August 18, 2009

Arctic root revisited

>> This post is slightly delayed since, you know, stuff gets in the way. But better late than never.

A comment on my post "lack of evidence for arctic root "natural medicine" raised a few points that I think are worthy of delving into. I wrote that post quite hastily with the only intention of just mentioning the review by Blomkvist, Taube and Larhammar published in Planta Medica, so it also gives me the opportunity to revisit the subject more in depth.


Firstly, let's state the facts as presented by the comprehensive scientific review of the most recent medical studies of arctic root/roseroot published by Blomkvist et. al.

Six of the seven recent (since 2000) studies that supposedly showed an effect of arctic root/roseroot had significant flaws, including irrelevant comparisons, inappropriate statistical methods, exaggerated conclusions, and mistakes in the presentation of the data. These mistakes go beyond simple holes in the statistics, they are of embarrassingly poor scientific quality.

Some of the problems are quite extraordinary. For instance, Spasov et al. based their final conclusion on a follow-up study that was not described in their article and remains unpublished. Darbinyan et al. claimed to have found a significant improvement over placebo despite contradictory results that they explained away with an unfounded assumption. The second study by Darbinyan et al. used irrelevant tests and an inappropriate statistical comparison. Bystritsky et al. and Fintelman and Gruenwald claim to have observed an effect but did not use a placebo control. Shevtsov et al. is riddled with misprints and mix-ups which make it difficult for the reader to interpret the text and understand the procedure. Also, the use of pulse pressure as a measure for physical fitness is incorrect, and the levels of statistical significance presented in the study appear unreasonably high.

They also reviewed four studies (and two reviews) that had not found any effects of arctic root/roseroot in the same critical way and found no errors, but commented that one of the studies had used a small number of test subjects making it of questionable value.

The Swedish Herbal Institute (SHI henceforth), makers and marketers of arctic root/roseroot preparations, were involved in four of the six flawed studies. Spasov et al. published in 2000; two studies by Darbinyan et al. published in 2000 and 2003; and Shevtsov et al. published in 2003. As exposed in the op-ed in Dagens Nyheter and summarized in my previous post, there were suspicious circumstances surrounding the publication of two of these articles, both co-authored by Georg Wikman of SHI. These circumstances certainly cast a shadow of doubt over the company as a serious research institution. It should be enough to make any reasonably skeptical person realize that there were serious faults committed in both the scientific and editorial processes.

The question is then: How much scrutiny is reasonable? Shouldn't the consumers be allowed to decide for themselves what works for them? Why attack good people and companies that just want to provide people with a product they want?

The first point raised in the comment to my previous post was that small companies, such as the SHI don't have the resources available to big pharmaceutical corporations. They are simply doing the best they can with what they have to discover and market the benefits of natural products. Furthermore they should be commended for their efforts and innovation and for having the guts to invest in this research and for giving something back even though they don't have to.

The second point is that by referring to the name of this particular company, Swedish Herbal Institute, as deceptive I'm doing the company wrong and hurting the nice folks there.

I really find little merit in SHI's supposed "efforts" to do "research". It's pretty clear to anyone that they have not gone through any sort of scientifically satisfying process in generating or publishing their data, despite the ridiculous boasts on their website.

I fail to see how their resources (or lack thereof) or their good will has anything to do with their adherence to proper scientific proceedings. Should those companies that can't afford the proper scientific procedures simply be exempt from them? As if it were optional. And why should they be exempt from critical and scientific scrutiny of their work simply because they are nice caring people who provide a service some people want?

As a minimum, they should not be permitted to promote and market their product with statements such as "clinically proven to enhance energy and improve mental clarity during stressful periods of work or studies" or "proven efficacy in clinical studies published in international scientific journals", which are clear exaggerations of the already unfounded scientific claims. Both statements appear prominently on SHI's website, as exemplified in the image below, and on many national ads.

Currently the Swedish Medical Products Agency lists this arctic root preparation as a so called "traditional herbal medicinal product" (link), meaning that it has been tested for safety but has a very limited scientific foundation, its indications being based only on traditional use for longer than 30 years. This stands in contrast to the claims presented in the marketing of the product.


Ref: www.shi.se

Even if done in good faith, this can only be qualified as deception. Especially now that the scientific faults of the studies have been exposed. The fact that SHI has a commercial interest in the product and continue to promote is under false scientific claims just gives anyone the more reason to be skeptical about their intentions.

