A Doctor’s Guide to Alternative Medicine (Lyons Press, 2014), by Mel Borins, uses scientific research to educate patients and physicians on which traditional medicines and therapies are worth trying, which aren’t and why, and how to use the effective ones safely. Written in clear, accessible language for the layperson while providing citations to full studies for the medical professional, Borins covers natural health products, herbal remedies, acupuncture physical therapies and psychological therapies. In the following excerpt from Chapter 2, "Echinacea for Upper Respiratory Infections," Borins presents research that suggests that the echinacea herb is helpful, research that shows that it doesn't work and his own conclusion.
Do you remember your last cold, and how everyone you met offered some advice or had a folk remedy that was sure to cure the virus? A typical scene might unfold like this:
You call your boss to say you’re not well and when she hears the sound of your runny nasal passages and chesty cough she replies, “Take the day off, go to bed, and drink lots of liquids.” Then Grandpa, who recently moved in with the family, suggests his own remedy, “Eat garlic. That always scares the colds away, and it works on vampires too.” You frown at Grandpa, wondering just how many vampires he’s been fighting off lately. You shuffle slowly up the stairs, climb into bed, and soon your daughter enters, bearing two glasses, each one filled with a suspicious-looking liquid. “My biology teacher,” she announces brightly, “said we should gargle with salt water when we have a cold and we should drink apple cider vinegar every morning.” You reply, “No thanks, Honey,” to the proffered glass of diluted vinegar, but seeing the hurt look on your daughter’s face, you agree to gargle with the (extra salty) salt water.
Dragging yourself out of bed, you shuffle to the bathroom, gargling glass in hand. Your body aches, and your chest hurts when you cough, and all you really want is a rum hot toddy and someone to give you a mentholated chest rub along with lots of sympathy. Finally, your spouse comes in and hands you a glass of water with a cheery, “I put a few drops of echinacea in it. Drink up!” Two days later, you begin to feel much better and you go back to work. Your spouse attributes your speedy recovery to the echinacea supplied every eight hours. So what’s the verdict? Did the echinacea do the job or was it the Vicks on your chest?
The Herb Echinacea
Echinacea is one of the most commonly used herbs in North America. The name, of Greek origin, means hedgehog—a good choice for a plant whose prickly characteristics somewhat resemble the animal. The flower boasts hot-pink or purple daisy-like petals that surround a prominent conical center of dark orange; the blossom sits upon a tall, robust stem with coarse, fuzzy leaves. If anything could tackle a cold, this sturdy plant looks like it has a winning chance.
There are nine known native species, of which Echinacea purpurea, Echinacea angustifolia, and Echinacea pallida are most commonly used. The plant also goes by the name of coneflower, purple coneflower, and American coneflower. The aboveground parts of the plant are used either fresh or dried to make teas, and they can be crushed (expressed) to make extracts. Anecdotally, many of my patients rave about its ability to decrease or stop the symptoms of upper respiratory infections.
Efficacy of Echinacea
Some of the difficulty scientists have had with evaluating whether this herb is effective stems from the different varieties of echinacea used; whether the whole plant, the roots, just the flowers or leaves, or a combination of these have been used; and also, how the herb’s medicinal constituent is extracted. Sometimes the extractions are done with alcohol and other times with water. But along with support from many generations of folk medicine use, there is some laboratory evidence that echinacea strengthens our immune system.
Controversy in the scientific literature over results of trials makes it downright confusing and you might ask, why can’t the scientists agree? But science isn’t a matter of opinion. Scientists report on data collected from trials, and using statistical math upon this data they can tell you only whether the results are significant (it appears to work) or that they don’t support the hypothesis about the plant having healing properties. Risking some readers’ frustration on how divergent scientific conclusions can be, I will present the opposing sides, each one supported by clinical trials. Don’t worry if you feel thoroughly mind-boggled with the debate. I will conclude this chapter with my own opinion, based on my interpretation of these results as well as the subjective and anecdotal experiences of my patients.
Research That Shows Echinacea Is Helpful
Ninety-five subjects with early symptoms of cold or flu either received Echinacea Plus tea at a dose of five to six cups per day, or a placebo. Result: In the Echinacea Plus group, there was a statistically significant decrease in cold and flu symptoms in a shorter period of time than with the placebo group. There were no side effects reported by any of the subjects in either group.
In another study, out of 282 participants between eighteen and sixty-five years of age, and with a history of two or more colds in the previous year, 128 contracted a common cold. At the onset of the first cold symptoms the participants received either echinacea, from freshly harvested Echinacea purpurea plants (commercially available as Echinilin), or a placebo. They took ten doses on the first day, and four doses per day on the subsequent seven days. The severity of their symptoms and dosing were recorded daily. A nurse examined the subjects on days three and eight after the onset of infection. Result: The total daily symptom scores were found to be 23.1 percent lower in the echinacea group than in the placebo group. Throughout the treatment period, the response rate to treatments was greater in the echinacea group. A few side effects were observed in both groups.
A third study included 430 children, aged one to five years, who were randomized to receive a placebo or an herbal extract preparation called Chizukit. This contained 50 mg/mL of echinacea, 50 mg/mL of propolis (plant resin collected by honeybees), and 10 mg/mL of vitamin C. Of those who received Chizukit, children in the group aged one to three years were given 5.0 mL, and those in the group aged four to five years were given 7.5 mL. Preparations and placebo were given twice daily as preventive medication for twelve weeks. Result: In the Chizukit group, there was a 55 percent reduction in the number of illness episodes, a 50 percent reduction in the number of episodes per child, and a 62 percent reduction in the number of days with fever per child. The total number of illness days and the duration of individual episodes were also significantly lower in the Chizukit group. Adverse drug reactions were rare, mild, and transient.
