.C.