As for the second point, the term "institute" is not protected in Sweden, but it would be naive of anyone to deny that both the words "Swedish" and "institute" are sensitive issue when it comes to the naming of companies. A parallel can be drawn to the UK where "British", "English", "Scottish" et.c. and "institute" are protected and are clearly found to "imply national or international pre-eminence" and require the support of representative and independent bodies before they can be approved in a company name (reference).

The name "Swedish Herbal Institute", or "Örtmedicinska Institutet" in Swedish, definitely suggests an official level of prominence that the company doesn't have and is therefore misleading. It deceptively mirrors the names given to national institutes, governing agencies and representative bodies such as Smittskyddsinstitutet (Swedish Institute for Infectious Disease Control), Konjunkturinstitutet (Swedish National Institute of Economic Research), Folkhälsoinstitutet (Swedish National Institute of Public Health) and others.

They are welcome to continue providing those that feel arctic root works for them with their product, but to do so under the false pretenses that the product has a confirmed clinical effect or that it has gone through the correct scientific testing of the purported effects in the first place is simply unacceptable and worthy of criticism. The fact that the criticism may hurt the company or the people involved in it is irrelevant. In fact, they should welcome the opportunity to defend their statements in the leading morning newspaper of the country and one of the prominent journals in their field, where the criticism has been presented. So far it's been very silent though.

Blomkvist, J., Taube, A., & Larhammar, D. (2009). Perspective on Roseroot Studies
Planta Medica DOI: 10.1055/s-0029-1185720


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22 comments:

  1. Carl DickensOctober 29, 2009

    here's an idea, why don't you climb down from your ivory tower,a ctually try some arctic root and then give it a review, rather than taking irrelevant, spiteful pot shots?

    i take the stuff and it's amazing!

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  2. Nah... I like it up here. It's nice and uncluttered by pseudoscientific woo and ill-informed conclusions. And I would take greater care to call anyone's posts "irrelevant, spiteful pot shots" after only a cursory reading of 10 minutes.

    I have actually tried roseroot. People from the SHI were here to clarify some of their "scientific" results to my professor, and they were nice enough to leave samples of their products. I tried a whole packet of roseroot following their recommendations and I didn't notice any effect at all.

    The point is exactly that personal experience cannot be trusted when it comes to asserting the efficiency of medicines, whether they are "natural" or not - neither my experience or yours counts. And aren't you glad this is the way it works! Think about that the next time you get sick and have to take a medicine.

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  3. I dont need scientific results to be convinced about the effect. I simply try it, and it works amazingly. To me this mumbo jumbo with "scientific proof" is just a nonsense that has no real impact on the behaviour. It is just an economic ivory tower, to gain control.

    If you have a map, that does not correspond to reality, we trust the map......, or?

    By all means, trust your own senses first!

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  4. Biology is a science. Medicine is not a science.

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  5. Now that last comment is just plain wrong on every level. Medicine is both a practice and a science. Even if we somehow bastardised the definition of science to not include medical science, it would still be evidence-based and require the same process of testing hypotheses and reaching conclusions as any other scientific practice.

    Weak.

    Olov Fahlander: I think that you would reconsider your point if you got seriously ill and had to take a "regular" medicine. I think you would be pretty damn thankful that the effects of that medicine had been verified and most importantly that the side effects had been documented. I think you would not "simply try it". I think you would reconsider "scientific proof".

    Let's hope you never get seriously ill.

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  6. Being a former academic myself (and still in love with scientific research) I think you raise very good points, Daniel. I also am convinced that to really show their worth in the end these herbal treatments will need to be subjected to the same double blind, randomized scrutiny that regular medical treatments get.

    On the other hand, I find the argumentation and anecdotal case descriptions in "The Rhodiola Revolution" http://www.amazon.com/Rhodiola-Revolution-Transform-Breakthrough-Century/dp/1579549241 and "Rhodiola rosea: A Phytomedicinal Overview" by bona fide researchers like Richard Brown http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=rpb1&DepAffil=Psychiatry quite convincing. So, I would give these kinds of adaptogens at least some serious benefit of the doubt until (many) more of those controlled studies have been done. As you say yourself, the small companies currently involved in rhodiola rosea production and sales do not have the orders of magnitude bigger budgets that the established pharmaceutical companies have. It is easy to get false positives, but also false negatives with a small number of studies.