A 2006 Cochrane review, which is a well-designed analysis of scientific studies, looked at trials comparing echinacea to a placebo. The trials were double-blinded and of good quality. A significant effect was found in nine trials, a trend was found in one trial and no effect was found in six trials. The authors concluded that there is some evidence to suggest that preparations made from the aerial parts of Echinacea purpurea might be effective in the early treatment of the common cold in adults. The review found it difficult, however, to compare individual echinacea trial results, as the preparations varied greatly.
Shah and his colleagues did a meta-analysis of fourteen studies on the prevention and treatment of echinacea for the common cold. They concluded that the published evidence supports echinacea’s benefit in decreasing the incidence and duration of the common cold.
However a more recent 2014 Cochrane review reports that results from prevention trials suggest that a number of echinacea products slightly reduce the risk of getting a cold in healthy individuals. They stated that although it seems possible that some echinacea products also have effects over placebo for treating colds, the overall evidence for clinically relevant treatment effects over placebo is weak.
Research That Shows Echinacea Does Not Work
Four hundred and thirty-seven young adults were divided into four groups. Each group received either placebo or one of three extractions of Echinacea angustifolia roots with distinct phytochemical profiles. The extractions were made using one of three methods: extraction with supercritical carbon dioxide, with 60 percent ethanol, or with 20 percent ethanol. The volunteers were then subdivided into seven groups that received the various echinacea combinations and/or a placebo. The trial was performed in two phases: a prophylaxis (preventive) phase and a treatment phase. The prophylaxis phase lasted seven days. On the seventh day, the already-treated volunteers were exposed to a nasal mist containing the common cold (rhinovirus). Result: There were no statistically significant effects of the three echinacea extracts on rates of infection, severity of symptoms, or virus titres (the lowest concentration of virus that still infects cells).
In another study, 128 patients were given either placebo or 100 mg of Echinacea purpurea as freeze-dried, pressed juice made from the aerial (aboveground) portion of the plant. The treatment was taken three times daily within twenty-four hours of the onset of a cold until cold symptoms were relieved or until the end of fourteen days, whichever came first. Symptoms were scored subjectively by the patient and recorded daily in a diary. Result: There was no statistically significant difference between groups for either total symptom scores or the duration of symptoms.
Four hundred and seven healthy children, two to eleven years old, were given either echinacea or placebo for up to three upper respiratory infections over a four-month period. Study medication was begun at the onset of symptoms and continued throughout the upper respiratory infection, for a maximum of ten days. Result: There was no statistically significant difference in the duration or severity of symptoms. There was no difference in the rate of adverse events, but rash occurred in 7.1 percent of the children treated with echinacea and only 2.7 percent of those treated with placebo. There was a significantly lower incidence in subsequent upper respiratory infections in those children receiving echinacea.
Finally, 148 students were given Echinacea in an encapsulated mixture (25/25/50) of unrefined E. purpurea herb and root and E. angustifolia root from Shaklee Tecnica. Doses of 1 g were given six times per day on the first day and three times per day for up to nine more days, or placebo, for the treatment of the common cold. Results: No significant difference was found on any outcome measures including cold duration and symptom severity.
In a structured review of 322 articles related to echinacea and colds, nine placebo-controlled, clinical trials were found. Of the nine studies, only two were judged to meet all the criteria of a well-designed, unbiased study. The results of these two studies did not support echinacea’s efficacy as a cold remedy. Of the remaining seven studies, the criterion most commonly missing was proof of double-blinding. Six of the seven trials reported positive results, and only one was judged to have negative results. This structured review suggested that the possible therapeutic effectiveness of echinacea in the treatment of colds has not been established.
It is usually advised that echinacea not be used in people with immune dysfunction or autoimmune disorders like multiple sclerosis, tuberculosis, AIDS, or lupus because it has not been properly studied in these kinds of conditions. It should probably not be used if you are on immune-modulating drugs like cyclosporine or prednisone. Although adverse reactions are uncommon there have been reports of allergic reactions, which may vary from mild to anaphylactic. Safety in pregnancy has not been established.
When trials of echinacea did not show positive findings, the poor outcomes were often blamed on a variety of reasons: using the wrong part of the herb; using inadequate concentrations; using the wrong echinacea variety; or because taking the preparations began too late after the beginning of the infection. There is also controversy about the different methods of extraction and the impact of the extraction type on the results of studies.
Although the scientific evidence is mixed, from my years of clinical experience, I do believe echinacea works for the treatment of the common cold. I take it myself when I feel a cold coming on. At the first sign of infection, I use echinacea and vitamin C. I get feedback from my patients that using echinacea seems to stop that recurring cold situation.
If you are interested in using this herbal alternative, I recommend that you take a tincture of echinacea manufactured from a water extraction method and not an alcohol-based extraction, as some researchers have said that alcohol kills the active ingredient. You should take ten to twenty drops in water every few hours at the first sign of a cold.
Want to learn more about alternative medicine in general? Read Enhance Your Health With Traditional Medicines to learn about traditional medicines and their place in the modern world.
From A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why, by Mel Borins, M.D. Copyright © Mel Borins. Used by arrangement with the publisher. All rights reserved. No part of this excerpt may be reproduced or printed without permission in writing from the publisher.