    I was wondering: have you and your group been in touch with Richard Brown cs. to get his take and latest research results on this?

    Aldo

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  7. Are you even aware that recent clinical trials found that Prozac is no better than Placebo to treat severe depression? So, how can you claim that the "Big Pharma" solutions are any better than Rhodiola? At best this is an ignorant piece, at worse you're trying to mislead others. Period.

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  8. Your comment (Jcrr) is like taken straight from the anti-medicine woo woo playbook. It's your regular boring standard answer and makes it seem like you didn't read my post at all.

    Where do I claim that "the Big Pharma solutions are any better than Rhodiola"? On the contrary, this is exactly the kind of talk that I'm trying to avoid, precisely because it's the kind of stupid remarks that proponents of unscientific woo thrive in. It's a false discussion. Leave your "Big Pharma" talk out of it. It reveals your intent (and ignorance) immediately.

    If indeed recent clinical trials show what you claim, and I'll get to that in a bit, that just proves the point I'm making even more. To show that something has the effect that it's purported to have, you need to do the proper trials. End of story. That's good science. The kind of science that progresses and renews itself. New findings might change older views, that's part of it, but it's not a permit to abandon all reason. Especially not based on ONE study, which you apparently think is argument enough to doubt the points that I make in my entry.

    Rhodiola has NOT been PROVEN to work and the studies that have been done are seriously lacking and in some cases show scientific misconduct, yet it's marketed and sold under the FALSE claim that it's effects are supported by science. That not only bad science, it's dishonest. Period. Who is the misleading one?

    Just for clarity's sake I'll point this out once again, as the authors of the critical analysis against the Rhodiola studies have done: Arctic root MIGHT STILL WORK, it might have an effect. But it's has not been sufficiently proven that it has the purported effects or even that it has any effect at all. It's still a black hole... but that's not what the marketing says. Again: Who is the misleading one?

    As for the Prozac study that I think you're referring too, might I suggest some reading? The following posts and the articles that they link to are quite informative:

    http://scienceblogs.com/cortex/2010/02/prozac.php

    http://scienceblogs.com/cortex/2010/04/prozac_and_plasticity.php

    And just for good measure, I suspect you could learn a thing or two about placebo:

    http://scienceblogs.com/whitecoatunderground/2009/09/placebo_is_not_what_you_think.php

    I don't think you know what you're talking about when you bring up the example of Prozac and placebos in this case.

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  9. You failed to get my point. Re-read my previous comment. Nowhere did I say that Rhodiola is effective for depression or any other issues; I never tried it myself, and I certainly agree that more research needs to be done before drawing any conclusions. But I do see a double standard here: you're trying to undermine the credibility of herbs such as Rhodiola, while ignoring a few facts about anti-depressant drugs: 1) decades of false and misleading propaganda, aiming to create billions of dollars in profit; 2) the unbelievable list of side effects associated with these drugs; 3) the horrible withdrawal effects that many people experience after taking Prozac and similar drugs; (I'd suggest you take a look at the message board paxilprogress.com); just to name a few.

    Spare me the BS; you're not the only one who understands science. Nice spin, but no thanks (see how quick you are in defending these drugs - double standard...)

    Bottom line: if people are looking for natural alternatives to drugs, in this case Rhodiola Rosea, I really can't see why it's a bad idea at all. If it doesn't work, well, at least it is the lesser of two evils.

    Take care.

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  10. What a retard.

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  11. people used to take mercury to cure syphillis....it worked great!.......then they died of mercury poisoning!

    thank god for the FDA

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  12. I am from the UK and anyone here can use the name British or English in any business name if they so wish. It does not at all suggest that it is an official business or represents something national. People might use the name because they are proud to be British or so that on the internet people know where they are based or even just that it sounds nice. I agree with Jerr in that it has been proven time and time again that big pharma will use underhand methods to sell their products - and that includes clinical trials that are biased. I don't see that allopathic medicine has all the answers. Equally it is correct that conventional medicine has a great deal of understanding about illness so it should not be ignored. I also think that ignoring anecdotal evidence is arrogant. It also seems to me that double blind clinical trials may not cover all situations in healing an illness and this is a sign of arrogance on the part of orthodox medicine.

    Of course one of the problems with medicine is that if something goes wrong the victim can sue and so doctors, hospitals etc only feel able to explore options in known ways. Clinical trials are supposed to deliver objectivety and therefore be free from human error but the paradox is that at a general level it is only people who can understand people and that may be more important than it is so far given.

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    Replies
    1. In fact according to the GP1 Incorporation and Names (Companies Act) of 2006, British businesses MAY NOT use terms such as "British" or "English" in their company names "if they so wish". They have to be approved by several representative and independent bodies in the field first since such company names "imply national or international pre-eminence". That is a direct quote from the Companies Act of 2006. Here is a link: http://www.companieshouse.gov.uk/about/gbhtml/gbf2.shtml

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  13. Jcrr: Couldn't have said it better myself!

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  14. Whilst the research carried out by Swedish Herbal Institute may be flawed or not, what about the other research carried out in Russia and other Nordic countries much of which is NOT published in English?

    I've tried some of this stuff at the recommended dose and I didnt experience anything. Doubled the dose and I experienced a reduction in stress and more creative thinking, so for some people not experiencing any noticeable effect it could simply be down to inadequate doses.

    Lets face it some drugs even pharmaceutical drugs are not effective at weak doses so finding the right dose is important.

    If people also consider the recent research into the strength of Vitamin D supplements where the study showed some capsules from the same batch of supplements only contained just 9% of the stated amount on the packaging, its entirely possible this problem of supplements not containing enough could be prevalent across other supplements.

    We also should not under estimate the methods pioneered by Ancel Keys which is to use statistics to sell an argument. Statistics is big business, so much so some of the largest pharmaceutical companies recruit more statisticians than chemists, recruitment pages & drives in universities can be very illuminating.

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    Replies
    1. The review article described by my original post, Blomqvist et. al (2009), examined precisely those Russian studies. There aren't that many so I assume we're talking about the same ones. In fact the review goes through the whole scientific literature on Rhodiola until 2009, and as far as I know nothing new has been published in the last 4 years since then. If I'm wrong and there are new studies you're aware of I'd honestly really like to read them. It's possible I have missed something.

      The Swedish Herbal Institute (SHI) as an institution has not published studies on Rhodiola at all, even though they like to claim that they do research. People involved with the SHI, notably Georg Wikman, appear a co-authors on some studies - although it appears that this co-authorship was achieved through dishonest methods, as described in the article I link to in the post.

      Statistics can surely be used, and has been used, for deceptive purposes. But it's though better statistical methods that you can best uncover those deceptions. In fact, the review from Blomqvist et al. that I write about above does exactly that - it uncovers the faulty statistics in studies that are used to promote Rhodiola products. So statistics do count when it comes to lending support to alt-med studies, but it doesn't count when pharmaceutical companies or university researcher do it? Statistics is the best tool to uncover statistical deceptions. Someone who doesn't understand that, and is dismissive of statistics as a whole, is frankly not qualified to have an opinion on the matter.

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    2. Correction: The review by Blomqvist et al (2009) examines the studies on Rhodiola published between 2000 and 2009, not the whole scientific literature.

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    3. Its very easy finding fault in nearly all scientific studies simply because humans are complex organisms, so a very large number of variables are simply not measured or taken into account. Scientists are experts in a specific range of details but simply do not have the physical capabilities to comprehend every facet of the human body. An AI on the other hand can tirelessly search the internet, interpret the results from studies published online and draw a better conclusion whilst also being able to measure the number of anecdotals published by users. Lessor more specific AI's are also in use and being developed which can predict outcomes from raw study data like http://hdl.handle.net/10443/1552 or http://www.ncbi.nlm.nih.gov/pubmed/14519642

      An AI is superior to any General Practitioner which is why Google the most notable and public of all AI's is now being used by more people today to find out solutions to health complaints the medical profession have failed to cure let alone provide suitable relief from the symptoms of. The Milgram observed Authority Effect is waning, people are now challenging or simply walking away from the advice given out by some medical professionals. The drugs companies are struggling to come up with patentable drugs which is threatening their future viability as seen by recent annoucements of redundancie, whilst some large companies engage in underhand practices by via blogs and comments from sock puppets http://en.wikipedia.org/wiki/Sockpuppet_%28Internet%29, one the most recent being Samsung http://www.iosdoc.com/samsung-admitted-to-have-been-posting-negative-reviews-to-rival-smartphones/

      Good raw data which clearly shows the facts, does not need statistical manipulation to show the benefits. This is why I mentioned Ancel Keys, he pioneered the modern methods used by drug companies to show that fat causes heart disease, this was jumped upon by the Sugar industry which pushed their products as an alternative. Well if fat causes heart disease then why do we need fat soluble vitamins ADEK? Likewise some studies into heart disease dont often show the link with low levels of magnesium. Nothing to do with the medical industry failing to come up with a cheap readily available magnesium level test. Sure we can measure serum Mg but the body goes to great lengths to maintain the serum Mg levels, too little and we have a heart attack, too much and we can go into a coma. Yet we also know Mg is stored in the bones and muscles, is highly volatile in bones for rapid deployment into the blood and helps the muscles relax when its not contracting due to the Calcium antagonist mechanism. It should be noted the Heart has the highest concentration of magnesium of all muscle tissue or the fact todays Western diet is low on eating organs like Liver, Kidney & Heart which are good sources of Mg or the fact most vegetables are boiled excessively so the Mg which is highly water soluble ends up in the water which is often thrown away.

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    4. I would refer people to the wiki link on Ancel Keys but his page has been rewritten a number of times over the last few years along with other wiki pages, his place in history portays him in a better light today or more kindly than it did a few years ago.

      With regard to your point that nothing new about Artic Root has been published since 2009, I would suggest you look again, its not hard, Google is your friend as they say, but there are other studies available via subscription media outlets online and in printed form. Likewise if the studies are flawed why are there not more peer reviewed studies showing the flaws? That is after all what peer reviewed studies are meant to do, yet so little studies exist possibly becuase there is no money to be made from it like most viatmins or minerals. Apart from your blog and a few others, I have yet to find any scientific studies reaching different conclusions.

      Its easy to introduce doubt into an argument, its what the Tobacco industry pioneered last century and is so common today in all walks of life. One could argue its what I am doing with your blog comments on Artic Root subject.


      I noticed in the top left of your blog you state "You've reached the site of Daniel Ocampo Daza, resident of Uppsala, Sweden, biologist and newly graduated PhD.

      *******This is not a blog.*******
      On occasion I write about evolution, criticism of creationism and other superstitions, neuroscience and sometimes general biological subjects that I find interesting."

      Yet you also say "November 30, 2011
      Two ways of looking at the same proteins: Insulin-like Growth Factor Binding Proteins
      Research

      Back in June *******I blogged******* about a research paper that we had just published with myself as the lead author. "

      You are also using blogging technology, so I would suggest you need to make your mind about whether this is a blog or not.

      I'm probably one of biggest cynics and sceptics out there, I just like to deal in facts, but the over whelming number of anecdotals regarding this plant is not something to be dismissed. So whilst you might have an issue with the Swedish Herbal Institute, we shouldn't ignore the fact that diet has always been the best method to maintain a healthy body. Prevention is better than cure, but when one considers todays supermaket mass produced vegetables contain just 14% of the vitamins and minerals that were sold in the 1930's before the rise of oil based fertilizers, and the fertilizer companies are linked to pharmaceutical companies where board directors often sit on both, its hard not to question what is going on.

      I also understand the dilemma scientists & others face in the medical industry. Cures are rare because there is no recurring income, simply put, if you cure something, the problem is solved and no further revenues can be made, in effect a cure will make you unemployed. This is why most medical treatments simply treat symptoms, there is no money or future in cures. This is down the flaws in the financial system and why capitalism in its current implementation is detrimental to many.

      Anyway I digress, bottom line is, there are other studies, I've seen from Poland, the US and elsewhere, all positive towards this plant.

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  15. AnonymousJune 18, 2013

    have you seen this latest study?

    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0063886

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  16. Surrey University have conducted a pilot study on stress using another type of rhodiola -- in the UK it retails under the brand name Vitano. Results are not out. But here is the reference

    http://clinicaltrials.gov/ct2/show/NCT01411709

    Incidentally, my son has taken Arctic Root and doesn't feel anything. Me? I find that it definitely has an energising effect but later in the day it gives me a headache, something I never suffer from. Tried it several times to make sure that it wasn't coincidence.

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  17. Thank You for this article and thanks to everybody who wrote their point of view :) My life is still important for me...

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